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Wáng YXJ, Blake GM, Tang SN, Guermazi A, Griffith JF. Quantitative CT lumbar spine BMD cutpoint value for classifying osteoporosis among older East Asian women should be lower than the value for Caucasians. Skeletal Radiol 2024; 53:1473-1480. [PMID: 38411702 DOI: 10.1007/s00256-024-04632-4] [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: 01/19/2024] [Revised: 02/20/2024] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
For Caucasian women, the QCT (quantitative CT) lumbar spine (LS) bone mineral density (BMD) cutpoint value for classifying osteoporosis is 80 mg/ml. At the age of approximate 78 years, US Caucasian women QCT LS BMD population mean is 80 mg/ml, while that of Chinese women and Japanese women is around 50 mg/ml. Correlation analyses show, for Chinese women and Japanese women, QCT LS BMD of 45 mg/ml corresponds to the dual-energy X-ray absorptiometry cutpoint value for classifying osteoporosis. For Chinese and Japanese women, if QCT LS BMD 80 mg/ml is used as the threshold to classify osteoporosis, then the specificity of classifying subjects with vertebral fragility fracture into the osteoporotic group is low, whereas threshold of 45 mg/ml approximately achieve a similar separation for women with and without vertebral fragility fracture as the reports for Caucasian women. Moreover, by using 80mg/ml as the cutpoint value, LS QCT leads to excessively high prevalence of osteoporosis for Chinese women, with the discordance between hip dual-energy X-ray absorptiometry and LS QCT measures far exceeding expectation. Considering the different bone properties and the much lower prevalence of fragility fractures in the East Asian women compared with Caucasians, we argue that the QCT cutpoint value for classifying osteoporosis among older East Asian women will be close to and no more than 50 mg/ml LS BMD. We suggest that it is also imperative the QCT osteoporosis classification criterion for East Asian male LS, and male and female hips be re-examined.
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Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Sheng-Nan Tang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Wáng YXJ, Griffith JF, Blake GM, Diacinti D, Xiao BH, Yu W, Su Y, Jiang Y, Guglielmi G, Guermazi A, Kwok TCY. Revision of the 1994 World Health Organization T-score definition of osteoporosis for use in older East Asian women and men to reconcile it with their lifetime risk of fragility fracture. Skeletal Radiol 2024; 53:609-625. [PMID: 37889317 DOI: 10.1007/s00256-023-04481-7] [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: 08/22/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
The 1994 WHO criterion of a T-score ≤ -2.5 for densitometric osteoporosis was chosen because it results in a prevalence commensurate with the observed lifetime risk of fragility fractures in Caucasian women aged ≥ 50 years. Due to the much lower risk of fragility fracture among East Asians, the application of the conventional WHO criterion to East Asians leads to an over inflated prevalence of osteoporosis, particularly for spine osteoporosis. According to statistical modeling and when a local BMD reference is used, we tentatively recommend the cutpoint values for T-score of femoral neck, total hip, and spine to be approximately -2.7, -2.6, and -3.7 for Hong Kong Chinese women. Using radiographic osteoporotic vertebral fracture as a surrogate clinical endpoint, we empirically demonstrated that a femoral neck T-score of -2.77 for Chinese women was equivalent to -2.60 for Italian women, a spine T-score of -3.75 for Chinese women was equivalent to -2.44 for Italian women, and for Chinese men a femoral neck T-score of -2.77 corresponded to spine T-score of -3.37. For older Chinese men, we tentatively recommend the cutpoint values for T-score of femoral neck, total hip, and spine to be approximately -2.7, -2.6, and -3.2. With the BMD reference published by IKi et al. applied, T-score of femoral neck, total hip, and spine of -2.75, -3.0, and -3.9 for Japanese women will be more in line with the WHO osteoporosis definition. The revised definition of osteoporosis cutpoint T-scores for East Asians will allow a more meaningful international comparison of disease burden.
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Affiliation(s)
- Yi Xiang J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology, and Pathology, Sapienza University of Rome, Rome, Italy
| | - Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Yebin Jiang
- VA Healthcare System, University of Michigan, Ann Arbor, MI, USA
| | - Giuseppe Guglielmi
- Radiology Unit, Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
- Department of Radiology, Scientific Institute "Casa Sollievo Della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Timothy C Y Kwok
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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Wáng YXJ, Blake GM, Xiao BH, Guglielmi G, Su Y, Jiang Y, Guermazi A, Kwok TCY, Griffith JF. East Asians' T-scores for the diagnosis of osteoporosis should be calculated using ethnicity- and gender-specific BMD reference ranges: justifications. Skeletal Radiol 2024; 53:409-417. [PMID: 37566149 DOI: 10.1007/s00256-023-04423-3] [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: 06/19/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
The 2013 ISCD consensus recommended a Caucasian female reference database for T-score calculation in men, which says "A uniform Caucasian (non-race adjusted) female reference database should be used to calculate T-scores for men of all ethnic groups." However, this statement was recommended for the US population, and no position was taken with respect to BMD reference data or ethnicity matching outside of the USA. In East Asia, currently, a Japanese BMD reference database is universally adopted in Japan for clinical DXA diagnosis, while both local BMD and Caucasian BMD reference databases are in use in Mainland China, South Korea, Taiwan, and Singapore. In this article, we argue that an ethnicity- and gender-specific BMD database should be used for T-score calculations for East Asians, and we list the justifications why we advocate so. Use of a Caucasian BMD reference database leads to systematically lower T-scores for East Asians and an overestimation of the prevalence of osteoporosis. Using a female BMD reference database to calculate T-scores for male patients leads to higher T-score values and an underestimation of the prevalence of osteoporosis. Epidemiological evidence does not support using a female BMD reference database to calculate T-scores for men. We also note that BMD reference databases collected in Asia should be critically evaluated for their quality.
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Affiliation(s)
- Yi Xiang J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Giuseppe Guglielmi
- Radiology Unit, Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
- Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Yebin Jiang
- VA Healthcare System, University of Michigan, Ann Arbor, MI, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Timothy C Y Kwok
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
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Wu Q, Dai J. Racial/Ethnic Differences in Bone Mineral Density for Osteoporosis. Curr Osteoporos Rep 2023; 21:670-684. [PMID: 38019343 DOI: 10.1007/s11914-023-00838-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW We primarily aim to review differences in bone mineral density (BMD) for osteoporosis among different racial/ethnic groups and to highlight the magnitude of racial/ethnic differences in obesity and diabetes. We also explore the factors contributing to the BMD differences among various subgroups. In addition, we investigate the existing disparities in research, educational initiatives, screening practices, and treatment options for osteoporosis and discuss these findings' clinical and public health implications. RECENT FINDINGS Racial/ethnic differences in BMD for osteoporosis exist in the USA and other countries. There are disparities regarding osteoporosis screening and treatment. Understanding the factors contributing to these differences can help develop targeted interventions and policies to reduce their impact. Clinicians should consider the racial/ethnic differences in BMD when making treatment decisions and providing preventive care. Future research could contribute to developing effective strategies for preventing osteoporosis among different racial/ethnic groups. This review offered a comprehensive examination of differences in BMD across various racial and ethnic groups, elucidating the influence of genetic, lifestyle, and cultural factors on these differences. This review also highlighted the disparities in osteoporosis screening, treatment options, research on medical effectiveness, and educational outreach tailored to each subgroup. Recognizing the importance of addressing these inequalities, we present this review to advocate for targeted interventions to reduce disparities in osteoporosis and improve bone health for all populations.
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Affiliation(s)
- Qing Wu
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA.
| | - Jingyuan Dai
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA
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Lo JC, Yang W, Park-Sigal JJ, Ott SM. Osteoporosis and Fracture Risk among Older US Asian Adults. Curr Osteoporos Rep 2023; 21:592-608. [PMID: 37542683 PMCID: PMC10858302 DOI: 10.1007/s11914-023-00805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the current knowledge regarding osteoporosis and fracture among older US Asian adults. RECENT FINDINGS Asian adults have lower (areal) bone density than non-Hispanic White adults and thus are more likely to be diagnosed and treated for osteoporosis, despite their lower risk of hip fracture. The latter may relate to favorable characteristics in hip geometry, volumetric bone density, and bone microarchitecture; lower risk of falls; and other clinical factors. The fracture risk calculator FRAX accounts for the lower risk of hip fracture among US Asian adults. However, data on major osteoporotic fracture risk remain limited. Fracture rates also vary by Asian subgroup, which may have implications for fracture risk assessment. Furthermore, among women receiving bisphosphonate drugs, Asian race is a risk factor for atypical femur fracture, an uncommon complication associated with treatment duration. Recent clinical trial efficacy data pertaining to lower bisphosphonate doses and longer dosing intervals may be relevant for Asian adults. More research is needed to inform osteoporosis care of US Asian adults, including risk-benefit considerations and the optimal duration of bisphosphonate treatment. Greater evidence-based guidance for primary fracture prevention among US Asian adults will ensure health equity in the prevention of osteoporotic fractures.
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Affiliation(s)
- Joan C Lo
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
- The Permanente Medical Group, Oakland, CA, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Wei Yang
- The Permanente Medical Group, Oakland, CA, USA
- Department of Endocrinology, Kaiser Permanente San Jose Medical Center, San Jose, CA, USA
| | - Jennifer J Park-Sigal
- The Permanente Medical Group, Oakland, CA, USA
- Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA
| | - Susan M Ott
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Moncada-Jiménez J, Dicker EE, Chacón-Araya Y, Peralta-Brenes M, Briceño-Torres JM, Villarreal-Ángeles M, Salazar-Villanea M, Vidoni ED, Burns JM, Johnson DK. Exploring Handgrip Strength as a Cross-cultural Correlate of Body Composition and Upper Body Strength in Older Adults from Costa Rica and Kansas. J Cross Cult Gerontol 2023; 38:223-244. [PMID: 37410203 PMCID: PMC10447276 DOI: 10.1007/s10823-023-09481-7] [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] [Accepted: 04/27/2023] [Indexed: 07/07/2023]
Abstract
Sarcopenia and disability in older adults are often characterized by body composition measurements; however, the gold standard of body composition measurement, dual-energy X-ray absorptiometry (DEXA), is expensive to acquire and maintain, making its use in low and middle income countries (LMIC) it out-of-reach in developing nations. Because these LMIC will bear a disproportionate amount of chronic disease burden due to global aging trends, it is important that reliable, low-cost surrogates need to be developed. Handgrip strength (HGS) is a reliable measure of disability in older adults but has not been used widely in diverse populations. This study compared HGS to multiple measurements of body composition in older adults from the US (Kansas) and a middle-income country (Costa Rica) to test if HGS is a cross-culturally appropriate predictive measure that yields reliable estimates across developed and developing nations. Percent body fat (%BF), lean tissue mass index (LTMI), appendicular lean soft tissue index (ALSTI), body fat mass index (BFMI), bone mineral density (BMD), and HGS were measured in older Costa Ricans (n = 78) and Kansans (n = 100). HGS predicted lean arm mass with equal accuracy for both samples (p ≤ 0.05 for all groups), indicating that it is a reliable, low-cost and widely available estimate of upper body lean muscle mass. Older adults from Costa Rica showed different body composition overall and HGS than controls from Kansas. Handgrip operates equivalently in the US and Mesoamerica and is a valid estimate of lean arm muscle mass as derived by the more expensive DEXA.
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Affiliation(s)
- José Moncada-Jiménez
- Human Movement Sciences Research Center, University of Costa Rica, San Jose, Costa Rica
- School of Physical Education and Sports, University of Costa Rica, San Jose, Costa Rica
| | - Eva E Dicker
- Alzheimer's Disease Research Center-East Bay, University of California, Davis, 100 N. Wiget Lane, Suite 150, Walnut Creek, CA, 94598, USA
- Department of Psychological Sciences, Rice University, 6100 Main St, Houston, TX, 77005, USA
| | - Yamileth Chacón-Araya
- Human Movement Sciences Research Center, University of Costa Rica, San Jose, Costa Rica
- School of Physical Education and Sports, University of Costa Rica, San Jose, Costa Rica
| | | | - José M Briceño-Torres
- Human Movement Sciences Research Center, University of Costa Rica, San Jose, Costa Rica
| | | | | | - Eric D Vidoni
- KU Alzheimer's Disease Center, University of Kansas, 4350 Shawnee Mission Pkwy, Fairway, KS, 66205, USA
| | - Jeffery M Burns
- KU Alzheimer's Disease Center, University of Kansas, 4350 Shawnee Mission Pkwy, Fairway, KS, 66205, USA
| | - David K Johnson
- Alzheimer's Disease Research Center-East Bay, University of California, Davis, 100 N. Wiget Lane, Suite 150, Walnut Creek, CA, 94598, USA.
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Osteoporosis Prevention, Screening, and Diagnosis: ACOG Clinical Practice Guideline No. 1. Obstet Gynecol 2021; 138:494-506. [PMID: 34412075 DOI: 10.1097/aog.0000000000004514] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To provide updated evidence-based recommendations for the prevention, screening, and diagnosis of postmenopausal osteoporosis. TARGET POPULATION Postmenopausal patients without identified risk factors for fracture, low bone mineral density, or secondary osteoporosis related to medication or a medical condition. METHODS This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two specialists in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines-Gynecology and one external subject matter expert. ACOG medical librarians completed a comprehensive literature search for primary literature within the Cochrane Library, Cochrane Collaboration Registry of Controlled Trials, EMBASE, PubMed, and MEDLINE. Studies that moved forward to the full-text screening stage were assessed by two authors from the writing team on the basis of standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations, Assessment, Development and Evaluations) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS This Clinical Practice Guideline includes updated recommendations on the role of exercise, calcium, and vitamin D in osteoporosis prevention; osteoporosis screening and diagnosis; rescreening intervals; and interventions to prevent falls. Recommendations are classified by strength and evidence quality. Ungraded Good Practice Points are included to provide guidance when a formal recommendation could not be made because of inadequate or nonexistent evidence.
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Lo JC, Chandra M, Lee C, Darbinian JA, Ramaswamy M, Ettinger B. Bone Mineral Density in Older U.S. Filipino, Chinese, Japanese, and White Women. J Am Geriatr Soc 2020; 68:2656-2661. [PMID: 33047307 DOI: 10.1111/jgs.16785] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND/OBJECTIVES Bone mineral density (BMD) reference data exist for U.S. White, Black, and Hispanic (Mexican American) populations but not for U.S. Asians. Few studies have compared BMD findings among different U.S. Asian ethnicities. DESIGN Retrospective observational study. SETTING Large northern California healthcare system. PARTICIPANTS Asian and White women aged 50 to 79 years with BMD testing from 1998 to 2017 excluding those with estrogen or osteoporosis treatment, recent fracture, or select disorders affecting skeletal health. MEASUREMENTS Femoral neck (FN)-BMD and height data. METHODS Differences in FN-BMD were examined by ethnicity and age, comparing Filipino, Chinese, and Japanese women and non-Hispanic White women. Differences in BMD were also examined after adjustment for height. RESULTS There were 37,224 Asian women (including 11,147 Filipino, 10,648 Chinese, and 2,519 Japanese) and 115,318 non-Hispanic White women. Mean height was similar among the Asian subgroups and about 6 to 8 cm lower than Whites. Mean FN-BMDs differed by less than 3% for Filipino, Chinese, and Japanese and all were lower than Whites, with smaller Asian-White differences among younger women (<3%; ages 50-59) and larger differences among older women (6-8%; ages 65-79). Adjusting FN-BMD for height reduced White-Asian differences by about 30% to 40%. CONCLUSION Mean FN-BMD and height for Filipino, Chinese, and Japanese women were similar but consistently lower than White women, especially among older women. Although Asian-White BMD differences were substantially attenuated after height adjustment; some differences persisted for older women. Future studies should investigate potential age-cohort effects and the extent to which these BMD differences influence fracture risk and clinical care.
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Affiliation(s)
- Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,The Permanente Medical Group, Oakland, California, USA
| | - Malini Chandra
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA.,The Permanente Medical Group, Oakland, California, USA
| | - Jeanne A Darbinian
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Mohan Ramaswamy
- The Permanente Medical Group, Oakland, California, USA.,Department of Nuclear Medicine, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, California, USA
| | - Bruce Ettinger
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
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Differences in fracture prevalence and in bone mineral density between Chinese and White Canadians: the Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos 2020; 15:147. [PMID: 32955674 DOI: 10.1007/s11657-020-00822-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fracture determinants differ between Canadians of Chinese and White descent, the former constituting the second largest visible minority group in Canada. The results of this study support the importance of characterizing bone health predictors in Canadians of different ethnicity to improve population-specific fracture prevention and treatment strategies. PURPOSE We aimed to compare clinical risk factors, bone mineral density, prevalence of osteoporosis, and fractures between Chinese and White Canadians to identify ethnicity-specific risks. METHODS We studied 236 Chinese and 8945 White Canadians aged 25+ years from the Canadian Multicentre Osteoporosis Study (CaMos). The prevalence of osteoporosis using ethnicity-specific peak bone mass (PBM), and of prior and incident low trauma fractures were assessed and compared between groups. Linear regressions, adjusting for age and anthropometric measures, were used to examine the association between baseline and 5-year changes in BMD and ethnicity. RESULTS Chinese participants had shorter stature, lower BMI, and lower rate of falls than White participants. Adjusted models showed no significant differences in baseline BMD between ethnic groups except in younger men where total hip BMD was 0.059 g/cm2 (0.009; 0.108) lower in Chinese. Adjusted 5-year BMD change at lumbar spine was higher in older Chinese women and men compared with Whites. When using Chinese-specific PBM, the prevalence of osteoporosis in Chinese women was 2-fold lower than when using that of White women The prevalence of fractures was higher in White women compared with Chinese with differences up to 14.5% (95% CI 9.2; 19.7) and 10.5% (95% CI 4.5-16.4) in older White men. Incident fractures were rare in young Chinese compared with White participants and not different in the older groups. CONCLUSION Our results support the importance of characterizing bone strength predictors in Chinese Canadians and the development of ethnicity-specific fracture prediction and prevention strategies.
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Song JH, Jo WL, Lee KH, Cho YJ, Park J, Oh S. Subsidence and perioperative periprosthetic fractures using collarless hydroxyapatite-coated stem for displaced femoral neck fractures according to Dorr type. J Orthop Surg (Hong Kong) 2020; 27:2309499019877530. [PMID: 31578134 DOI: 10.1177/2309499019877530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Hydroxyapatite (HA)-coated stem has been introduced to decrease complications and eventually achieve quicker implant ingrowth and long-term stability. The aim of this study was to determine subsidence rate and incidence of perioperative periprosthetic fracture (PPF) of uncemented collarless Corail stem for displaced femoral neck fractures according to Dorr type. METHODS A retrospective review of plain radiographs and clinical data was carried out to identify consecutive patients who underwent uncemented hip hemiarthroplasty using collarless HA-coated Corail stem between March 2010 and August 2014. The risk of subsidence and PPF according to Dorr type was evaluated. RESULTS Dorr types A, B, and C were found in 66 (median age 74, 29.7%), 107 (median age 77, 48.2%), and 49 (median age 80, 22.1%) cases, respectively. Subsidence of stem occurred in eight (3.6%) cases. Dorr type had significant relationship (p < 0.05) with subsidence. Type C canals had higher rates of subsidence. PPFs occurred in 11 (5.0%) cases without showing significant difference among Dorr types not significant (n.s.). Female gender was not influential on subsidence (n.s.) and PPF (n.s.). CONCLUSION Dorr type C had higher risk of subsidence when using uncemented collarless HA-coated stem. Dorr canal type had no bearing on risk of PPFs. Women did not have significantly higher risk of both subsidence and PPFs compared to men. A collarless fully HA-coated Corail stem had 3.6% of radiological subsidence and 5.0% of PPF risk.
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Affiliation(s)
- Joo-Hyoun Song
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Woo-Lam Jo
- Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Kee-Haeng Lee
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Yoon-Joo Cho
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Joonyoung Park
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
| | - Seungbae Oh
- Department of Orthopaedic Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Korea
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Lo JC, Ettinger B. How Should We Counsel Asian Americans about Fracture Risk? J Am Geriatr Soc 2020; 68:1613-1614. [PMID: 32374424 DOI: 10.1111/jgs.16444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Joan C Lo
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Bruce Ettinger
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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12
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Lee YS, Nichols JF, Domingo A, Kim Y, Park SM, Han G, Seo H, Hovell M. Balance performance and related soft tissue components across three age groups. Health Care Women Int 2019; 42:67-81. [PMID: 31617834 DOI: 10.1080/07399332.2019.1678160] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With the aging process, falls and related injuries are common and unwanted events among older women. Lost balance is the last step before the frequent experience of falls. After menopause, women's bone conditions regarding health and balance performance steeply decline often resulting in serious injury. Our purpose in the study is to identify balance performance and its associations with soft tissue components among Korean-American (KA) women with three menopausal conditions. Researchers conducted a cross-sectional study with 63 KA women divided into three age groups: 25-35 years (young), 45-55 years old (middle), and 65+ years (old). Lean and fat mass on the entire body, appendicular and gynoid areas were measured by using the dual X-ray absorptiometry. Static and dynamic balance and physical performance (floor sit to stand) were tested. We found that with increased aging, lean mass, fat and body mass index were changed; balance and physical performance decreased significantly. In regression models, age and fat ratio of android/gynoid changes explain static balance and physical performance; appendicular lean mass predicted dynamic balance. With advancing age, maintaining lean mass and proportion of fat accumulation is critical for stable balance.
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Affiliation(s)
- Young-Shin Lee
- School of Nursing, San Diego State University, San Diego, California, USA
| | - Jeanne F Nichols
- Department of Family Medicine and Public Health, University of California, San Diego, California, USA
| | - Antoinette Domingo
- School of Exercise and Nutritional Sciences, San Diego State University, California, USA
| | - Yeongri Kim
- Neuro/Trauma ICU at Banner Desert Medical Center, Mesa, Arizona, USA
| | - Sae Mi Park
- Los Angeles County + USC Medical Center, Los Angeles, California, USA
| | - Giyeon Han
- Paradise Valley Hospital, National City, California, USA
| | - Hyeran Seo
- San Diego State University, California, USA
| | - Mel Hovell
- Graduate School of Public Health, San Diego State University, California, USA
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13
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Tng HY, Thu WPP, Logan S, Aris IM, Cauley J, Yong EL. Sleep apnea and femoral neck BMD among Singaporean mid-life women. Arch Osteoporos 2018; 13:19. [PMID: 29508086 DOI: 10.1007/s11657-018-0428-6] [Citation(s) in RCA: 5] [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] [Received: 08/23/2017] [Accepted: 01/28/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED The relationship between sleep apnea and bone health remains controversial. This study explored the relationship between sleep apnea and femoral neck BMD in midlife Asian women. Partner-witnessed apnea predicted higher femoral neck BMD, an effect validated by the STOP index. Our findings suggest that sleep apnea may protect bone health. PURPOSE The menopause transition is associated with decline in bone mineral density (BMD) and sleep quality. However, any relationship between these two factors remains controversial. This study explored the association between sleep apnea and femoral neck BMD in middle-aged women. METHODS Participants (n = 1201) aged 45-69 years attending well-women visits at the National University Hospital, Singapore were recruited. Self-reported breathing discomfort and snoring, partner-witnessed apnea and snoring were assessed from the Pittsburgh Sleep Quality Index. Femoral neck BMD was assessed with dual-energy X-ray absorptiometry scan and classified into tertiles based on T-scores. Factors reported to affect sleep apnea and bone health in medical literature were potential covariates, p < 0.10. Multivariable ordinal regression analyses assessed associations between sleep measures and BMD. To further validate our findings, we analyzed four sleep apnea characteristics from the STOP questionnaire, a screening tool for sleep apnea. All analyses were performed using SPSS version 20.0. RESULTS Mean (SD) age of participants was 56.3 (6.2) years. Partner-witnessed apnea predicted higher BMD tertiles (OR per unit increase in severity 1.39, 95% CI [1.02, 1.89]), independent of age, ethnicity, diabetes, BMI, and handgrip strength. This was further corroborated by the STOP index (OR 1.45, 95% CI [1.07, 1.96]). CONCLUSIONS This study adds to the literature on sleep apnea and bone health in a non-Caucasian and younger population. Our findings support OSA-associated intermittent hypoxia protecting bone health.
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Affiliation(s)
- Han Ying Tng
- Department of Obstetrics and Gynecology, National University of Singapore, 1E, Road, Tower Block Level 12, Kent Ridge, 119228, Singapore
| | - Win Pa Pa Thu
- Department of Obstetrics and Gynecology, National University of Singapore, 1E, Road, Tower Block Level 12, Kent Ridge, 119228, Singapore
| | - Susan Logan
- Department of Obstetrics and Gynecology, National University of Singapore, 1E, Road, Tower Block Level 12, Kent Ridge, 119228, Singapore
| | - Izzuddin M Aris
- Department of Obstetrics and Gynecology, National University of Singapore, 1E, Road, Tower Block Level 12, Kent Ridge, 119228, Singapore
| | - Jane Cauley
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eu Leong Yong
- Department of Obstetrics and Gynecology, National University of Singapore, 1E, Road, Tower Block Level 12, Kent Ridge, 119228, Singapore.
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14
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Munhoz L, Aoki EM, Cortes ARG, de Freitas CF, Arita ES. Osteoporotic alterations in a group of different ethnicity Brazilian postmenopausal women: An observational study. Gerodontology 2018; 35:101-109. [PMID: 29380906 DOI: 10.1111/ger.12322] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To compare peripheral bone mineral density alterations among Brazilian postmenopausal women from three ethnic groups considering age and body mass index influence; to correlate their bone mineral density with the mandibular cortical index (MCI); and to evaluate the influence of age, body mass index and ethnicity in the MCI using risk factor analysis. BACKGROUND Osteoporosis risk is known to have ethical influences. However, little is known about the differences in ethnicity in radiomorphometric indices. MATERIALS AND METHODS A total of 150 postmenopausal women with different ethnicities (Caucasian, Asian and Afro-descendant) who underwent peripheral dual X-ray absorptiometry and panoramic examination were included. Bone mineral density and MCI were assessed. Adjusted odds ratio analyses were performed on bone density and MCI considering the effect of age, ethnicity and body mass index. The correlations between the MCI and the dual X-ray absorptiometry results were made. RESULTS Old age, low body mass index and non-Afro-descendant were associated with low bone density. Compared with Afro-descendants, Asians and Caucasians have higher chances of having decreased bone mass. For the MCI, statistical analysis showed that age is the only variable associated with osteoporotic alterations in the mandible. Furthermore, an inverse correlation was found between the MCI and the T-scores. CONCLUSION Bone density is higher in Brazilian Afro-descendant women than in Caucasians and Asians. Patient's age is associated with bone density and the MCI. The mandibular cortical index is inversely correlated with the peripheral densitometry results within the study ethnic population.
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Affiliation(s)
- Luciana Munhoz
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Eduardo M Aoki
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Arthur R G Cortes
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Cláudio F de Freitas
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | - Emiko S Arita
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
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15
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Kwan ML, Yao S, Laurent CA, Roh JM, Quesenberry CP, Kushi LH, Lo JC. Changes in bone mineral density in women with breast cancer receiving aromatase inhibitor therapy. Breast Cancer Res Treat 2017; 168:523-530. [PMID: 29249058 DOI: 10.1007/s10549-017-4626-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 12/11/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE We assessed bone mineral density (BMD) change with aromatase inhibitor (AI) treatment in a contemporary cohort of women with breast cancer treated in Kaiser Permanente Northern California. METHODS Percent and estimated annual percent changes in BMD at the total hip and lumbar spine were examined in 676 women receiving AI therapy who had two serial BMD reports available (at least 1 year apart) before and after AI initiation (N = 317) or during continued AI therapy (N = 359). BMD changes were examined at the total hip and lumbar spine and compared by age and clinical subgroups. RESULTS Women experienced BMD declines after AI initiation or continued therapy, with median annual percent change - 1.2% (interquartile range, IQR - 2.4 to - 0.1%) at the hip and - 1.0% (IQR - 2.3 to 0.1%) at the spine after AI initiation, and - 1.1% (IQR - 2.4 to 0.1%) at the hip and - 0.9% (IQR - 2.4 to 0.5%) at the spine during continued therapy. Higher levels of bone loss were observed among younger (< 55 years) compared with older (≥ 75 years) women at the hip (- 1.6% vs. - 0.8%) and at the spine (- 1.5% vs. - 0.5%) after AI initiation, and at the hip (- 1.4% vs. - 1.2%) and at the spine (- 2.4% vs. - 0.001%) during continued therapy. CONCLUSIONS Small but consistent declines in total hip and lumbar spine BMD were present in breast cancer patients following AI therapy initiation or continued AI therapy. Although the overall rates of osteoporosis were low, greater estimated levels of annual bone loss were evident among women < 55 years.
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Affiliation(s)
- Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Song Yao
- Department of Cancer Prevention and Control, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY, 14263, USA
| | - Cecile A Laurent
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Joan C Lo
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
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