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Funakoshi Y, Maruyama K, Kato T, Saito I, Takanashi N, Tanno K, Yamagishi K, Muraki I, Yasuda N, Arima K, Nakashima H, Yamaji T, Iwasaki M, Inoue M, Tsugane S, Sawada N. Association of depressive symptoms with incident fractures: the Japan Public Health Center-based Prospective Study for the Next Generation (JPHC-NEXT). Osteoporos Int 2024; 35:1261-1271. [PMID: 38733393 DOI: 10.1007/s00198-024-07106-4] [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: 11/08/2023] [Accepted: 04/25/2024] [Indexed: 05/13/2024]
Abstract
This 5-year longitudinal study investigated the relationship between depressive symptoms and fracture risk in a large Japanese cohort. Depressive symptoms were a significant risk factor for hip fractures in women. PURPOSE A relationship between depressive symptoms and fractures has not been clearly demonstrated. We aimed to investigate the relationship between depressive symptoms and 5-year fracture risk in the Japan Public Health Center-based Prospective Study for the Next Generation. METHODS From 2011 to 2016, 114,092 participants were enrolled, and a follow-up survey was conducted 5 years later. We analyzed 30,552 men and 38,063 women aged 40-74 years who had no past fractures at baseline. Presence of depressive symptoms was defined as a modified 11-item Center for Epidemiological Studies Depression Scale score of 8 or higher, a history of depression, or use of antidepressants. Subjects were asked to report vertebral, upper limb, and/or hip fractures, except for traffic or work accidents, that occurred during the follow-up period. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for fracture were analyzed via logistic regression analysis to evaluate the relationship between depressive symptoms and fracture. RESULTS Women with depressive symptoms demonstrated a high AOR for hip fractures (AOR: 2.78, 95% CI: 1.30 - 5.92); this result was consistent in post menopause women. In men, this association was not found for any age group or any type of fracture. CONCLUSIONS Depressive symptoms in women may increase the risk of hip fractures. Further studies are required to explore this relationship in more detail.
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Affiliation(s)
- Yayoi Funakoshi
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu City, Oita, 879-5593, Japan
| | - Koutatsu Maruyama
- Laboratory of Community Health and Nutrition, Special Course of Food and Health Science, Department of Bioscience, Graduate School of Agriculture, Ehime University, 3-5-7 Tarumi, Matsuyama City, Ehime, 790-8566, Japan
| | - Tadahiro Kato
- Center for Education and Educational Research, Faculty of Education, Ehime University, 3 Bunkyocho, Matsuyama City, Ehime, 790-0826, Japan
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-Machi, Yufu City, Oita, 879-5593, Japan.
| | - Nobuyuki Takanashi
- Department of Hygiene and Preventive Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-Cho, Shiwa-Gun, Iwate, 028-3694, Japan
| | - Kozo Tanno
- Department of Hygiene and Preventive Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-Cho, Shiwa-Gun, Iwate, 028-3694, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-0817, Japan
- Ibaraki Western Medical Center, 555 Otsuka, Chikusei, Ibaraki, 308-0813, Japan
| | - Isao Muraki
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Nobufumi Yasuda
- Department of Public Health, Kochi University Medical School, Kohasu, Nankoku-Shi, Kochi, Okoh-Cho, 783-8505, Japan
| | - Kazuhiko Arima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Hiroki Nakashima
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Taiki Yamaji
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Motoki Iwasaki
- Division of Epidemiology, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Manami Inoue
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
- Division of Prevention, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
| | - Shoichiro Tsugane
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 7-6-8 Saitoasagi, Ibaraki, Osaka, 567-0085, Japan
- International University of Health and Welfare Graduate School of Public Health, Tokyo, 107-8402, Japan
| | - Norie Sawada
- Division of Cohort Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-Ku, Tokyo, 104-0045, Japan
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Jin H, Zhao H, Jin S, Yi X, Liu X, Wang C, Zhang G, Pan J. Menopause modified the association of blood pressure with osteoporosis among gender: a large-scale cross-sectional study. Front Public Health 2024; 12:1383349. [PMID: 38756892 PMCID: PMC11097953 DOI: 10.3389/fpubh.2024.1383349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/02/2024] [Indexed: 05/18/2024] Open
Abstract
Purpose This study aimed to assess the potential association between blood pressure and osteoporosis in a rural population with limited resources. Existing evidence on this association is limited, particularly in such settings. Methods Data from 7,689 participants in the Henan Rural Cohort study were analyzed. Four blood pressure indicators [systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP)] were measured. The logistic regression model and restricted cubic spline plots were used to assess the relationship between blood pressure indicators and osteoporosis prevalence. Results Positive trends were noted between blood pressure indicators and osteoporosis prevalence in the entire group and women (P trend < 0.05 for SBP, MAP, and PP). Women with higher SBP and PP exhibited elevated odds of osteoporosis compared with those with the lowest SBP and PP (ORs ranging from 1.15 to 1.5 for SBP and 1.06 to 1.83 for PP). No such associations were found in men. These relationships were only evident in postmenopausal women. Dose-response analysis confirmed these findings. Excluding participants taking hypertension medication did not alter the results. Conclusion In resource-limited settings, higher SBP and PP are associated with the increased prevalence of osteoporosis in women, potentially influenced by menopause-related factors. This indicates that potential gender-based differences and social inequalities may affect bone health. Clinical trial registration The Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699) http://www.chictr.org.cn/showproj.aspx?proj=11375.
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Affiliation(s)
- Haidong Jin
- Department of Orthopaedic Surgery, The Second Clinical Medical School, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Hongfei Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Sufan Jin
- Faculty Development Center (Education Supervision and Teaching Evaluation Center), Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xianhong Yi
- Department of Orthopaedic Surgery, The Second Clinical Medical School, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiaotian Liu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Chongjian Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Gongyuan Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jun Pan
- Department of Orthopaedic Surgery, The Second Clinical Medical School, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Ma H, Cai X, Hu J, Song S, Zhu Q, Zhang Y, Ma R, Shen D, Yang W, Zhou P, Zhang D, Luo Q, Hong J, Li N. Association of systemic inflammatory response index with bone mineral density, osteoporosis, and future fracture risk in elderly hypertensive patients. Postgrad Med 2024; 136:406-416. [PMID: 38753519 DOI: 10.1080/00325481.2024.2354158] [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: 04/01/2024] [Accepted: 05/08/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES This study sought to investigate the relationship between the systemic inflammatory response index (SIRI) and bone mineral density (BMD), osteoporosis, and future fracture risk in elderly hypertensive patients. METHODS Elderly hypertensive patients (age ≥60 years) who attended our hospital between January 2021 and December 2023 and completed BMD screening were included in the study. Analyses were performed with multivariate logistic and linear regression. RESULTS The multiple linear regression indicated that SIRI levels were significantly negatively correlated with lumbar 1 BMD (β = -0.15, 95% CI: -0.24, -0.05), lumbar 2 BMD (β = -0.15, 95% CI: -0.24, -0.05), lumbar 3 BMD (β = -1.35, 95% CI: -0.23, -0.02), lumbar 4 BMD (β = -0.11, 95% CI: -0.30, -0.10), femur neck BMD (β = -0.11, 95% CI: -0.18, -0.05) and Ward's triangle BMD (β = -0.12, 95% CI: -0.20, -0.05) among elderly hypertensive patients, after fully adjusting for confounders. Furthermore, we observed that SIRI was positively associated with future fracture risk in elderly hypertensive patients. Specifically, SIRI was associated with an increased risk of major osteoporotic fractures (β = 0.33) and hip fractures (β = 0.25). The logistic regression analysis indicated that there is an association between the SIRI level and an increased risk of osteoporosis (OR = 1.60, 95% CI = 1.37, 1.87), after fully adjusting for confounders. CONCLUSIONS Our findings indicate a potential association between SIRI and BMD, osteoporosis, and the risk of future fractures in elderly hypertensive patients. However, further studies are warranted to confirm these findings.
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Affiliation(s)
- Huimin Ma
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Xintian Cai
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Junli Hu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Shuaiwei Song
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Qing Zhu
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Yingying Zhang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Rui Ma
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Di Shen
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Wenbo Yang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Pan Zhou
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Delian Zhang
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Qin Luo
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Jing Hong
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
| | - Nanfang Li
- Hypertension Center of People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang Hypertension Institute, NHC Key Laboratory of Hypertension Clinical Research, Key Laboratory of Xinjiang Uygur Autonomous Region "Hypertension Research Laboratory", Xinjiang Clinical Medical Research Center for Hypertension (Cardio-Cerebrovascular) Diseases, Urumqi, China
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Schneider H, Brüdgam D, Nowotny HF, Schmidmaier R, Reincke M, Adolf C. Moderate salt restriction in primary aldosteronism improves bone metabolism through attenuation of urinary calcium and phosphate losses. Eur J Endocrinol 2024; 190:K47-K52. [PMID: 38557596 DOI: 10.1093/ejendo/lvae020] [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] [Received: 09/15/2023] [Revised: 01/09/2024] [Accepted: 02/05/2024] [Indexed: 04/04/2024]
Abstract
Accumulating evidence links osteoporosis and dietary salt consumption. Primary aldosteronism (PA) is a model disease with increased dietary salt intake and constitutes an independent risk factor for osteoporosis. We, thus, assessed whether a short-term moderate reduction in salt intake in PA results in detectable osteoanabolic effects. Forty-one patients with PA on stable mineralocorticoid receptor antagonist therapy were subjected to a 12-week salt restriction. Serum and urinary electrolytes, markers of bone turnover, and a 15 steroids plasma profile were registered. After 12 weeks, urinary calcium and phosphate decreased, while plasma testosterone, serum phosphate, and bone alkaline phosphatase (BAP) all increased significantly. Longitudinal changes in BAP were independently correlated with changes in serum phosphate, parathyroid hormone, and urinary calcium in multivariate analysis. Salt restriction in PA limits urinary calcium and phosphate losses and may confer favorable osteoanabolic effects. Our findings suggest that salt restriction should be considered in patients with PA to improve bone health.
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Affiliation(s)
- Holger Schneider
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Denise Brüdgam
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Hanna F Nowotny
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ralf Schmidmaier
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Martin Reincke
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
| | - Christian Adolf
- Department of Medicine IV, LMU University Hospital, LMU Munich, Munich, Germany
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Guo L, Zhang N, Zhang Y, Xing L, Xu W, Li W, Zhang L, Hou X, Chen S, Wu S, Tian F. Arterial stiffness and risk of new-onset fragility fracture in Chinese men and women: The Kailuan cohort study. Bone 2024; 180:116991. [PMID: 38141749 DOI: 10.1016/j.bone.2023.116991] [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: 08/11/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Previous studies have shown an association between increased arterial stiffness and reduced bone mineral density. However, the relationship between arterial stiffness and fragility fracture remains unclear. In this study, we explored the impact of arterial stiffness on the risk of new-onset fragility fracture. METHODS The study included 53,107 participants in the Kailuan Study in whom brachial-ankle pulse wave velocity (baPWV) measurements were obtained between 2010 and 2021. All participants were free of fragility fractures at baseline. A Cox proportional hazard regression model was used to estimate the hazard ratio (HR) and 95 % confidence interval (CI) for incident fragility fracture on the baseline baPWV groups: <1400 cm/s (reference), 1400 ≤ baPWV < 1800 cm/s, and ≥1800 cm/s. RESULTS In total, 327 incident fragility fractures were recorded during an average follow-up of 4.99 ± 3.02 years. After adjustment for potential confounders, the HR for the risk of new-onset fragility fracture was 1.66 (95 % CI 1.14-2.42) for the arterial stiffness group in comparison with the normal baPWV group. The risk of fragility fracture was higher in men (HR 1.64, 95 % CI 1.05-2.57). There was a linear association between higher baPWV and fragility fracture. CONCLUSIONS Arterial stiffness as measured by baPWV was associated with the risk of fragility fracture.
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Affiliation(s)
- Lu Guo
- The School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Nan Zhang
- Department of Orthopedics, Kailuan General Hospital, Tangshan, Hebei, China
| | - Yimeng Zhang
- Medical Department, The First Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Lei Xing
- Department of General Practice, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China
| | - Wenqi Xu
- The School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Wenjuan Li
- The School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Lisha Zhang
- The School of Clinical Medicine, North China University of Science and Technology, Tangshan, Hebei, China
| | - Xiaoli Hou
- The School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, Hebei, China
| | - Faming Tian
- The School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China.
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Uragami M, Matsushita K, Shibata Y, Takata S, Karasugi T, Sueyoshi T, Masuda T, Nakamura T, Tokunaga T, Hisanaga S, Yugami M, Sugimoto K, Yonemitsu R, Ideo K, Fukuma Y, Takata K, Arima T, Kawakami J, Maeda K, Yoshimura N, Matsunaga H, Kai Y, Tanimura S, Shimada M, Tateyama M, Miyamoto K, Kubo R, Tajiri R, Tian X, Homma F, Morinaga J, Yamanouchi Y, Takebayashi M, Kajitani N, Uehara Y, Miyamoto T. A machine learning-based scoring system and ten factors associated with hip fracture occurrence in the elderly. Bone 2023; 176:116865. [PMID: 37562661 DOI: 10.1016/j.bone.2023.116865] [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: 07/04/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
Hip fractures are fragility fractures frequently seen in persons over 80-years-old. Although various factors, including decreased bone mineral density and a history of falls, are reported as hip fracture risks, few large-scale studies have confirmed their relevance to individuals older than 80, and tools to assess contributions of various risks to fracture development and the degree of risk are lacking. We recruited 1395 fresh hip fracture patients and 1075 controls without hip fractures and comprehensively evaluated various reported risk factors and their association with hip fracture development. We initially constructed a predictive model using Extreme Gradient Boosting (XGBoost), a machine learning algorithm, incorporating all 40 variables and evaluated the model's performance using the area under the receiver operating characteristic curve (AUC), yielding a value of 0.87. We also employed SHapley Additive exPlanation (SHAP) values to evaluate each feature importance and ranked the top 20. We then used a stepwise selection method to determine key factors sequentially until the AUC reached a plateau nearly equal to that of all variables and identified the top 10 sufficient to evaluate hip fracture risk. For each, we determined the cutoff value for hip fracture occurrence and calculated scores of each variable based on the respective feature importance. Individual scores were: serum 25(OH)D levels (<10 ng/ml, score 7), femoral neck T-score (<-3, score 5), Barthel index score (<100, score 3), maximal handgrip strength (<18 kg, score 3), GLFS-25 score (≥24, score 2), number of falls in previous 12 months (≥3, score 2), serum IGF-1 levels (<50 ng/ml, score 2), cups of tea/day (≥5, score -2), use of anti-osteoporosis drugs (yes, score -2), and BMI (<18.5 kg/m2, score 1). Using these scores, we performed receiver operating characteristic (ROC) analysis and the resultant optimal cutoff value was 7, with a specificity of 0.78, sensitivity of 0.75, and AUC of 0.85. These ten factors and the scoring system may represent tools useful to predict hip fracture.
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Affiliation(s)
- Masaru Uragami
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kozo Matsushita
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuto Shibata
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shu Takata
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Tatsuki Karasugi
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takanao Sueyoshi
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Tetsuro Masuda
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takayuki Nakamura
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takuya Tokunaga
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Satoshi Hisanaga
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Masaki Yugami
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kazuki Sugimoto
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Ryuji Yonemitsu
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Katsumasa Ideo
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuko Fukuma
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kosei Takata
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takahiro Arima
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Jyunki Kawakami
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kazuya Maeda
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Naoto Yoshimura
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hideto Matsunaga
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuki Kai
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shuntaro Tanimura
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Masaki Shimada
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Makoto Tateyama
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kana Miyamoto
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Ryuta Kubo
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Rui Tajiri
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Xiao Tian
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Fuka Homma
- Department of Clinical Investigation, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556, Japan
| | - Jun Morinaga
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yoshinori Yamanouchi
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Naoto Kajitani
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; Center for Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yusuke Uehara
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
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Zhang R, Yin H, Yang M, Lei X, Zhen D, Zhang Z. Advanced Progress of the Relationship Between Antihypertensive Drugs and Bone Metabolism. Hypertension 2023; 80:2255-2264. [PMID: 37675564 DOI: 10.1161/hypertensionaha.123.21648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Hypertension and osteoporosis are common comorbidities among elderly individuals. Drug therapy has been widely used in clinical practice as the preferred antihypertensive treatment. Therefore, antihypertensive drugs have become some of the most commonly prescribed drugs in healthcare settings. However, antihypertensive drugs have different effects on bone metabolism. The results of animal and clinical studies on the effects of antihypertensive drugs on osteoporosis or fracture risk are controversial and have aroused widespread concern among clinicians. Recent studies found that angiotensin receptor blockers, selective β-adrenergic receptor blockers, and thiazide diuretics might improve bone trabecular number and bone mineral density by stimulating osteoblast differentiation, reducing osteoclast generation, and other mechanism. Furthermore, nonselective β-adrenergic receptor blockers and dihydropyridine calcium channel blockers were found to have no significant relationship with bone mineral density or bone strength, and α-adrenergic receptor blockers and loop diuretics might increase fracture risk by decreasing bone mineral density. This article aimed to review previous animal experiments, clinical studies, and meta-analyses focusing on the effects of different antihypertensive drugs on bone metabolism, and to provide a new approach for the prevention and treatment of osteoporosis.
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Affiliation(s)
- Ruixing Zhang
- The First Clinical Medical College, Lanzhou University, China (R.Z., M.Y.)
- Department of Heart Center (R.Z., Z.Z.), The First Hospital of Lanzhou University, China
| | - Hongtao Yin
- Department of Endocrinology (H.Y., M.Y., D.Z.), The First Hospital of Lanzhou University, China
| | - Mengdi Yang
- The First Clinical Medical College, Lanzhou University, China (R.Z., M.Y.)
- Department of Endocrinology (H.Y., M.Y., D.Z.), The First Hospital of Lanzhou University, China
| | - Xianqiong Lei
- Department of Geriatrics, The First People's Hospital of Yibin, China (X.L.)
| | - Donghu Zhen
- Department of Endocrinology (H.Y., M.Y., D.Z.), The First Hospital of Lanzhou University, China
| | - Zheng Zhang
- Department of Heart Center (R.Z., Z.Z.), The First Hospital of Lanzhou University, China
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8
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Shi W, Zhang Q. Association between Metabolic Syndrome and the Musculoskeletal System. Nutrients 2023; 15:4475. [PMID: 37892550 PMCID: PMC10609780 DOI: 10.3390/nu15204475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Metabolic syndrome (MetS) and osteoporosis are chronic health disorders worldwide [...].
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Affiliation(s)
| | - Qian Zhang
- Key Laboratory of Precision Nutrition and Food Quality, Department of Nutrition and Health, China Agricultural University, Beijing 100193, China;
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9
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Fan Z, Kitaura H, Ren J, Ohori F, Noguchi T, Marahleh A, Ma J, Kanou K, Miura M, Narita K, Lin A, Mizoguchi I. Azilsartan inhibits inflammation-triggered bone resorption and osteoclastogenesis in vivo via suppression of TNF-α expression in macrophages. Front Endocrinol (Lausanne) 2023; 14:1207502. [PMID: 37795376 PMCID: PMC10545845 DOI: 10.3389/fendo.2023.1207502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Hypertension is a major risk factor for cardiovascular disease (CVD) and is associated with increased bone loss due to excessive activity of the local renin-angiotensin system (RAS). Angiotensinogen/Angiotensin (ANG) II/Angiotensin II type 1 receptor (AT1R) axis is considered as the core axis regulating RAS activity. Azilsartan is an FDA-approved selective AT1R antagonist that is used to treat hypertension. This study aimed to determine whether azilsartan affects formation of osteoclast, resorption of bone, and the expression of cytokines linked with osteoclastogenesis during lipopolysaccharide (LPS)-triggered inflammation in vivo. Methods In vivo, following a 5-day supracalvarial injection of LPS or tumor necrosis factor-alpha (TNF-α) with or without azilsartan, the proportion of bone resorption and the number of tartrate-resistant acid phosphatase (TRAP)-positive multinucleated cells, which are identified as osteoclasts on mice calvariae were counted. The mRNA expression levels of TRAP, cathepsin K, receptor activator of NF-κB ligand (RANKL), and TNF-α were also evaluated. In vitro, the effect of azilsartan (0, 0.01, 0.1, 1, and 10 μM) on RANKL and TNF-α-triggered osteoclastogenesis were investigated. Also, whether azilsartan restrains LPS-triggered TNF-α mRNA and protein expression in macrophages and RANKL expression in osteoblasts were assessed. Furthermore, western blotting for analysis of mitogen-activated protein kinases (MAPKs) signaling was conducted. Results Azilsartan-treated calvariae exhibited significantly lower bone resorption and osteoclastogenesis than those treated with LPS alone. In vivo, LPS with azilsartan administration resulted in lower levels of receptor activator of RANKL and TNF-α mRNA expression than LPS administration alone. Nevertheless, azilsartan did not show inhibitory effect on RANKL- and TNF-α-triggered osteoclastogenesis in vitro. Compared to macrophages treated with LPS, TNF-α mRNA and protein levels were lower in macrophages treated by LPS with azilsartan. In contrast, RANKL mRNA and protein expression levels in osteoblasts were the same in cells co-treated with azilsartan and LPS and those exposed to LPS only. Furthermore, azilsartan suppressed LPS-triggered MAPKs signaling pathway in macrophages. After 5-day supracalvarial injection, there is no difference between TNF-α injection group and TNF-α with azilsartan injection group. Conclusion These findings imply that azilsartan prevents LPS-triggered TNF-α production in macrophages, which in turn prevents LPS-Triggered osteoclast formation and bone resorption in vivo.
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Affiliation(s)
- Ziqiu Fan
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Hideki Kitaura
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Jiayi Ren
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Fumitoshi Ohori
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Takahiro Noguchi
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Aseel Marahleh
- Frontier Research Institute for Interdisciplinary Sciences, Tohoku University, Sendai, Miyagi, Japan
| | - Jinghan Ma
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kayoko Kanou
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Mariko Miura
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Kohei Narita
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Angyi Lin
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
| | - Itaru Mizoguchi
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Miyagi, Japan
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Park JH, Park MS, Kim HJ, Lee H, Kim JW, Song TJ. Better oral hygiene is associated with a reduced risk of osteoporotic fracture: a nationwide cohort study. Front Endocrinol (Lausanne) 2023; 14:1253903. [PMID: 37780632 PMCID: PMC10539647 DOI: 10.3389/fendo.2023.1253903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background The aim of this study was to examine the longitudinal association between oral health parameters and osteoporotic fracture. Methods The study included participants who received oral health screening by dentists from the National Health Screening cohort database of Korea between 2003 and 2006. The primary outcome was osteoporotic fracture occurrence, which was defined using specific international classification of diseases-10 codes; vertebral fracture (S22.0, S22.1, S32.0, S32.7, T08, M48.4, M48.5, and M49.5), hip fracture (S72.0 and S72.1), distal radius fracture (S52.5 and S52.6), and humerus fracture (S42.2 and S42.3). The presence of periodontitis and various oral health examination findings, such as missing teeth, caries, frequency of tooth brushing, and dental scaling, were analyzed using a Cox proportional hazard model to assess their association with osteoporotic fracture occurrence. Results The analysis included a total of 194,192 participants, among whom 16,683 (8.59%) developed osteoporotic fracture during a median follow-up of 10.3 years. Poor oral health status, including periodontitis (adjusted hazard ratio [aHR]: 1.09, 95% confidence interval [CI]: 1.01-1.18, p = 0.039), a higher number of missing teeth (≥15; aHR: 1.59, 95% CI: 1.45-1.75, p < 0.001), and dental caries (≥6; aHR: 1.17, 95% CI: 1.02-1.35, p = 0.030), was associated with an increased risk of osteoporotic fracture. On the other hand, better oral hygiene behaviors such as brushing teeth frequently (≥3 times per day; aHR: 0.82, 95% CI: 0.78-0.86, p < 0.001) and having dental scaling within 1 year (aHR: 0.87, 95% CI: 0.84-0.90, p < 0.001) were negatively associated with the occurrence of osteoporotic fracture. Conclusion The study found that poor oral health, such as periodontitis, missing teeth, and dental caries, was associated with an increased risk of osteoporotic fracture. Conversely, good oral hygiene behaviors like frequent teeth brushing and dental scaling within 1 year were associated with a reduced risk. Further research is needed to confirm this association.
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Affiliation(s)
- Jung-Hyun Park
- Department of Oral and Maxillofacial Surgery, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Moo-Seok Park
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Jun Kim
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Heajung Lee
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Jin-Woo Kim
- Department of Oral and Maxillofacial Surgery, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Tae-Jin Song
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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Abdelrahman Ali MA, Sweed HS, Allam MF, Aly WW, Mohamed Matter AH, Abdelalim Elshabrawy WE. Proportion and Risk Factors of Silent Vertebral Fractures Among Egyptian Females With Fragility Hip Fracture Presenting to the Emergency Room of Ain Shams University Hospitals. Cureus 2023; 15:e46214. [PMID: 37905273 PMCID: PMC10613479 DOI: 10.7759/cureus.46214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Background Fragility fractures caused by osteoporosis are known to increase the risk of further fragility fractures. Also, several factors have been associated with an increasing risk of fracture in postmenopausal women with osteoporosis, as prior fracture, advancing age, low bone mineral density (BMD), greater risk or history of falls certain, pharmacologic therapies such as glucocorticoids, and medical conditions increase the risk of secondary osteoporosis and related fractures through their direct impact on bone density or structure. Menstrual history including age at menarche menopause and a history of amenorrhea is documented as a predicting osteoporotic fracture. Objective The aim of the current study is to find the proportion of hidden vertebral fractures among Egyptian females with fragility hip fracture. Patients and methods A cross-sectional study was conducted on patients who presented to the orthopedic emergency room (ER) of Ain Shams University Hospitals in Cairo, Egypt, from September 2020 to September 2021. Our inclusion criteria include females aged 40 years or older, who presented to the ER with fragility hip fractures. A simple random sample of females fulfilling our inclusion criteria for osteoporotic hip fracture was thoroughly investigated. Conventional lateral and anteroposterior radiographs of the dorsolumbar spine were obtained excluding those with high-impact fractures or pathological fractures. Results During the study period, a total of 43,935 persons presented to the orthopedic ER, of whom 30,901 were females, comprising 70.03% of total orthopedic ER visits. A sample of 150 females met our inclusion criteria. Results showed that 16 of our 150 cases had concomitant vertebral fracture, meaning that 10.7% of cases had hidden vertebral fracture at the time of osteoporotic hip fracture, as diagnosed by the screening lumbosacral plain X-rays. Older age at menarche, younger age at menopause, and amenorrhea are shown to be risk factors for hidden vertebral fracture in Egyptian females. Conclusion Osteoporosis is a complex and costly disease. Osteoporotic fractures may be largely preventable, as environmental factors are open to intervention, and effective pharmacological agents are available. Concomitant hidden vertebral fracture is prevalent among females with osteoporotic hip fractures, and those who had later menarche, earlier menopause, and menstrual irregularities have a higher incidence of developing associated vertebral fracture, which warrants identification and management to evade complications and mortality.
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Affiliation(s)
| | | | | | - Walaa W Aly
- Geriatrics, Ain Shams University, Cairo, EGY
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Chen X, He B, Zhou Y, Zhang X, Zhao L. Investigating the effect of history of fractures and hypertension on the risk of all-cause death from osteoporosis: A retrospective cohort study. Medicine (Baltimore) 2023; 102:e33342. [PMID: 37000086 PMCID: PMC10063279 DOI: 10.1097/md.0000000000033342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/07/2023] [Accepted: 03/02/2023] [Indexed: 04/01/2023] Open
Abstract
To assess the coexistence effect between history of fractures and hypertension on the all-cause death risk of osteoporosis. In this retrospective cohort study, some characteristics of osteoporosis patients aged ≥ 20 years were extracted from the National Health and Nutrition Examination Survey (NHANES) database (2005-2010, 2013-2014), such as age, gender, smoking, drinking, the history of diabetes, cardiovascular and cerebrovascular diseases, fractures and hypertension. The outcome of this study was defined as all-cause death of osteoporosis. These patients were followed up until 2015 with an average follow-up time of 62.00 ± 34.79 months. Univariate and multivariate logistic regression was utilized to evaluate the association of history of fractures and hypertension on all-cause death risk of osteoporosis, respectively. The death risk factors were presented by using relative risk (RR) and 95% confidence interval (CI). The attributable proportion (AP) to explore the interaction between history of fractures and hypertension on the all-cause death risk of osteoporosis. Of the total 801 osteoporosis patients, 227 died. After adjusting age, gender, marital status, education background, annual household income, diabetes, the prior use of prednisone or cortisone medication, cardiovascular and cerebrovascular diseases, the history of fractures (RR = 1.502, 95% CI: 1.035-2.180), spine fracture (RR = 2.944, 95% CI: 1.244-6.967), hip fracture (RR = 2.033, 95% CI: 1.066-3.875) was significantly associated with the increased death risk of osteoporosis. However, there was no significant difference between hypertension and the all-cause death risk of osteoporosis (P > .05). Additionally, there was a significant interaction between the history of fractures and hypertension on the all-cause death risk of osteoporosis, and the interaction was an enhancement effect (AP = 0.456, 95% CI: 0.005-0.906). The co-existence of the history of fractures and hypertension could increase the all-cause death risk of osteoporosis, which indicated that osteoporosis patients with the history of fractures should actively monitor blood pressure levels and prevent the occurrence of hypertension.
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Affiliation(s)
- Xiao Chen
- Department of TCM Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, P.R. China
| | - Binbin He
- Department of TCM Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, P.R. China
| | - Youliang Zhou
- Department of TCM Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, P.R. China
| | - Xinguo Zhang
- Department of TCM Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, P.R. China
| | - Liang Zhao
- Department of TCM Orthopedics, Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, P.R. China
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Association between Wrist Circumference and Risk of Any Fracture in Adults: Findings from 15 Years of Follow-Up in the Tehran Lipid and Glucose Study. J Clin Med 2022; 11:jcm11237048. [PMID: 36498622 PMCID: PMC9736297 DOI: 10.3390/jcm11237048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 11/30/2022] Open
Abstract
We evaluated whether wrist circumference (WrC), as a novel anthropometric measure, is associated with incidences of any fractures. The study population included 8288 adults (45.3% men) aged ≥30 years, who were followed for incidences of any fractures from 31 January 1999 to 16 March 2016. We used Cox proportional hazard models adjusted for well-known risk factors to evaluate the association of WrC, both as continuous and categorical variables (bottom tertile as reference), with incidences of any fractures and major osteoporotic fractures (MOF). Over 15 years of follow-ups, 348 fractures occurred (men = 162). For a 1 cm increase in WrC, hazard ratios (HRs) were 1.18 (95% CI: 1.03-1.35) for incident any fractures and 1.22 (1.01-1.49) for incident MOF. In addition to WrC, age, female sex, lower BMI, higher WC, current smoking, and usage of steroidal medications were significantly associated with the incidences of any fractures. Moreover, participants in the middle and top tertiles of WrC had a higher risk of incidence for any fractures [HR = 1.62 (1.19-2.20) and 1.70 (1.14-2.55), respectively, p-value for trend = 0.012]. We presented WrC as a strong and independent risk factor for incidences of any fractures that might be considered in the risk prediction of bone fracture in Iranian adults.
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Lian Z, Zhu C, Yuan H, Wang J. Association between changes in depressive symptoms and hip fracture among middle-aged and older Chinese individuals: a prospective cohort study. BMC Geriatr 2022; 22:844. [PMID: 36348273 PMCID: PMC9644634 DOI: 10.1186/s12877-022-03484-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although studies have shown that depressive symptoms are associated with an increased risk of hip fracture (HF). Depressive symptoms are dynamic, and it is unclear whether HF risk persists if depressive symptoms remit. This study aims to examine the associations between changes in depressive symptoms and HF risk. Methods Data were from the China Health and Retirement Longitudinal Study from 2011 to 2018. Depressive symptoms were measured using the 10-item version of the Center for Epidemiological Studied Depression scale (cutoff ≥ 10). Changes in depressive symptoms were classified into four groups by two successive surveys (stable low/no, recent-onset, recently remitted, and stable high depressive symptoms). Multivariable logistic regressions were performed to assess whether changes in depressive symptoms were associated with HF incidents reported through 2018, adjusting for age, sex, educational level, marital status and other potential confounding factors. Results In total, 8574 participants were included, 265 (3.1%) of whom had reported HF incidents in the subsequent 5-year period. Participants with recent-onset (OR = 1.97, 95% CI = 1.40–2.77) or stable high (OR = 2.15, 95% CI = 1.53–3.02) symptoms had a higher risk of HF than those with stable low/no depressive symptoms, whereas those with improved depressive symptoms (OR = 1.27, 95% CI = 0.89–1.82) had no elevation in HF risk. Conclusion Stable high and recent-onset depressive symptoms were associated with increased HF risk, and no elevated HF risk was observed if symptoms remitted, suggesting that strategies to reduce depressive symptoms may be beneficial for HF prevention. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03484-8.
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Multimorbidity and Polytherapy in Patients with Femoral Neck Fracture: A Retrospective Observational Study. J Clin Med 2022; 11:jcm11216405. [PMID: 36362631 PMCID: PMC9654078 DOI: 10.3390/jcm11216405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 11/25/2022] Open
Abstract
Fractures of the femoral neck are one of the most common reasons for admission to an orthopedic institute. These patients also show multimorbidity (≥2 chronic conditions) and polytherapy (≥5 drugs). Multimorbidity and polytherapy are associated with a high risk of hospitalization and a reduction in quality of life. The present retrospective observational study was conducted to evaluate the prevalence of multimorbidity and polytherapy in patients aged ≥65 years and surgically treated for femoral neck fractures at an orthopedic institute over 3 years. Multimorbidity was evaluated with Elixhauser’s comorbidity measure and polytherapy was obtained from the patient’s medical record. This study identified 917 patients (84 ± 7.6 years); most of them were females. Most patients presented ≥2 chronic conditions, the most frequent of which was uncomplicated hypertension, and most patients used ≥5 drugs, of which antithrombotic ones were the most frequently taken. No significant gender and age differences were found between the presence or not of multimorbidity or polytherapy. Multimorbidity and polytherapy were statistically associated with an increased and decreased risk of 1-year mortality, respectively. This retrospective study has evaluated the variables required for the establishment of a minimum core of descriptors of the prevalence of polytherapy and multimorbidity in the orthopedic field.
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Cho HW, Jin HS, Eom YB. FGFRL1 and FGF genes are associated with height, hypertension, and osteoporosis. PLoS One 2022; 17:e0273237. [PMID: 35980984 PMCID: PMC9387819 DOI: 10.1371/journal.pone.0273237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/04/2022] [Indexed: 11/21/2022] Open
Abstract
Hypertension and osteoporosis are two major disorders, which interact with each other. Specific genetic signals involving the fibroblast growth factor receptor-like 1 (FGFRL1) gene are related to high blood pressure and bone growth in giraffes. FGFRL1 is associated with cardiovascular system and bone formation. We performed an association study to investigate the role of FGFRL1 in hypertension, osteoporosis, and height determination in humans. In addition, we identified three kinds of phenotypes in fibroblast growth factor (FGF) genes and examined their association with the FGFRL1 gene. We identified 42 SNPs in the FGFRL1 gene associated with each trait. We then analyzed the potential functional annotation of each SNP. The FGFRL1 gene was found to be associated with height, hypertension, and osteoporosis, consistent with the results of a previous study. In addition, the FGF2, FGF4, FGF10, FGF18, and FGF22 genes were found to interact with the FGFRL1 gene. Our study suggests that both FGFRL1 and FGFRL1-related genes may determine the height and the prevalence of osteoporosis and hypertension in the Korean population.
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Affiliation(s)
- Hye-Won Cho
- Department of Medical Sciences, Graduate School, Soonchunhyang University, Asan, Chungnam, Republic of Korea
| | - Hyun-Seok Jin
- Department of Biomedical Laboratory Science, College of Life and Health Sciences, Hoseo University, Asan, Chungnam, Republic of Korea
| | - Yong-Bin Eom
- Department of Medical Sciences, Graduate School, Soonchunhyang University, Asan, Chungnam, Republic of Korea
- Department of Biomedical Laboratory Science, College of Medical Sciences, Soonchunhyang University, Asan, Chungnam, Republic of Korea
- * E-mail:
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Association of Thiazide Use in Patients with Hypertension with Overall Fracture Risk: A Population-Based Cohort Study. J Clin Med 2022; 11:jcm11123304. [PMID: 35743377 PMCID: PMC9225296 DOI: 10.3390/jcm11123304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Thiazide diuretics have long been widely used as antihypertensive agents. In addition to reducing blood pressure, thiazides also control calcium homeostasis and increase bone density. We hypothesized that the use of thiazides in patients with hypertension would reduce overall fracture risk. We used the Taiwan National Health Insurance Research Database to find patients with a hypertension diagnosis who accepted antihypertensive treatment from 2000 to 2017. The patients were further classified into thiazide users and nonthiazide users. Multivariable Cox regression analysis and Kaplan-Meier survival analysis were performed to estimate the adjusted hazard ratios (aHRs) and cumulative probability of fractures. After 1:1 propensity score matching by sex, age, urbanization level of place of residence, income, comorbidities, and medications, there were 18,483 paired thiazide users and non-users, respectively. The incidence densities of fractures (per 1000 person-months) were 1.82 (95% CI: 1.76-1.89) and 1.99 (95% CI: 1.92-2.06) in the thiazide and nonthiazide groups, respectively. The results indicated a lower hazard ratio for fractures in thiazide users (aHR = 0.93, 95% CI: 0.88-0.98). Kaplan-Meier survival analysis revealed a significantly lower cumulative incidence of fractures in the thiazide group (log-rank test; p = 0.0012). In conclusion, our results reveal that thiazide use can reduce fracture risk. When antihypertensive agents are being considered, thiazide may be a better choice if the patient is at heightened risk of fracture.
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Pramusita A, Kitaura H, Ohori F, Noguchi T, Marahleh A, Nara Y, Kinjo R, Ma J, Kanou K, Tanaka Y, Mizoguchi I. Salt-Sensitive Hypertension Induces Osteoclastogenesis and Bone Resorption via Upregulation of Angiotensin II Type 1 Receptor Expression in Osteoblasts. Front Cell Dev Biol 2022; 10:816764. [PMID: 35445013 PMCID: PMC9013777 DOI: 10.3389/fcell.2022.816764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/07/2022] [Indexed: 12/11/2022] Open
Abstract
Hypertension is a chronic-low grade inflammatory disease, which is known to be associated with increased bone loss. Excessive activity of the local renin–angiotensin system (RAS) in bone leads to increased bone resorption. As inflammatory cytokines may activate RAS components, we hypothesized that the elevated proinflammatory cytokine levels in hypertension activate bone RAS and thus lead to increased bone resorption. To investigate whether salt-sensitive hypertension (SSHTN) induces osteoclastogenesis and bone resorption, we generated a model of SSHTN in C57BL/6J mice by post-Nω-nitro-l-arginine methyl ester hydrochloride (l-NAME) high-salt challenge. SSHTN led to the reduction of distal femur trabecular number and bone volume fraction, while trabecular separation of femoral bone showed a significant increase, with no change in cortical thickness. Histomorphometric examination showed a significant reduction in trabecular bone volume fraction with an increased number of multinucleated tartrate-resistant acid phosphatase (TRAP)-positive cells and increased osteoclast surface fraction in the trabecular distal femur of hypertensive mice. Furthermore, analysis of gene expression in bone tissue revealed that TRAP and RANKL/OPG mRNA were highly expressed in hypertensive mice. TNF-α and angiotensin II type 1 receptor (AGTR1) mRNA and protein expression were also upregulated in SSHTN mice. These observations suggested that TNF-α may have an effect on AGTR1 expression leading to osteoclast activation. However, TNF-α stimulation did not promote AGTR1 mRNA expression in osteoclast precursors in culture, while TNF-α increased AGTR1 mRNA expression in osteoblast culture by activation of downstream p38. Angiotensin II was also shown to increase TNF-α-induced RANKL/OPG mRNA expression in primary osteoblast culture and osteoclastogenesis in a TNF-α-primed osteoblast and osteoclast precursor co-culture system. In addition, local injection of lipopolysaccharide into the supracalvariae of SSHTN mice markedly promoted osteoclast and bone resorption. In conclusion, mice with SSHTN show increased osteoclastogenesis and bone resorption due mainly to increased TNF-α and partly to the upregulation of AGTR1 in osteoblasts.
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Affiliation(s)
- Adya Pramusita
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Hideki Kitaura
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
- *Correspondence: Hideki Kitaura,
| | - Fumitoshi Ohori
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Takahiro Noguchi
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Aseel Marahleh
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yasuhiko Nara
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Ria Kinjo
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Jinghan Ma
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Kayoko Kanou
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Yukinori Tanaka
- Division of Dento-Oral Anesthesiology, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - Itaru Mizoguchi
- Division of Orthodontics and Dentofacial Orthopedics, Tohoku University Graduate School of Dentistry, Sendai, Japan
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García-Rojas MD, Palma-Cordero G, Martínez-Ramírez CO, Ponce de León-Suárez V, Valdés-Flores M, Castro-Hernández C, Rubio-Lightbourn J, Hernández-Zamora E, Reyes-Maldonado E, Velázquez-Cruz R, Barredo-Prieto B, Casas-Avila L. Association of Polymorphisms in Estrogen Receptor Genes ( ESR1 and ESR2) with Osteoporosis and Fracture-Involvement of Comorbidities and Epistasis. DNA Cell Biol 2022; 41:437-446. [PMID: 35285722 DOI: 10.1089/dna.2021.1165] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Single-nucleotide polymorphisms (SNPs) in the ESR1/ESR2 genes play a role in osteoporosis (OP). Our objective was to determine associations of polymorphisms in ESR genes with OP and fracture, SNP-SNP interactions, and involvement of comorbidities. We analyzed 170 Mexican osteoporotic women (FNOP), 173 with hip fracture (HFx), and 210 controls. The SNPs, ESR1 rs2234693CC, rs851982CC and rs1999805AA, were associated with reduced OP risk (odds ratios [ORs] = 0.35, 0.40 and 0.32, respectively; p < 0.05); rs2234693CC was associated with reduced fracture risk (OR = 0.24; p < 0.05). The obese/overweight carriers of rs9340799GG had a lower OP (OR = 0.15, p = 0.016) and fracture (OR = 0.12, p = 0.0057) risk. The rs9479055AA and rs3020404AA hypertensive carriers had a higher OP risk (OR = 5.96, p = 0.032; and OR = 5.29, p = 0.02, respectively). In addition, rs3020404AA had a higher risk of fracture (OR = 4.90, p = 0.045). The rs2228480GG hypertensive carriers had a higher risk of fracture (OR = 6.22, p = 0.0038). We found a synergic relation between the ESR1 rs3020331 and rs1999805 in femoral neck OP and HFx. The rs2234693 (PvuII) and rs9340799 (XbaI) polymorphisms are associated with a high risk forming a haplotype. The epistasis analysis suggests the contribution of both genes (ESR1/ESR2) to the risk of OP and fracture. Epistasis and involvement of obesity and hypertension lead to a significant modification of the risk.
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Affiliation(s)
| | - Grecia Palma-Cordero
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | | | | | - Margarita Valdés-Flores
- Laboratorio de Medicina Genómica, Instituto Nacional de Rehabilitación, Ciudad de México, México
| | - Clementina Castro-Hernández
- Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Julieta Rubio-Lightbourn
- Medicina Genómica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Edgar Hernández-Zamora
- Laboratorio de Medicina Genómica, Instituto Nacional de Rehabilitación, Ciudad de México, México
| | - Elba Reyes-Maldonado
- Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México, México
| | - Rafael Velázquez-Cruz
- Laboratorio de Genómica del Metabolismo Óseo, Instituto Nacional de Medicina Genómica, Ciudad de México, México
| | - Blanca Barredo-Prieto
- Laboratorio de Medicina Genómica, Instituto Nacional de Rehabilitación, Ciudad de México, México
| | - Leonora Casas-Avila
- Laboratorio de Medicina Genómica, Instituto Nacional de Rehabilitación, Ciudad de México, México
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Tohidi M, Barzegar N, Hasheminia M, Azizi F, Hadaegh F. Association of different lipid measures with incident bone fractures: Tehran Lipid and Glucose Study. Postgrad Med 2022; 134:326-332. [PMID: 35264057 DOI: 10.1080/00325481.2022.2050980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE to investigate the association between different lipid measures and long-term hospitalization-required incident fracture among Iranian men and women. METHODS A total of 3309 individuals aged ≥50 years (men = 1598) were included in the study. Multivariate Cox proportional hazard analyses were performed to assess the risk of incident fracture across quintiles, considering first quintile as reference, as well as for 1-standard deviation (SD) increase in each lipid measures i.e. total cholesterol (TC), triglycerides (TG), low and high density lipoprotein cholesterol (LDL-C and HDL-C, respectively), non-HDL-C, and related indices (TG/HDL-C and TC/HDL-C). Covariates included age, body mass index, current smoking, type 2 diabetes mellitus, hypertension, lipid lowering-drugs, and steroid medications (for women). RESULTS During a median follow-up of 18 years, incident fracture was observed in 201 cases (men=87). In both gender no linear association were found between different lipid measures and incident fracture. Among men only the fourth quartile of TG was associated with lower risk of fracture in the age adjusted analysis with hazard ratio (HR) and 95% confidence interval (CI) as [0.45 (0.21-0.95)]. Among women, the age-adjusted HRs and 95% CIs for the second, third, fourth and fifth quintiles of non-HDL-C were [0.46 (0.25-0.87)], [0.73 (0.42-1.25)], [0.90 (0.54-1.51)], [0.52 (0.29-0.95)], respectively; the corresponding values in the multivariate model, were [[0.48 (0.26-0.90)], [0.76 (0.4-1.32)], [0.94 (0.56-1.58)], and [0.52 (0.28-0.95)], respectively. The second quintile of LDL-C was also associated with lower risk for incident fracture in the multivariate analysis [0.53 (0.29-0.98)]. CONCLUSIONS Among Iranian women a nonlinear association between non-HDL-C and LDL-C and incident fracture were found as the second and fifth quintile of the former and the second quintile of the latter were associated with about 50% lower risk of fracture .Generally our findings did not support harmful impact of these lipid measures on incident fracture.
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Affiliation(s)
- M Tohidi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N Barzegar
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Hasheminia
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - F Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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21
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Matsuo T, Ito H, Mitsunari K, Ohba K, Miyata Y. Relationship between Urinary Calcium Excretion and Lower Urinary Tract Symptoms. Metabolites 2022; 12:metabo12030229. [PMID: 35323672 PMCID: PMC8953485 DOI: 10.3390/metabo12030229] [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: 02/10/2022] [Revised: 03/02/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022] Open
Abstract
To date, few detailed studies have been conducted on the convenient and useful markers for the prevalence of lower urinary tract symptoms (LUTS), including overactive bladder (OAB) and nocturia. A high level of calcium (Ca) excretion (hypercalciuria) is indicative of lifestyle-related diseases such as hypertension, which are associated with the onset of LUTS. Hence, in this study we attempted to clarify the relationship between urinary Ca excretion and OAB, nocturia, and nocturnal polyuria in adults. The present study showed that patients with hypercalciuria frequently experienced OAB, nocturia, and nocturnal polyuria. In addition, this study revealed that the severity of LUTS is significantly associated with urinary Ca excretion and that hypercalciuria is an important risk factor for OAB, nocturia, and nocturnal polyuria.
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22
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Khinda R, Valecha S, Kumar N, Walia JPS, Singh K, Sethi S, Singh A, Singh M, Singh P, Mastana S. Prevalence and Predictors of Osteoporosis and Osteopenia in Postmenopausal Women of Punjab, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052999. [PMID: 35270692 PMCID: PMC8910053 DOI: 10.3390/ijerph19052999] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 01/02/2023]
Abstract
The prevalence and predictors of osteoporosis and osteopenia remain to be examined in the postmenopausal women of Punjab, India. The present cross-sectional study screened 1628 postmenopausal women during September 2019 to March 2020. Osteoporosis and osteopenia were confirmed on the basis of T-scores using dual energy X-ray absorptiometry (DXA) at the hip (femoral neck) and lumbar spine regions (L1−L4 vertebrae). The prevalence of osteoporosis and osteopenia was observed to be 30.50% and 44.20%, respectively, in postmenopausal women of Punjab. In univariable and multivariable regression analysis, variables independently influencing the risk of osteoporosis and osteopenia were: higher systolic blood pressure (95%CI: 1.22−3.11 & 1.08−2.49), triglyceride levels (95%CI: 1.21−3.10 & 1.42−2.51), poor sleep quality (95%CI: 1.91−2.47 & 1.76−3.47) and C-reactive protein levels (95%CI: 2.18−3.56 & 1.03−2.18). Years since menopause >10 years was observed to be an independent predictor for the risk of osteopenia but not for osteoporosis. Higher body mass index (>30 kg·m−2) was observed to be a significant protective factor against the risk of osteoporosis (95%CI: 0.26−0.68) and osteopenia (95%CI: 0.19−0.52). The higher prevalence rates of osteoporosis and osteopenia in postmenopausal women of Punjab are alarming, which solicits awareness and earlier testing of those women who are approaching menopause.
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Affiliation(s)
- Rubanpal Khinda
- Department of Human Genetics, Punjabi University, Patiala 147002, Punjab, India; (R.K.); (S.V.); (N.K.); (M.S.)
| | - Srishti Valecha
- Department of Human Genetics, Punjabi University, Patiala 147002, Punjab, India; (R.K.); (S.V.); (N.K.); (M.S.)
| | - Nitin Kumar
- Department of Human Genetics, Punjabi University, Patiala 147002, Punjab, India; (R.K.); (S.V.); (N.K.); (M.S.)
| | - J. P. S. Walia
- Department of Orthopedics, Aggarsain Charitable Hospital, Patiala 147002, Punjab, India;
| | - Kuldeep Singh
- Department of Orthopedics, Government Medical College and Hospital, Patiala 147002, Punjab, India;
| | - Sudhir Sethi
- Department of Orthopedics, Mata Kaushalya Hospital, Patiala 147002, Punjab, India;
| | - Avtar Singh
- Department of Orthopedics, Amandeep Hospital, Amritsar 143001, Punjab, India;
| | - Monica Singh
- Department of Human Genetics, Punjabi University, Patiala 147002, Punjab, India; (R.K.); (S.V.); (N.K.); (M.S.)
| | - Puneetpal Singh
- Department of Human Genetics, Punjabi University, Patiala 147002, Punjab, India; (R.K.); (S.V.); (N.K.); (M.S.)
- Correspondence: (P.S.); (S.M.)
| | - Sarabjit Mastana
- Human Genomics Lab, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
- Correspondence: (P.S.); (S.M.)
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23
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Baek YH, Cho SW, Jeong HE, Kim JH, Hwang Y, Lange JL, Shin JY. 10-Year Fracture Risk in Postmenopausal Women with Osteopenia and Osteoporosis in South Korea. Endocrinol Metab (Seoul) 2021; 36:1178-1188. [PMID: 34915604 PMCID: PMC8743593 DOI: 10.3803/enm.2021.1215] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/06/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In South Korea, women aged 66 years are eligible for complimentary bone mineral density (BMD) screening via the National Screening Program for Transitional Ages. We aimed to evaluate the 10-year fracture risk in women receiving BMD screening between January 2008 and December 2015. METHODS BMD was classified as normal (T-score ≥-1.0 standard deviation [SD]), osteopenia (T-score <-1.0 SD and >-2.5 SD), and osteoporosis (T score ≤-2.5 SD) from dual-energy X-ray absorptiometry. Follow-up continued from the screening date until a diagnosis for clinical fragility fracture (including sites of the vertebrae, hip, pelvis, clavicle, humerus, forearm, wrist, lower leg, and ankle), censored at the earliest date of trauma, death, or December 2017; fracture was ascertained using diagnostic codes from the National Health Insurance Service database. A multivariable Cox proportional hazard model was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of fracture in women with osteopenia or osteoporosis relative to women with normal BMD. RESULTS Among the 271,197 women screened, 44.0% had osteopenia and 35.2% had osteoporosis. The 10 year cumulative incidence of fragility fractures was 31.1%, 37.5%, and 44.3% in women with normal BMD, osteopenia, and osteoporosis, respectively. Fracture risk was higher in women with osteopenia (HR, 1.31; 95% CI, 1.28 to 1.34) and osteoporosis (HR, 1.68; 95% CI, 1.64 to 1.72) than in women with normal BMD. CONCLUSION Women with osteopenia and women with osteoporosis, identified by the national BMD screening program, demonstrated a substantially elevated risk of fracture.
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Affiliation(s)
- Yeon-Hee Baek
- School of Pharmacy, Sungkyunkwan University, Suwon,
Korea
- Amgen Korea, Seoul,
Korea
| | - Sun Wook Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul,
Korea
| | - Han Eol Jeong
- School of Pharmacy, Sungkyunkwan University, Suwon,
Korea
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, Suwon,
Korea
| | - Yunji Hwang
- Amgen Korea, Seoul,
Korea
- Center for Observational Research, Amgen, Thousand Oaks, CA,
USA
| | - Jeffrey L. Lange
- Center for Observational Research, Amgen, Thousand Oaks, CA,
USA
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon,
Korea
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon,
Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul,
Korea
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Barcelos A, Lopes DG, Canhão H, da Cunha Branco J, Rodrigues AM. Multimorbidity is associated with fragility fractures in women 50 years and older: A nationwide cross-sectional study. Bone Rep 2021; 15:101139. [PMID: 34754887 PMCID: PMC8564033 DOI: 10.1016/j.bonr.2021.101139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Multimorbidity is a worldwide health problem, especially in elderly patients who have a higher risk of fragility fracture. Currently, there is insufficient knowledge about the burden of multimorbidity in patients with previous fragility fracture. The aim of this study was to evaluate the association between multimorbidity and previous fragility fracture, and to assess the effect of fragility fracture and/or multimorbidity in the perception of quality-of-life and physical function, in women 50 years of age and older. METHODS Women aged ≥50 years from the EpiReumaPt study (2011-2013), a nationwide population-based study, were evaluated. Self-reported data regarding sociodemographics, health-related quality of life, physical functioning, fragility fracture, and multimorbidity were collected using a semi-structured questionnaire. Multimorbidity was defined as 2 or more chronic non-communicable diseases. Descriptive exploratory analysis of the data was performed using hypothesis testing. Multiple logistic regression modelling was used to assess the association between multimorbidity and fragility fractures, and linear regression was used for the quality-of-life and physical function outcomes. RESULTS The estimated prevalence of fragility fracture in women older than 50 years was 17.5%. A higher prevalence of multimorbidity (74.6%) was found in the group of women with previous fragility fracture than in those without previous fragility fracture. Multivariate logistic regression analysis revealed that women with multimorbidity had a higher odds of fragility fracture (adjusted odds ratio, 1.38; 95% confidence interval, 1.12-1.69), compared with women with 1 or no self-reported non-communicable chronic diseases. In women with previous fragility fracture, rheumatic diseases (62.7%) and hypertension (58.6%) were the most frequently self-reported non-communicable chronic diseases. The combination of fragility fracture and multimorbidity was associated with a lower quality of life and higher degree of disability. CONCLUSIONS Women 50 years and older with multimorbidity had a significantly increased odds of fragility fracture. Fragility fracture combined with multimorbidity was negatively associated with quality of life and positively associated with disability. This study emphasizes the need to redesign health services to care for patients to prevent non-communicable chronic diseases and fragility fracture, particularly in women 50 years and older, in whom these diseases are likely to potentiate the risk of fragility fracture.
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Affiliation(s)
- Anabela Barcelos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, CHBV, Aveiro, Portugal
| | - David G. Lopes
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, CHULC, Lisboa, Portugal
| | - Jaime da Cunha Branco
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, CHLO, Lisboa, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, Hospital dos Lusíadas, Lisboa, Portugal
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25
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Effect of Multimorbidity on Fragility Fractures in Community-Dwelling Older Adults: Shimane CoHRE Study. J Clin Med 2021; 10:jcm10153225. [PMID: 34362008 PMCID: PMC8348412 DOI: 10.3390/jcm10153225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 07/15/2021] [Accepted: 07/20/2021] [Indexed: 12/14/2022] Open
Abstract
Fragility fractures (FFxs), which are a common musculoskeletal injury in older adults, is associated with an increased frequency of falls. Both FFxs and falls may result from drugs, habits, and co-occurring diseases. We aimed to evaluate the effects of various diseases on the risk of FFx. This retrospective study included 1420 individuals aged ≥60 years. We evaluated the history of clinical FFx and diseases using a detailed questionnaire and a health examination. The risk of comorbidities was assessed using the Age-Adjusted Charlson Comorbidity (AAC) Index. We performed binary logistic regression analysis to determine the risk of FFx and falls after adjusting for covariates. In elderly men, the incidence of FFx positively correlated with rheumatoid arthritis and parent's hip fracture. For elderly women, the incidence of FFx positively correlated with rheumatoid arthritis and antihypertensive drugs but was inversely associated with dyslipidemia and antilipidemic drugs. The FFX risk of older adults with an AAC Index ≥6 was higher than those with an AAC Index of 1-3. In addition, the AAC Index and falls were independently and strongly associated with a higher risk of FFx. Taken together, multimorbidity increases the risk of clinical FFx independent of falls in the community-dwelling elderly population.
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Kim EG, Bae G, Kwon HY, Yang H. Aging and direct medical costs of osteoporotic fractures. J Bone Miner Metab 2021; 39:589-597. [PMID: 33417008 DOI: 10.1007/s00774-020-01192-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 12/03/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION This study estimated the direct medical costs of osteoporotic fractures from a large claims database in Korea. MATERIALS AND METHODS We compared the medical costs of hip, vertebral, and wrist fractures between two age groups (50-64 years vs 65 years and older). We used a generalized linear model to investigate the drivers of osteoporotic fracture medical costs. RESULTS Hip fractures had the highest costs, regardless of age, followed by vertebral and wrist. The cost of hip fracture was USD 7285 for those aged 65 years and over and USD 6589 for those aged 50-64 years. The length of hospital days was higher in hip fracture patients, regardless of age, followed by vertebral and wrist. As the number of hospitalizations increased, the medical cost increased by 33.0% (p < 0.0001). Patients older than 65 years who were hospitalized for a fracture had a longer total length of hospital stay, compared to patients aged 50-64, regardlessness of the site of the fracture. The cost of treating fractures among those 65 years and older increased by 31.8% compared to those 50-64 years old (p < 0.0001). The direct medical costs increased by 8.6% as the number of fractures increased (p = 0.041). CONCLUSIONS We identified that osteoporotic fracture-related medical costs and hospitalization days increased with age. Interventions are effective in reducing fracture risk the potential to yield substantial cost savings.
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Affiliation(s)
- Eu Gene Kim
- Graduate school of Public Health, Seoul National University, Seoul, Korea
| | - Green Bae
- Collge of Pharmacy, Ewha Woman's University, Seoul, South Korea
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Hadaegh F, Asgari S, Toreyhi H, Eskandari F, Fahimfar N, Bozorgmanesh M, Hosseinpanah F, Azizi F. Sex-specific incidence rates and risk factors for fracture: A 16-year follow-up from the Tehran lipid and glucose study. Bone 2021; 146:115869. [PMID: 33529827 DOI: 10.1016/j.bone.2021.115869] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/06/2021] [Accepted: 01/27/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the population-based incidence of any-fracture and its potential risk factors in a sex-split cohort of the Iranian population. MATERIALS AND METHODS A total of 3477 men and 4085 women with a mean (SD) age of 47.92(13.1) and 45.88(11.47) years, respectively were entered into the study. The age-standardized incidence rates per 100,000 person-years were reported for the whole population and each sex separately. Cox proportional hazard models were used to estimate hazard ratios (HR) for potential risk factors. Only fractures requiring inpatients' care were considered as the outcome. We also defined major osteoporotic fractures (MOF) as the composite of the fractures that occurred in the vertebral, wrist, hip and pelvic sites among population aged ≥50 years. RESULTS During the median (IQR) follow-up of 15.9 years, 4.34%men and 3.75% women experienced at least one incident any-fracture. The annual age-standardized incidence rates (95% CI) among men and women were 330.9 (279.6-388.9) and 319.4(268.1-377.3) per 100,000 person-years, respectively; the corresponding values for incidence of MOF was 202.2(142.3-278.6) in men and 342.1(260.4-441.0) per 100,000 person-years for women. In the multivariable model, among the whole population, age groups ≥50 years, central obesity [HR: 95% CI 1.77(1.32-2.39)], current smoking [1.59(1.15-2.20)] and using steroid medications [2.20(1.04-4.67)] significantly increased the risk of incident fracture (all P < 0.05); however the impact of the first two risk factors were more prominent among women (P for interaction ≤0.01). Moreover, being obese was associated with a lower risk of incident first fracture in the total population [HR: 95% CI: 0.61(0.40-0.92)]. Being men [HR: 95% CI: 0.54(0.30-0.99)] and prediabetes status [HR: 95% CI: 0.53(0.30-0.95)] were also associated with lower risk for MOF. CONCLUSION This is the first report of long-term incidence rate of any-fracture and MOF conducted in the metropolitan city of Tehran. Among modifiable risk factors of fracture, in the whole population smoking habit and using steroid medications and particularly for women central obesity should be considered as main risk factors for preventive strategies. Prediabetes status was associated with lower risk of MOF.
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Affiliation(s)
- Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Samaneh Asgari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Toreyhi
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Eskandari
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Noushin Fahimfar
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shaheed Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Antihypertensive drug classes and the risk of hip fracture: results from the Swedish primary care cardiovascular database. J Hypertens 2020; 38:167-175. [PMID: 31568060 DOI: 10.1097/hjh.0000000000002245] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Hypertension and fractures related to osteoporosis are major public health problems that often coexist. This study examined the associations between exposure to different antihypertensive drug classes and the risk of hip fracture in hypertensive patients. METHOD We included 59 246 individuals, 50 years and older, diagnosed with hypertension during 2001-2008 in the Swedish Primary Care Cardiovascular Database. Patients were followed from 1 January 2006 (or the date of diagnosis of hypertension) until they had their first hip fracture, died, or reached the end of the study on 31 December 2012. Cox proportional hazards models were used to calculate the risk of hip fracture across types of antihypertensive medications, adjusted for age, sex, comorbidity, medications, and socioeconomic factors. RESULTS In total, 2593 hip fractures occurred. Compared to nonusers, current use of bendroflumethiazide or hydrochlorothiazide was associated with a reduced risk of hip fracture (hazard ratio 0.86; 95% CI 0.75-0.98 and hazard ratio 0.84; 95% CI 0.74-0.96, respectively), as was use of fixed drug combinations containing a thiazide (hazard ratio 0.69; 95% CI 0.57-0.83). Current use of loop diuretics was associated with an increased risk of hip fracture (hazard ratio 1.23; 95% CI 1.11-1.35). No significant associations were found between the risk of hip fracture and current exposure to beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone-receptor blockers or calcium channel blockers. CONCLUSION In this large observational study of hypertensive patients, the risk of hip fracture differed across users of different antihypertensive drugs, results that could have practical implications when choosing antihypertensive drug therapy.
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Yang S, Lix LM, Yan L, Walld R, Roos LL, Goguen S, Leslie WD. Parental cardiorespiratory conditions and offspring fracture: A population-based familial linkage study. Bone 2020; 139:115557. [PMID: 32730928 DOI: 10.1016/j.bone.2020.115557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/26/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The role of parental cardiorespiratory conditions on fracture risk is unclear. We examined the associations between parental cardiorespiratory conditions and offspring fracture risk. METHODS In this population-based retrospective cohort study, we identified 279,085 offspring aged≥40 years between April 1, 1997 and December 31, 2015 with successful linkage to 273,852 mothers and 254,622 fathers. Parental cardiorespiratory conditions, including cerebral vascular disease, congestive heart failure, hypertension, ischemic heart disease, myocardial infarction, chronic obstructive pulmonary disease (COPD) and peripheral vascular disease, were ascertained using physician and hospital records dating back to 1979. The outcome was offspring incident major osteoporotic fracture (MOF). RESULTS During an average of 11.8 years of offspring follow-up, we identified 8762 (3.1%) incident MOF. Either parent congestive heart failure (adjusted hazard ratio [HR]: 1.13; 95% confidence interval [CI] 1.07-1.19) and COPD (adjusted HR: 1.12; 95% CI 1.07-1.17) were independently associated with increased offspring MOF risk; all their false discovery rates were <0.001. Similar risk estimates were observed when analyses were performed for fathers only, mothers only or both parents, in multivariable models with and without adjustment for offspring cardiorespiratory conditions, and stratified by offspring sex and offspring incident fracture site. Parental cerebrovascular disease, hypertension, ischemic heart disease and myocardial infarction were not associated with offspring MOF. CONCLUSIONS Parental congestive heart failure and parental COPD are independent risk factors for offspring MOF.
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Affiliation(s)
- Shuman Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China.
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lin Yan
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Randy Walld
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Leslie L Roos
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephanie Goguen
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Sherer JA, Huang Q, Kiel DP, Benjamin EJ, Trinquart L. Atrial Fibrillation and the Risk of Subsequent Fracture. Am J Med 2020; 133:954-960. [PMID: 32147449 PMCID: PMC7658792 DOI: 10.1016/j.amjmed.2020.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is conflicting evidence regarding the association between atrial fibrillation and the risk of subsequent fractures. METHODS We included participants aged 45 years or older from the Framingham Heart Study Offspring, Third-Generation, New Offspring Spouse, Omni 1, and Omni 2 cohorts. We prespecified analyzing index age 65 years as our primary analysis; we repeated analyses for index ages 45, 55, and 75 years. The primary outcome was any incident bone fracture, except finger, toe, foot, skull, and facial fractures. We assessed the association between time-varying atrial fibrillation and subsequent fractures by an illness-death model that accounted for the competing risk of death. We estimated hazard ratios (HR) adjusted for age, sex, body mass index, smoking, diabetes, alcohol intake, and prior fracture. RESULTS We included 3403 participants (mean age of 68 years, 53.3% female) in the analysis at index age 65 years and above. In all, 525 (15%) participants suffered incident fractures during follow-up (median 12.5 years). The HR between atrial fibrillation and subsequent fracture was 1.37; 95% confidence interval (CI), 1.06-1.79. There was no evidence of effect modification by sex (HR 1.55; 95% CI, 1.06-2.26 in men; HR 1.22; 95% CI, 0.84-1.77 in women; interaction P value .27). Results were consistent at other index ages. CONCLUSION Atrial fibrillation was associated with increased risk of incident fracture in the community-based Framingham Heart Study.
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Affiliation(s)
- Jason A Sherer
- Department of Medicine, Boston University School of Medicine, Mass.
| | - Qiuxi Huang
- Department of Biostatistics, Boston University School of Public Health, Mass
| | - Douglas P Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass; Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass
| | - Emelia J Benjamin
- National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Mass; Preventive Medicine and Section of Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, Mass; Department of Epidemiology, Boston University School of Public Health, Mass
| | - Ludovic Trinquart
- Department of Biostatistics, Boston University School of Public Health, Mass; National Heart, Lung, and Blood Institute's and Boston University's Framingham Heart Study, Framingham, Mass
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Nakamura Y, Nakano M, Suzuki T, Sato J, Kato H, Takahashi J, Shiraki M. Two adipocytokines, leptin and adiponectin, independently predict osteoporotic fracture risk at different bone sites in postmenopausal women. Bone 2020; 137:115404. [PMID: 32360897 DOI: 10.1016/j.bone.2020.115404] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 01/09/2023]
Abstract
Although associations among obesity, adipocytokines, and bone mineral density have been reported, the influence of adipocytokines on osteoporotic fractures remains unclear. This study aimed to assess the impact of the adipocytokines leptin and adiponectin on the risk of incident vertebral and long-bone fractures in postmenopausal women. Clinical data were obtained from the retrospective Nagano Cohort Study of outpatients followed at a single primary care institute in Nagano Prefecture, Japan, between 1993 and 2018. The primary outcome was the occurrence of incident vertebral or long-bone fractures. In total, 1167 Japanese postmenopausal women (mean age: 65.9 years) completed the follow-up and the average observation period was 7.2 years. The subjects were divided into 4 groups (quartile 1 to 4) based respective leptin and adiponectin values. Kaplan-Meier analysis demonstrated a significantly lower incident long-bone fracture rate in the higher quartiles of serum leptin levels (p = 0.002). A significantly higher and more rapid occurrence of incident vertebral fractures, but not long-bone fractures, was found in the highest adiponectin quartile (p < 0.001). A Cox proportional hazards model adjusted for confounders including age, body weight, and either leptin or adiponectin revealed lower leptin levels and higher adiponectin levels as significant independent risk factors for incident long-bone fractures (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.50-0.96; p = 0.03) and vertebral fractures (HR 1.18, 95% CI 1.02-1.37; p = 0.02), respectively. Therefore, serum leptin and adiponectin may be independent risk factors for osteoporotic fractures affecting different bone types and sites. Determining patient adipocytokine levels may help predict the occurrence of specific osteoporotic fractures, thereby enabling optimal treatment for osteoporosis and improving quality of life.
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Affiliation(s)
- Yukio Nakamura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan.
| | - Masaki Nakano
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Takako Suzuki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan; Department of Human Nutrition, Faculty of Human Nutrition, Tokyo Kasei Gakuin University, 22 Sanban-cho, Chiyoda-ku, Tokyo 102-8341, Japan
| | - Junto Sato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Masataka Shiraki
- Research Institute and Practice for Involutional Diseases, 1610-1 Meisei, Misato, Azumino, Nagano 399-8101, Japan
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Ma X, Xia H, Wang J, Zhu X, Huang F, Lu L, He L. Re-fracture and correlated risk factors in patients with osteoporotic vertebral fractures. J Bone Miner Metab 2019; 37:722-728. [PMID: 30465091 DOI: 10.1007/s00774-018-0974-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 10/31/2018] [Indexed: 02/07/2023]
Abstract
Re-fracture risk is higher following osteoporotic fracture. However, there is no accurately reported rate of re-fracture incidence in southwest China. The purpose of this study was to describe the osteoporotic vertebral fracture (OVF) survival for re-fracture state and analyze the risk of re-fracture. This historical cohort study was conducted in four hospitals in southwest China. Patients aged ≥ 50 years (n = 586) with OVF who were supposed to receive anti-osteoporosis drugs after the fracture were included (2012-2017). Telephone follow-up and referring case files were used to estimate the survival for re-fracture and identify the determinants of re-fracture. A total of 555 patients completed the follow-up investigation. Overall, 285 patients experienced a re-fracture, and the longest follow-up investigation time was 72 months. The survival rates for re-fracture at 12 months, 24 months, 36 months, and 48 months were 82.0%, 71.5%, 61.7%, and 34.0%, respectively. The factors correlated with re-fracture hazard were advanced age [hazard ratio (HR) = 1.996], being female (HR = 1.342), smoking (HR = 1.435), history of hypertension (HR = 1.219) and diabetes (HR = 3.271), and persistence of taking anti-osteoporosis drugs after fracture [0-3 months, 4-6 months, 7-12 months, and more than 12 months (HR = 0.703)]. OVF patients with advanced age, who were female, smoked, had fracture with hypertension or diabetes, and who complied poorly with anti-osteoporosis drug treatment presented higher prevalence of re-fracture and low anti-osteoporosis adherence in southwest China. The management of anti-osteoporosis after fracture is necessary in this area.
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Affiliation(s)
- Xinling Ma
- School of Nursing, Fudan University, Shanghai, 200032, China
| | - Haiou Xia
- School of Nursing, Fudan University, Shanghai, 200032, China.
| | - Jinhua Wang
- Youjiang Medical University for Nationalities, Baise, 533000, China
- West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Sichuan, 610041, China
| | - Xiaoxiao Zhu
- School of Nursing, Fudan University, Shanghai, 200032, China
| | - Fangyan Huang
- Youjiang Medical University for Nationalities, Baise, 533000, China
| | - Liuxue Lu
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, China
| | - Lanyan He
- The Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, China
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Shi TT, Min M, Zhang Y, Sun CY, Liang MM, Sun YH. Depression and risk of hip fracture: a systematic review and meta-analysis of cohort studies. Osteoporos Int 2019; 30:1157-1165. [PMID: 30972449 DOI: 10.1007/s00198-019-04951-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/21/2019] [Indexed: 12/13/2022]
Abstract
Recently published studies on the association between depression and hip fracture (HF) are inconsistent. Therefore, we performed this meta-analysis with the main aim to clarify the association between depression and HF, and also to identify possible susceptible groups. Relevant literature published until February 2019 was obtained and screened according to established inclusion criteria. Two researchers independently processed quality assessment and data extraction prior to the meta-analysis. Pooled hazard ratios (HRs) with 95%CI (confidence intervals) were calculated. To explore the sources of heterogeneity, subgroup analyses were performed based on study design, study region, NOS scores, follow-up duration, diagnostic criteria, sex, national income level, and adjustments (bone mineral density (BMD), antidepressant, calcium intake, and smoking). Ten studies with 13 estimates, involving 375,438 participants and 4576 HFs, were included. It was found that patients with depression had a higher risk of HF than non-depressed patients (HR = 1.21; 95%CI 1.11-1.31). Sensitivity analysis results show that the association is relatively stable. The studies that were not adjusted for confounders (e.g., antidepressant, BMD, calcium intake, and smoking) had higher overall HR compared to the studies that adjusted for the corresponding confounding factors. HFs are more likely to occur in European and male depression patients. This meta-analysis provided evidence of a modest positive association between depression and the risk of HFs, and the association is stronger in European and male patients. Implementation of practical measures to prevent and treat depression is of great public health significance.
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Affiliation(s)
- T T Shi
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - M Min
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Y Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - C Y Sun
- AMITA Health Saint Joseph Hospital Chicago, Chicago, 60657, Illinois, USA
| | - M M Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Y H Sun
- Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
- Center for Evidence-Based Practice, Anhui Medical University, No. 81 Meishan Road, Hefei, 230032, Anhui, China.
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Kaewboonchoo O, Sung FC, Lin CL, Hsu HC, Kuo CT. Risk of osteoporosis and fracture in victims with burn injury. Osteoporos Int 2019; 30:837-843. [PMID: 30734067 DOI: 10.1007/s00198-018-04818-2] [Citation(s) in RCA: 4] [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: 06/28/2018] [Accepted: 12/17/2018] [Indexed: 12/31/2022]
Abstract
UNLABELLED Osteoporosis is a well-known bone disorder affecting people worldwide. Patients with osteoporosis have an increased risk of bone fracture. This study provides new information on the risk of developing osteoporosis post burn injury and the risk of fracture among those with osteoporosis developed. INTRODUCTION The relationship between burn injury and hip fracture risk is unclear. Population-based evaluation on relationships between burn injury and osteoporosis development and subsequent fractures is limited. We conducted a retrospective cohort study as the investigation. METHODS From the insurance data of Taiwan, we established a cohort of 43,532 patients with a burn injury in 2000-2012 and a comparison cohort of 174,124 individuals without such an injury, frequency matched by sex, age, and diagnosis date. Both cohorts were followed up to the end of 2013 to evaluate the occurrence of osteoporosis and hip fracture. RESULTS The incidence of osteoporosis was greater in the burn cohort than in the comparison cohort (6.40 vs. 4.75 per 1,000 person-years) with an adjusted IRR of 1.35 (95% confidence interval = 1.32-1.39). The incidence rates in both cohorts were greater in women than in men, increased with age, income, and Charlson comorbidity index. Patients with burns involving 20%-49% of total body surface area and with burns confined to the lower/upper limbs had the greatest incidence rates, 8.32 and 8.58 per 1,000 person-years, respectively. Osteoporosis incidence increased further to 22.7 per 1,000 person-years for burn victims with comorbid diabetes. The risk of fracture was over five-fold greater for burn victims with osteoporosis developed than for comparisons without osteoporosis. CONCLUSION Patients who have a burn injury deserve prevention intervention to reduce the risk of osteoporosis and fracture.
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Affiliation(s)
- O Kaewboonchoo
- Department of Public Health Nursing, Mahidol University Faculty of Public Health, Bangkok, Thailand
| | - F C Sung
- Department of Public Health Nursing, Mahidol University Faculty of Public Health, Bangkok, Thailand
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - C L Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - H C Hsu
- Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - C T Kuo
- Department of Public Health Nursing, Mahidol University Faculty of Public Health, Bangkok, Thailand.
- Department of Public Health, China Medical University College of Public Health, 91 Hseuh Shis Road, Taichung, 404, Taiwan.
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Association between depression and the risk for fracture: a meta-analysis and systematic review. BMC Psychiatry 2018; 18:336. [PMID: 30333001 PMCID: PMC6192066 DOI: 10.1186/s12888-018-1909-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/25/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several studies have suggested that depression is associated with an increased risk for fracture; however, the results are conflicting. This study aimed to conduct a meta-analysis of cohort studies assessing the association between depression and the risk for fracture. METHODS Relevant studies were identified by a search of Web of Science, PubMed, Embase, China National Knowledge Infrastructure and WanFang database to Feb 2018. Cohort studies on the relationship between depression and the risk for fracture in the general population were included in the meta-analysis. Data collection was in accordance with the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines, and the quality of the included studies was assessed using the Newcastle-Ottawa scale. Two independent investigators screened the abstracts and full texts of the studies, extracted data, and assessed the quality of the study. Either a fixed-effect or random-effects model was used to compute the pooled risk estimates when appropriate. RESULTS In total, 16 cohort studies with 25 independent reports that included 414,686 participants during a follow-up duration of 3-14 years were included in the analysis. The pooled hazard ratio (HR) for total fracture was 1.24 (95% confidence interval [CI]: 1.14-1.35; P < 0.001 for heterogeneity; random-effects model). In the subgroup analyses conducted in terms of study region, the pooled HR for the studies conducted in Europe was higher (HR: 1.76; 95% CI: 1.44-2.17; P = 0.792 for heterogeneity) than that in America and Asia, with a significant difference between the groups (P = 0.036). CONCLUSION The results of our meta-analysis suggest that depression is prospectively associated with a significantly increased risk for fracture, which may have substantial implications, both clinical and preventive.
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Rodríguez AJ, Scott D, Ebeling PR. Comments on Li et al.: Meta-analysis of hypertension and osteoporotic fracture risk in women and men. Osteoporos Int 2018; 29:257-258. [PMID: 28986611 DOI: 10.1007/s00198-017-4246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/24/2017] [Indexed: 10/18/2022]
Affiliation(s)
- A J Rodríguez
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia.
| | - D Scott
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
- Australian Institute for Musculoskeletal Science, Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Australia
| | - P R Ebeling
- Bone and Muscle Health Research Group, Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
- Australian Institute for Musculoskeletal Science, Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Australia
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37
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Li C, Wang Q. Meta-analysis of hypertension and osteoporotic fracture risk in women and men: response to comments by Rodríguez et al. Osteoporos Int 2018; 29:259-260. [PMID: 28986610 DOI: 10.1007/s00198-017-4245-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 09/24/2017] [Indexed: 12/12/2022]
Affiliation(s)
- C Li
- Department of Epidemiology and Biostatistics, MOE, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Q Wang
- Department of Epidemiology and Biostatistics, MOE, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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