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Zhang SC, Makebeh T, Mesinovic J, Djopseu K, Martin C, Lui LY, Cawthon PM, Schneider ALC, Zmuda JM, Strotmeyer ES, Schafer A, Ebeling PR, Zebaze RM. Epidemiology of fractures in adults of African ancestry with diabetes mellitus: A systematic review and meta-analysis. Bone 2024; 185:117133. [PMID: 38789095 DOI: 10.1016/j.bone.2024.117133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 04/16/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
Diabetes mellitus (DM) is associated with increased fracture risk in White adults. However, the impact of DM on fractures in Black adults is unknown. This systematic review and meta-analysis investigated the association between DM and fractures in adults of African ancestry. MEDLINE, Scopus, CINAHL and Embase databases were searched from their inception up to November 2023 for all studies in the English language investigating the epidemiology of fractures (prevalence, incidence, or risk) in Black men and women (age ≥ 18 years) with type 1 or type 2 DM. Effect sizes for prevalence of previous fractures (%) and incident fracture risk (hazard ratio [HR]) were calculated using a random-effects model on Stata (version 18.0). There were 13 eligible studies, of which 12 were conducted in Black adults from the United States, while one was conducted in adults of West African ancestry from Trinidad and Tobago. We found no fracture data in Black adults with DM living in Africa. Five studies were included in a meta-analysis of incident fracture risk, reporting data from 2926 Black and 6531 White adults with DM. There was increased risk of fractures in Black adults with DM compared to non-DM (HR = 1.65; 95 % confidence interval [CI]: 1.14, 2.39). The risk of fractures was also higher in White adults with DM compared to non-DM (HR = 1.31; 95 % CI: 1.06, 1.61) among these studies. Five studies were included in a meta-analysis of fracture prevalence, of which three also reported fracture prevalence in White adults. There were 175 previous fractures among 993 Black adults with DM and 384 previous fractures among 1467 White adults with DM, with a pooled prevalence of 17.5 % (95 % CI: 15.4, 19.6) and 25.8 % (95 % CI: 4.8, 46.8), respectively. Our results indicate a high burden of fractures in Black adults with DM.
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Affiliation(s)
- Simon C Zhang
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | | | - Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Australia
| | | | - Catherine Martin
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Li-Yung Lui
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Andrea L C Schneider
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Joseph M Zmuda
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elsa S Strotmeyer
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne Schafer
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA; Endocrine Research Unit, San Francisco Veterans Affairs Health Care System, San Francisco, USA.; Department of Medicine, University of California, San Francisco, CA, USA
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Roger M Zebaze
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.
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Jammy GR, Boudreau RM, Miljkovic I, Sharma PK, Reddy SP, Greenspan SL, Newman AB, Cauley JA. Peripheral bone structure, geometry, and strength and muscle density as derived from peripheral quantitative computed tomography and mortality among rural south Indian older adults. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000333. [PMID: 36962497 PMCID: PMC10022329 DOI: 10.1371/journal.pgph.0000333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 07/08/2022] [Indexed: 11/05/2022]
Abstract
Multiple studies have observed a relationship of bone mineral density (BMD) measured by Dual energy X-ray absorptiometry (DXA) and mortality. However, areal BMD (aBMD) measured by DXA is an integrated measure of trabecular and cortical bone and does not measure the geometry of bone. Peripheral Quantitative Computed Tomography (pQCT) provides greater insights on bone structure, geometry and strength. To examine whether higher bone phenotypes and muscle density as measured by pQCT are associated with a lower all-cause mortality, we studied 245 men and 254 women (all age >60) recruited in the Mobility and Independent Living among Elders Study in rural south India. Cox proportional hazards models estimated hazard ratios (HR [95% Confidence Intervals]). After an average follow-up of 5.3 years, 73 men and 50 women died. Among men, trabecular volumetric bone mineral density (vBMD) of radius (HR per SD increase in parameter = 0.59 [0.43, 0.81]) and tibia (0.60[0.45, 0.81]), cortical vBMD of radius (0.61, [0.47, 0.79]) and tibia (0.62, [0.49, 0.79]), cortical thickness of radius (0.55, [0.42, 0.7]) and tibia (0.60, [0.47, 0.77]), polar strength strain index (SSIp) of tibia (0.73 [0.54, 0.98]), endosteal circumference of radius (1.63, [1.25, 2.12]) and tibia (1.54, [1.19, 1.98]) were associated with all-cause mortality. Muscle density (0.67, [0.51, 0.87]) was associated with lower mortality in men. Among women cortical vBMD of radius (0.64, [0.47, 0.87]) and tibia (0.60 [0.45, 0.79]), cortical thickness of radius (0.54, [0.37, 0.79]) and tibia (0.43, [0.30, 0.61]), SSIp of radius (0.70 [0.48,1.01]) and tibia (0.58 [0.37, 0.90]) and endosteal circumference of radius (1.33 [0.97, 1.82]) and tibia (1.83, [1.37, 2.45]) were associated with all-cause mortality. Among men, gait speed mediated the association of muscle density and mortality but there was no mediation for any bone parameters. Conclusion: pQCT bone measures and muscle density were independently associated with mortality among rural south Indian elders.
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Affiliation(s)
- Guru Rajesh Jammy
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- SHARE INDIA-Mediciti Institute of Medical Sciences, Medchal District, Telangana, India
| | - Robert M Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Iva Miljkovic
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Pawan Kumar Sharma
- SHARE INDIA-Mediciti Institute of Medical Sciences, Medchal District, Telangana, India
| | - Sudhakar Pesara Reddy
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- SHARE INDIA-Mediciti Institute of Medical Sciences, Medchal District, Telangana, India
| | - Susan L Greenspan
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
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Kim KM, Moon JH, Choi SH, Lim S, Lim JY, Kim KW, Jang HC. Lower baseline value and greater decline in BMD as independent risk factors for mortality in community dwelling elderly. Bone 2019; 121:204-211. [PMID: 30660675 DOI: 10.1016/j.bone.2019.01.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 12/11/2022]
Abstract
Skeleton plays diverse roles via crosstalk between others, thus it is conceivable that lower BMD per se may reflect negative influences on health status and threats to life independent of fracture events. We investigated investigate the association between BMD and mortality, and to examine whether the rate of bone loss can predict future mortality in an elderly population. This study was conducted as a part of the Korean Longitudinal Study on Health and Aging, a community-based prospective study of Korean people aged 65 years and older that began in 2005. A total of 648 people (318 men and 330 women) were included. Dual energy X-ray absorptiometry were conducted at baseline and at 5 years. Mortality data were collected until the date of death or the last follow-up in December 2014. Osteoporosis in all skeletal sites significantly related to increased risk of mortality in men and women, but the associations were stronger for BMD in the femur neck and total hip than in the lumbar spine. A multivariable Cox proportional-hazards model showed that baseline BMD level was a significant independent predictor of increased all-cause mortality for all three skeletal sites in men, and for lumbar spine and total hip in women. Furthermore, faster bone loss of BMDs, as shown by the decline in BMD in the lumbar spine, femur neck, and total hip, was significantly related to increased risk of mortality after adjusting for all covariates in men. Faster BMD loss at femur neck was also related to the increased risks of mortality in women. Conclusively, both a lower baseline values and greater decline in BMD were associated with excess morality in community-dwelling elderly population; there associations were stronger in men than in women. This study emphasizes the importance of skeletal health for healthy aging, revealing lower bone mass and faster bone loss may be markers of poorer health that are driving excess mortality.
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Affiliation(s)
- Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Jae Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea; Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea.
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Lenchik L, Weaver AA, Ward RJ, Boone JM, Boutin RD. Opportunistic Screening for Osteoporosis Using Computed Tomography: State of the Art and Argument for Paradigm Shift. Curr Rheumatol Rep 2018; 20:74. [PMID: 30317448 DOI: 10.1007/s11926-018-0784-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Osteoporosis is disproportionately common in rheumatology patients. For the past three decades, the diagnosis of osteoporosis has benefited from well-established practice guidelines that emphasized the use of dual x-ray absorptiometry (DXA). Despite these guidelines and the wide availability of DXA, approximately two thirds of eligible patients do not undergo testing. One strategy to improve osteoporosis testing is to employ computed tomography (CT) examinations obtained as part of routine patient care to "opportunistically" screen for osteoporosis, without additional cost or radiation exposure to patients. This review examines the role of opportunistic CT in the evaluation of osteoporosis. RECENT FINDINGS Recent evidence suggests that opportunistic measurement of bone attenuation (radiodensity) using CT has sensitivity comparable to DXA. More importantly, such an approach has been shown to predict osteoporotic fractures. The paradigm shift of using CTs obtained for other reasons to opportunistically screen for osteoporosis promises to substantially improve patient care.
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Affiliation(s)
- Leon Lenchik
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Ashley A Weaver
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Robert J Ward
- Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - John M Boone
- University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Robert D Boutin
- University of California Davis School of Medicine, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
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