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Duan JY, You RX, Zhou Y, Xu F, Lin X, Shan SK, Zheng MH, Lei LM, Li FXZ, Guo B, Wu YY, Chen X, Tang KX, Cao YC, Wu YL, He SY, Xiao R, Yuan LQ. Assessment of causal association between the socio-economic status and osteoporosis and fractures: a bidirectional Mendelian randomization study in European population. J Bone Miner Res 2024; 39:942-955. [PMID: 38624186 DOI: 10.1093/jbmr/zjae060] [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: 11/29/2023] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 04/17/2024]
Abstract
The correlation between socio-economic status (SES) and bone-related diseases garners increasing attention, prompting a bidirectional Mendelian randomization (MR) analysis in this study. Genetic data on SES indicators (average total household income before tax, years of schooling completed, and Townsend Deprivation Index at recruitment), femoral neck bone mineral density (FN-BMD), heel bone mineral density (eBMD), osteoporosis, and five different sites of fractures (spine, femur, lower leg-ankle, foot, and wrist-hand fractures) were derived from genome-wide association summary statistics of European ancestry. The inverse variance weighted method was employed to obtain the causal estimates, complemented by alternative MR techniques, including MR-Egger, weighted median, and MR-pleiotropy residual sum and outlier (MR-PRESSO). Furthermore, sensitivity analyses and multivariable MR were performed to enhance the robustness of our findings. Higher educational attainment exhibited associations with increased eBMD (β: .06, 95% confidence interval [CI]: 0.01-0.10, P = 7.24 × 10-3), and reduced risks of osteoporosis (OR: 0.78, 95% CI: 0.65-0.94, P = 8.49 × 10-3), spine fracture (OR: 0.76, 95% CI: 0.66-0.88, P = 2.94 × 10-4), femur fracture (OR: 0.78, 95% CI: 0.67-0.91, P = 1.33 × 10-3), lower leg-ankle fracture (OR: 0.79, 95% CI: 0.70-0.88, P = 2.05 × 10-5), foot fracture (OR: 0.78, 95% CI: 0.66-0.93, P = 5.92 × 10-3), and wrist-hand fracture (OR: 0.83, 95% CI: 0.73-0.95, P = 7.15 × 10-3). Material deprivation appeared to increase the risk of spine fracture (OR: 2.63, 95% CI: 1.43-4.85, P = 1.91 × 10-3). A higher FN-BMD level positively affected increased household income (β: .03, 95% CI: 0.01-0.04, P = 6.78 × 10-3). All these estimates were adjusted for body mass index, type 2 diabetes, smoking initiation, and frequency of alcohol intake. The MR analyses show that higher educational levels is associated with higher eBMD, reduced risk of osteoporosis and fractures, while material deprivation is positively related to spine fracture. Enhanced FN-BMD correlates with increased household income. These findings provide valuable insights for health guideline formulation and policy development.
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Affiliation(s)
- Jia-Yue Duan
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Rui-Xuan You
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenetics, Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Yong Zhou
- Department of Cardiovascular Medicine, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Feng Xu
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Xiao Lin
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Su-Kang Shan
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Ming-Hui Zheng
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Li-Min Lei
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Fu-Xing-Zi Li
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Bei Guo
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Yun-Yun Wu
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Xi Chen
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Ke-Xin Tang
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Ye-Chi Cao
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Yan-Lin Wu
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Si-Yang He
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Rong Xiao
- Department of Dermatology, Hunan Key Laboratory of Medical Epigenetics, Clinical Medical Research Center for Systemic Autoimmune Diseases in Hunan Province, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
| | - Ling-Qing Yuan
- Department of Endocrinology and Metabolism, National Clinical Research Center for Metabolic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, The Second Xiangya Hospital of Central South University, Changsha, 410011, China
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Yue C, Li YF, Xu LL, Wang QY, Yang YY, Sheng ZF. Develop a bone mineral density T-score distribution nomograms based on osteoporosis risk factors for middle-aged and older adults. Geriatr Nurs 2024; 58:344-351. [PMID: 38875761 DOI: 10.1016/j.gerinurse.2024.06.010] [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: 02/27/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
Abstract
PURPOSE This study aimed to understand how age, health status, and lifestyle impact bone mineral density (BMD) in middle-aged and older adults, focusing on predicting osteoporosis risk. METHODS This study included 2836 participants aged 50-88 from the Health Improvement Program of Bone (HOPE) conducted from 2021 to 2023. We used logistic regression to make a prediction tool. Then checked its accuracy and reliability using receiver operating characteristic (ROC) and calibration curves. RESULTS Factors like age, body weight, prior fractures, and smoking were independently found to affect BMD T-score distribution in men. In women, age and body weight were identified as independent factors influencing BMD T-score distribution. A nomogram was created to visually illustrate these predictive relationships. CONCLUSIONS The nomogram proved highly accurate in identifying men aged 50 and above and postmenopausal women based on their BMD T-score distribution, improving clinical decision-making and patient care in osteoporosis evaluation and treatment.
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Affiliation(s)
- Chun Yue
- Health Management Center, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yong-Fang Li
- Department of Metabolism and Endocrinology, Zhuzhou Hospital of Xiangya School of Medicine,Central South University, Zhuzhou, Hunan, China
| | - Lu-Lu Xu
- Health Management Center, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Qin-Yi Wang
- Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yan-Yi Yang
- Health Management Center, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhi-Feng Sheng
- Health Management Center, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China; Health Management Center, National Clinical Research Center for Metabolic Diseases, Hunan Provincial Clinical Medicine Research Center for Intelligent Management of Chronic Disease, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
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Mahmud M, Muscatello DJ, Rahman MB, Osborne NJ. Association between socioeconomic deprivation and bone health status in the UK biobank cohort participants. Osteoporos Int 2024:10.1007/s00198-024-07115-3. [PMID: 38806788 DOI: 10.1007/s00198-024-07115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/27/2024] [Indexed: 05/30/2024]
Abstract
The effect of deprivation on total bone health status has not been well defined. We examined the relationship between socioeconomic deprivation and poor bone health and falls and we found a significant association. The finding could be beneficial for current public health strategies to minimise disparities in bone health. PURPOSE Socioeconomic deprivation is associated with many illnesses including increased fracture incidence in older people. However, the effect of deprivation on total bone health status has not been well defined. To examine the relationship between socioeconomic deprivation and poor bone health and falls, we conducted a cross-sectional study using baseline measures from the United Kingdom (UK) Biobank cohort comprising 502,682 participants aged 40-69 years at recruitment during 2006-2010. METHOD We examined four outcomes: 1) low bone mineral density/osteopenia, 2) fall in last year, 3) fracture in the last five years, and 4) fracture from a simple fall in the last five years. To measure socioeconomic deprivation, we used the Townsend index of the participant's residential postcode. RESULTS At baseline, 29% of participants had low bone density (T-score of heel < -1 standard deviation), 20% reported a fall in the previous year, and 10% reported a fracture in the previous five years. Among participants experiencing a fracture, 60% reported the cause as a simple fall. In the multivariable logistic regression model after controlling for other covariates, the odds of a fall, fracture in the last five years, fractures from simple fall, and osteopenia were respectively 1.46 times (95% confidence interval [CI] 1.42-1.49), 1.26 times (95% CI 1.22-1.30), 1.31 times (95% CI 1.26-1.36) and 1.16 times (95% CI 1.13-1.19) higher for the most deprived compared with the least deprived quantile. CONCLUSION Socioeconomic deprivation was significantly associated with poor bone health and falls. This research could be beneficial to minimise social disparities in bone health.
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Affiliation(s)
- Mafruha Mahmud
- School of Population Health, University of New South Wales, Sydney, Australia.
| | | | - Md Bayzidur Rahman
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Kirby Institute, UNSW, Kensington, Australia
- The School of Medicine, The University of Notre Dame, Sydney, Australia
| | - Nicholas John Osborne
- School of Population Health, University of New South Wales, Sydney, Australia
- School of Public Health, The University of Queensland, Herston, QLD, 4006, Australia
- European Centre for Environment and Human Health, University of Exeter, Truro, TR1 3HD, UK
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Petersen TG, Abrahamsen B, Høiberg M, Rothmann MJ, Holmberg T, Gram J, Bech M, Åkesson KE, Javaid MK, Hermann AP, Rubin KH. Ten-year follow-up of fracture risk in a systematic population-based screening program: the risk-stratified osteoporosis strategy evaluation (ROSE) randomised trial. EClinicalMedicine 2024; 71:102584. [PMID: 38638398 PMCID: PMC11024575 DOI: 10.1016/j.eclinm.2024.102584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Background Osteoporotic fractures pose a growing public health concern. Osteoporosis is underdiagnosed and undertreated, highlighting the necessity of systematic screening programs. We aimed to evaluate the effectiveness of a two-step population-based osteoporotic screening program. Methods This ten-year follow-up of the Risk-stratified Osteoporosis Strategy Evaluation (ROSE) randomized trial tested the effectiveness of a screening program utilizing the Fracture Risk Assessment Tool (FRAX) for major osteoporotic fractures (MOF) to select women for dual-energy x-ray absorptiometry (DXA) scan following standard osteoporosis treatment. Women residing in the Region of Southern Denmark, aged 65-80, were randomised (single masked) into a screening or a control group by a computer program prior to inclusion and subsequently approached with a mailed questionnaire. Based on the questionnaire data, women in the screening group with a FRAX value ≥15% were invited for DXA scanning. The primary outcome was MOF derived from nationwide registers. ClinicalTrials.gov: NCT01388244, status: Completed. Findings All randomised women were included February 4, 2010-January 8, 2011, the same day as approached to participate. During follow-up, 7355 MOFs were observed. No differences in incidences of MOF were identified, comparing the 17,072 women in the screening group with the 17,157 controls in the intention-to-treat analysis (IRR 1.01, 0.95; 1.06). However, per-protocol, women DXA-scanned exhibited a 14% lower incidence of MOF (IRR 0.86, 0.78; 0.94) than controls with a FRAX value ≥15%. Similar trends were observed for hip fractures, all fractures, and mortality. Interpretation While the ROSE program had no overall effect on osteoporotic fracture incidence or mortality it showed a preventive effect for women at moderate to high risk who underwent DXA scans. Hence the overall effect might have been diluted by those who were not at an intervention level threshold risk or those who did not show up for DXA. Using self-administered questionnaires as screening tools may be inefficient for systematic screening due to the low and differential screening uptake. Funding INTERREG and the Region of Southern Denmark.
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Affiliation(s)
- Tanja Gram Petersen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bo Abrahamsen
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Medicine, Holbæk Hospital, Holbæk, Denmark
| | - Mikkel Høiberg
- Department of Internal Medicine, Hospital of Southern Norway, Arendal, Norway
| | - Mette Juel Rothmann
- Research Unit for Endocrinology, Odense University Hospital; University of Southern Denmark, Odense, Denmark
- Research Unit for Steno Diabetes Center Odense, Odense University Hospital; University of Southern Denmark, Odense, Denmark
| | | | - Jeppe Gram
- Department of Endocrinology, Esbjerg Hospital, University Hospital of Southern Denmark
| | - Mickael Bech
- Department of Political Science and Public Management, University of Southern Denmark, Odense, Denmark
| | - Kristina E. Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmö, Lund University, Sweden and Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - M Kassim Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - Anne Pernille Hermann
- Research Unit for Endocrinology, Odense University Hospital; University of Southern Denmark, Odense, Denmark
| | - Katrine Hass Rubin
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Rubæk M, Broholm-Jørgensen M, Andersen S, Jakobsen PR, Rothmann MJ, Langdahl B, Hitz MF, Holmberg T. Development of a program theory for osteoporosis patient education in Denmark: a qualitative study based on realist evaluation. BMC Geriatr 2024; 24:346. [PMID: 38627654 PMCID: PMC11022455 DOI: 10.1186/s12877-024-04957-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Osteoporosis patient education is offered in many countries worldwide. When evaluating complex interventions like these, it is important to understand how and why the intervention leads to effects. This study aimed to develop a program theory of osteoporosis patient education in Danish municipalities with a focus on examining the mechanisms of change i.e. what is about the programs that generate change. METHODS The program theory was developed in an iterative process. The initial draft was based on a previous published systematic review, and subsequently the draft was continually refined based on findings from observations (10 h during osteoporosis patient education) and interviews (individual interviews with six employees in municipalities and three health professionals at hospitals, as well as four focus group interviews with participants in patient education (in total 27 informants)). The transcribed interviews were analyzed using thematic analysis and with inspiration from realist evaluation the mechanisms as well as the contextual factors and outcomes were examined. RESULTS Based on this qualitative study we developed a program theory of osteoporosis patient education and identified four mechanisms: motivation, recognizability, reassurance, and peer reflection. For each mechanism we examined how contextual factors activated the mechanism as well as which outcomes were achieved. For instance, the participants' motivation is activated when they meet in groups, and thereafter outcomes such as more physical activity may be achieved. Recognizability is activated by the participants' course of disease, which may lead to better ergonomic habits. Reassurance may result in more physical activity, and this mechanism is activated in newly diagnosed participants without previous fractures. Peer reflection is activated when the participants meet in groups, and the outcome healthier diet may be achieved. CONCLUSIONS We developed a program theory and examined how and why osteoporosis patient education is likely to be effective. Understanding these prerequisites is important for future implementation and evaluation of osteoporosis patient education.
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Affiliation(s)
- Mette Rubæk
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- National Research Center for Bone Health, Zealand University Hospital, Køge, Denmark
| | | | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Pernille Ravn Jakobsen
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bente Langdahl
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Friberg Hitz
- National Research Center for Bone Health, Zealand University Hospital, Køge, Denmark
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Wang X, Li B, Tong X, Fan Y, Wang S, Liu Y, Fang X, Liu L. Diagnostic Accuracy of Dual-Energy CT Material Decomposition Technique for Assessing Bone Status Compared with Quantitative Computed Tomography. Diagnostics (Basel) 2023; 13:diagnostics13101751. [PMID: 37238235 DOI: 10.3390/diagnostics13101751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the diagnostic accuracy when using various base material pairs (BMPs) in dual-energy computed tomography (DECT), and to establish corresponding diagnostic standards for assessing bone status through comparison with quantitative computed tomography (QCT). METHODS This prospective study enrolled a total of 469 patients who underwent both non-enhanced chest CT scans under conventional kVp and abdominal DECT. The bone densities of hydroxyapatite (water), hydroxyapatite (fat), hydroxyapatite (blood), calcium (water), and calcium (fat) (DHAP (water), DHAP (fat), DHAP (blood), DCa (water), and DCa (fat)) in the trabecular bone of vertebral bodies (T11-L1) were measured, along with bone mineral density (BMD) via QCT. Intraclass correlation coefficient (ICC) analysis was used to assess the agreement of the measurements. Spearman's correlation test was performed to analyze the relationship between the DECT- and QCT-derived BMD. Receiver operator characteristic (ROC) curves were generated to determine the optimal diagnostic thresholds of various BMPs for diagnosing osteopenia and osteoporosis. RESULTS A total of 1371 vertebral bodies were measured, and QCT identified 393 with osteoporosis and 442 with osteopenia. Strong correlations were observed between DHAP (water), DHAP (fat), DHAP (blood), DCa (water), and DCa (fat) and the QCT-derived BMD. DHAP (water) showed the best predictive capability for osteopenia and osteoporosis. The area under the ROC curve, sensitivity, and specificity for identifying osteopenia were 0.956, 86.88%, and 88.91% with DHAP (water) ≤ 107.4 mg/cm3, respectively. The corresponding values for identifying osteoporosis were 0.999, 99.24%, and 99.53% with DHAP (water) ≤ 89.62 mg/cm3, respectively. CONCLUSIONS Bone density measurement using various BMPs in DECT enables the quantification of vertebral BMD and the diagnosis of osteoporosis, with DHAP (water) having the highest diagnostic accuracy.
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Affiliation(s)
- Xu Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China
| | - Beibei Li
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China
| | - Xiaoyu Tong
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China
| | - Yong Fan
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China
| | - Shigeng Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China
| | - Yijun Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China
| | - Xin Fang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China
| | - Lei Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China
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Valentin G, Ravn MB, Jensen EK, Friis K, Bhimjiyani A, Ben-Shlomo Y, Hartley A, Nielsen CP, Langdahl B, Gregson CL. Socio-economic inequalities in fragility fracture incidence: a systematic review and meta-analysis of 61 observational studies. Osteoporos Int 2021; 32:2433-2448. [PMID: 34169346 DOI: 10.1007/s00198-021-06038-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/14/2021] [Indexed: 12/18/2022]
Abstract
UNLABELLED Individuals with low socio-economic status (SES) have a more than 25% higher risk of fragility fractures than individuals with high SES. Body mass index and lifestyle appear to mediate the effect of SES on fracture risk. Strategies to prevent fractures should aim to reduce unhealthy behaviours through tackling structural inequalities. INTRODUCTION This systematic review and meta-analysis aimed to evaluate the impact of socio-economic status (SES) on fragility fracture risk. METHODS Medline, Embase, and CINAHL databases were searched from inception to 28 April 2021 for studies reporting an association between SES and fragility fracture risk among individuals aged ≥50 years. Risk ratios (RR) were combined in meta-analyses using random restricted maximum likelihood models, for individual-based (education, income, occupation, cohabitation) and area-based (Index of Multiple Deprivation, area income) SES measures. RESULTS A total of 61 studies from 26 different countries including more than 19 million individuals were included. Individual-based low SES was associated with an increased risk of fragility fracture (RR 1.27 [95% CI 1.12, 1.44]), whilst no clear association was seen when area-based measures were used (RR 1.08 [0.91, 1.30]). The strength of associations was influenced by the type and number of covariates included in statistical models: RR 2.69 [1.60, 4.53] for individual-based studies adjusting for age, sex and BMI, compared with RR 1.06 [0.92, 1.22] when also adjusted for health behaviours (smoking, alcohol, and physical activity). Overall, the quality of the evidence was moderate. CONCLUSION Our results show that low SES, measured at the individual level, is a risk factor for fragility fracture. Low BMI and unhealthy behaviours are important mediators of the effect of SES on fracture risk. Strategies to prevent fractures and reduce unhealthy behaviours should aim to tackle structural inequalities in society thereby reducing health inequalities in fragility fracture incidence.
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Affiliation(s)
- G Valentin
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - M B Ravn
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - E K Jensen
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - K Friis
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - A Bhimjiyani
- Department of Clinical Biochemistry, Royal Free Hospital, London, UK
| | - Y Ben-Shlomo
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - A Hartley
- MRC Integrative Epidemiology Unit, Bristol Medical School, Oakfield House, Bristol, BS8 2BN, UK
| | - C P Nielsen
- Department of Public Health and Health Services Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - B Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology, Aarhus University Hospital, Aarhus, Denmark
| | - C L Gregson
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK
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Wang M, Zhou H, Cui W, Wang Z, Zhu G, Chen X, Jin T. Nomogram to Predict Cadmium-Induced Osteoporosis and Fracture in a Chinese Female Population. Biol Trace Elem Res 2021; 199:4028-4035. [PMID: 33415584 DOI: 10.1007/s12011-020-02533-w] [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: 10/15/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Cadmium exposure may increase the risk of osteoporosis. However, there is no quick method to get bone mineral density (BMD) unless dual-energy X-ray absorptiometry (DXA) examinations were performed. In the present study, we aimed to identify associated factors to osteoporosis and fracture in a Chinese female population with cadmium exposure and develop nomograms to predict the risk. A total of 488 women was included in this study. Cadmium in blood (BCd) and urine (UCd) were determined as exposure biomarkers. BMD was determined using single-photon absorptiometry. Urinary N-acetyl-β-d-glucosaminidase (UNAG) and urinary albumin (UALB) were determined as renal function biomarkers. Osteoporosis was defined if T-score < - 2.5. Multiple logistic regression showed that age, BCd, and menopausal status were independent risk factors for osteoporosis. The odds (OR) value was 1.19 (95% confidence interval (CI): 1.14-1.25) for age, 1.05 (95% CI: 1.004-1.10) for BCd, and 4.75 (95% CI: 1.65-13.69) for menopausal status after adjusting with cofounders. Age and UCd were the independent risk factors for bone fracture. Nomograms were developed based on the associated factors. Age was the main determinant for osteoporosis or fracture. Receiver operating curve showed acceptable performance in predicting osteoporosis (area under the curve (AUC) = 0.93, 95CI: 0.90-0.96) and fracture (AUC = 0.67, 95% CI: 0.58-0.75). Linear discriminant analysis (LDA) further showed that 88.9% of osteoporosis and 68.4% of fractures were correctly classified. Our study develops nomograms that may be used to predict cadmium-induced osteoporosis or fracture if BMD data is not available.
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Affiliation(s)
- Miaomiao Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Hao Zhou
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Wenjing Cui
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Zhongqiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China
| | - Guoying Zhu
- Institute of Radiation Medicine, Fudan University, 2094 Xietu Road, Shanghai, 200032, China
| | - Xiao Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, 210029, China.
| | - Taiyi Jin
- Department of Occupational Medicine, School of Public Health, Shanghai Medical College of Fudan University, 150 Dongan Road, Shanghai, 200032, China
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9
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Edelstein OE, Achdut N, Vered I, Sarid O. Determinants of Bone Mineral Screening Behavior among Three Ethno-Cultural Groups of Women in Israel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176138. [PMID: 32846956 PMCID: PMC7503566 DOI: 10.3390/ijerph17176138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/16/2020] [Accepted: 08/21/2020] [Indexed: 11/16/2022]
Abstract
Bone mineral density (BMD) screening is one of the main means to detect and treat osteoporosis. Yet, the manner in which ethno-cultural background is associated with BMD health cognitions and screening behavior remains limited. Several ethno-cultural groups (n = 100 in each group)—Israeli-born Jews, Israeli-born Bedouin-Muslims, and Jewish immigrants from the Former Soviet Union (FSU), mean age 70 (SD = 7.1)—participated in face-to-face interviews in a cross-sectional survey, using valid and reliable questionnaires on BMD screening behavior, knowledge about osteoporosis, and theory of planned behavior (TPB) components. FSU immigrants reported the lowest BMD screening behavior. The multivariate analysis showed that higher knowledge level, positive attitudes, supportive subjective norms, and greater intentions increase the probability of BMD screening behavior. The TPB attitude component had a more pronounced effect on the probability of undergoing BMD screening among Israeli-born Bedouin-Muslims compared to Israeli-born Jews. Our findings contribute to the TPB by deepening our understanding of the associations between TPB components and BMD screening behaviors, from an ethno-cultural perspective. To assure sufficient BMD screening behavior among all ethno-cultural groups, intervention programs—suited to address the unique characteristics of each ethno-cultural group—are required.
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Affiliation(s)
- Offer E. Edelstein
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Be’er Sheva 8410501, Israel; (N.A.); (O.S.)
- Correspondence:
| | - Netta Achdut
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Be’er Sheva 8410501, Israel; (N.A.); (O.S.)
| | - Iris Vered
- Division of Endocrinology, Diabetes and Metabolism, The Chaim Sheba Medical Centre, Tel Hashomer, Ramat Gan 5262000, Israel;
| | - Orly Sarid
- Spitzer Department of Social Work, Ben-Gurion University of the Negev, Be’er Sheva 8410501, Israel; (N.A.); (O.S.)
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10
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Christou MA, Ntritsos G, Markozannes G, Koskeridis F, Nikas SN, Karasik D, Kiel DP, Evangelou E, Ntzani EE. A genome-wide scan for pleiotropy between bone mineral density and nonbone phenotypes. Bone Res 2020; 8:26. [PMID: 32637184 PMCID: PMC7329904 DOI: 10.1038/s41413-020-0101-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 03/04/2020] [Accepted: 04/07/2020] [Indexed: 12/11/2022] Open
Abstract
Osteoporosis is the most common metabolic bone disorder globally and is characterized by skeletal fragility and microarchitectural deterioration. Genetic pleiotropy occurs when a single genetic element is associated with more than one phenotype. We aimed to identify pleiotropic loci associated with bone mineral density (BMD) and nonbone phenotypes in genome-wide association studies. In the discovery stage, the NHGRI-EBI Catalog was searched for genome-wide significant associations (P value < 5 × 10-8), excluding bone-related phenotypes. SNiPA was used to identify proxies of the significantly associated single nucleotide polymorphisms (SNPs) (r 2 = 1). We then assessed putative genetic associations of this set of SNPs with femoral neck (FN) and lumbar spine (LS) BMD data from the GEFOS Consortium. Pleiotropic variants were claimed at a false discovery rate < 1.4 × 10-3 for FN-BMD and < 1.5 × 10-3 for LS-BMD. Replication of these genetic markers was performed among more than 400 000 UK Biobank participants of European ancestry with available genetic and heel bone ultrasound data. In the discovery stage, 72 BMD-related pleiotropic SNPs were identified, and 12 SNPs located in 11 loci on 8 chromosomes were replicated in the UK Biobank. These SNPs were associated, in addition to BMD, with 14 different phenotypes. Most pleiotropic associations were exhibited by rs479844 (AP5B1, OVOL1 genes), which was associated with dermatological and allergic diseases, and rs4072037 (MUC1 gene), which was associated with magnesium levels and gastroenterological cancer. In conclusion, 12 BMD-related genome-wide significant SNPs showed pleiotropy with nonbone phenotypes. Pleiotropic associations can deepen the genetic understanding of bone-related diseases by identifying shared biological mechanisms with other diseases or traits.
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Affiliation(s)
- Maria A. Christou
- Department of Hygiene and Epidemiology, Clinical and Molecular Epidemiology Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Georgios Ntritsos
- Department of Hygiene and Epidemiology, Clinical and Molecular Epidemiology Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Georgios Markozannes
- Department of Hygiene and Epidemiology, Clinical and Molecular Epidemiology Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Fotis Koskeridis
- Department of Hygiene and Epidemiology, Clinical and Molecular Epidemiology Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Spyros N. Nikas
- Department of Hygiene and Epidemiology, Clinical and Molecular Epidemiology Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - David Karasik
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, and the Broad Institute of MIT & Harvard, Cambridge, MA USA
- Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel
| | - Douglas P. Kiel
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, and the Broad Institute of MIT & Harvard, Cambridge, MA USA
| | - Evangelos Evangelou
- Department of Hygiene and Epidemiology, Clinical and Molecular Epidemiology Unit, School of Medicine, University of Ioannina, Ioannina, Greece
- Department of Epidemiology and Biostatistics, Imperial College London, London, UK
| | - Evangelia E. Ntzani
- Department of Hygiene and Epidemiology, Clinical and Molecular Epidemiology Unit, School of Medicine, University of Ioannina, Ioannina, Greece
- Department of Health Services, Policy and Practice, Center for Research Synthesis in Health, School of Public Health, Brown University, Providence, RI USA
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11
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Lera L, Angel B, Márquez C, Saguez R, Albala C. Software for the Diagnosis of Sarcopenia in Community-Dwelling Older Adults: Design and Validation Study. JMIR Med Inform 2020; 8:e13657. [PMID: 32281942 PMCID: PMC7186874 DOI: 10.2196/13657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 11/28/2019] [Accepted: 01/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The usual diagnosis of sarcopenia requires a dual-energy x-ray absorptiometry (DXA) exam, which has low accessibility in primary care for Latin American countries. OBJECTIVE The aim of this study is to design and validate software for mobile devices (Android, IOS) and computers, based on an adapted version of the diagnostic algorithm of sarcopenia proposed by the European Working Group on Sarcopenia in Older People (EWGSOP). METHODS Follow-up exams were conducted on 430 community-dwelling Chileans 60 years and older (mean 68.2 years, SD 4.9) participating in the IsaMayor and Alexandros cohorts designed to study sarcopenia and disability associated with obesity, respectively. All the participants from the cohorts were randomly selected from the registries of primary health care centers and, for this study, must have a DXA scan at baseline. The software (HTSMayor) was designed according to an adapted version of the algorithm proposed by the EWGSOP and was divided into four phases: longitudinal validation of diagnostic algorithm of sarcopenia, alpha version, beta version, and release version. The software estimates appendicular skeletal muscle mass (ASM) using an anthropometric equation or DXA measurements with Chilean cut-off points. The predictive validation of the algorithm was estimated, comparing functional limitations (at least one activity of daily living, two instrumental activities of daily living, or three mobility limitations), falls, and osteoporosis at follow-ups in patients with and without sarcopenia at baseline, using adjusted logistic models. RESULTS After a median follow-up of 4.8 years (2078.4 person-years), 37 (9.9%) new cases of sarcopenia, out of the 374 patients without sarcopenia at baseline, were identified (incidence density rate=1.78 per 100 person-years). ASM estimated with the anthropometric equation showed both a high sensitivity and specificity as compared with those estimated by DXA measurements, yielding a concordance of 0.96. The diagnostic algorithm of sarcopenia considered in the software with the equation showed both a high sensitivity (82.1%) and specificity (94.9%) when compared with DXA (reference standard). Adults without sarcopenia (at baseline) showed better physical performance (after approximately 5 years) than adults with sarcopenia. Loss of functionality was greater in adults with sarcopenia (OR 5.0, 95% CI 2.2-11.4) than in adults without sarcopenia. In addition, the risks of falls (OR 2.2, 95% CI 1.1-4.3) and osteoporosis (OR 2.8, 95% CI 1.2-6.6) were higher in older persons with sarcopenia than those without sarcopenia. The measurements and results were completed for the beta and release tests with a mean time of 10 minutes and 11 minutes, respectively. CONCLUSIONS We developed and validated a software for the diagnosis of sarcopenia in older Chilean adults that can be used on a mobile device or a computer with good sensitivity and specificity, thus allowing for the development of programs for the prevention, delay, or reversal of this disease. To our knowledge, HTSMayor is the first software to diagnose sarcopenia. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/13657.
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Affiliation(s)
- Lydia Lera
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology, University of Chile, Santiago de Chile, Chile
| | - Bárbara Angel
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology, University of Chile, Santiago de Chile, Chile
| | - Carlos Márquez
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology, University of Chile, Santiago de Chile, Chile
| | - Rodrigo Saguez
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology, University of Chile, Santiago de Chile, Chile
| | - Cecilia Albala
- Public Health Nutrition Unit, Institute of Nutrition and Food Technology, University of Chile, Santiago de Chile, Chile
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