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Hawley S, Dela S, Burton A, Paruk F, Cassim B, Gregson CL. Incidence and number of fragility fractures of the hip in South Africa: estimated projections from 2020 to 2050. Osteoporos Int 2022; 33:2575-2583. [PMID: 35962821 DOI: 10.1007/s00198-022-06525-5] [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: 03/25/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
UNLABELLED Sub-Saharan Africa is undergoing rapid population ageing and better understanding of the burden of musculoskeletal conditions is needed. We have estimated a large increase in the burden of hip fractures for South Africa over the coming decades. These findings should support preparation of hip fracture services to meet this demand. INTRODUCTION A better understanding of the burden of fragility fractures in sub-Saharan Africa is needed to inform healthcare planning. We aimed to use recent hip fracture incidence data from South Africa (SA) to estimate the future burden of hip fracture for the country over the next three decades. METHODS Hip fracture incidence data within the Gauteng, KwaZulu-Natal and Western Cape provinces of SA were obtained from patients aged ≥ 40 years with a radiograph-confirmed hip fracture in one of 94 included hospitals. Age-, sex- and ethnicity-specific incidence rates were generated using the 2011 SA census population for the study areas. Incidence rates were standardised to United Nations (UN) population projections, for the years 2020, 2030, 2040 and 2050, and absolute numbers of hip fractures derived. RESULTS The 2767 hip fracture patients studied had mean (SD) age 73.7 (12.7) years; 69% were female. Estimated age- and ethnicity-standardised incidence rates (per 100,000 person-years) for the overall SA population in 2020 were 81.2 for females and 43.1 for males. Overall projected incidence rates were discernibly higher by the year 2040 and increased further by the year 2050 (109.0 and 54.1 for females and males, respectively). Estimates of the overall annual number of hip fractures for SA increased from approximately 11,000 in 2020 to approximately 26,400 by 2050. CONCLUSION The hip fracture burden for SA is expected to more than double over the next 30 years. Significant investment in fracture prevention services and inpatient fracture care is likely to be needed to meet this demand.
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Affiliation(s)
- Samuel Hawley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Learning and Research Building, Level 1, BS10 5NB, Bristol, UK.
| | - Sapna Dela
- Department of Internal Medicine, Edendale Hospital, Pietermaritzburg, South Africa
| | - Anya Burton
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Learning and Research Building, Level 1, BS10 5NB, Bristol, UK
| | - Farhanah Paruk
- Department of Rheumatology, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Bilkish Cassim
- Department of Geriatrics, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Southmead Hospital, Learning and Research Building, Level 1, BS10 5NB, Bristol, UK
- Department of Paediatrics, School of Clinical Medicine, SAMRC/Wits Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa
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2
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Fagundes U, Vancini RL, Seffrin A, de Almeida AA, Nikolaidis PT, Rosemann T, Knechtle B, Andrade MS, de Lira CAB. Adolescent female handball players present greater bone mass content than soccer players: A cross-sectional study. Bone 2022; 154:116217. [PMID: 34583063 DOI: 10.1016/j.bone.2021.116217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/07/2021] [Accepted: 09/21/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Osteoporosis is a systemic disease affecting half of women over the age of 50 years. Considering that almost 90% of peak of bone mass is achieved until the second decade of life, ensuring a maximal bone mineral content acquisition may compensate for age-associated bone loss. Among several other factors, physical activity has been recommended to improve bone mass acquisition. However, it is unknown whether athletes involved with sports with different impact loading characteristics differ in regards to bone mass measurements. AIM To compare the bone mass content, bone mass density and lean mass of young female soccer players (odd-impact loading exercise), handball players (high-impact loading exercises) and non-athletes. METHODS A total of 115 female handball players (15.5 ± 1.3 years, 165.2 ± 5.6 cm and 61.9 ± 9.3 kg) and 142 soccer players (15.5 ± 1.5 years, 163.7 ± 6.6 cm and 56.5 ± 7.7 kg) were evaluated for body composition using a dual-emission X-ray absorptiometry system, and 136 female non-athletes (data from NHANES) (15.1 ± 1.32 years, 163.5 ± 5.8 cm and 67.2 ± 19.4 kg) were considered as the control. RESULTS Handball players presented higher bone mass content values than soccer players for upper limbs (294.8 ± 40.2 g and 270.7 ± 45.7 g, p < 0.001), lower limbs (1011.6 ± 145.5 g and 967.7 ± 144.3 g, p = 0.035), trunk (911.1 ± 182.5 g and 841.6 ± 163.7 g, p = 0.001), ribs (312.4 ± 69.9 g and 272.9 ± 58.0 g, p < 0.001), spine (245.1 ± 46.8 g and 222.0 ± 45.1 g, p < 0.001) and total bone mass (2708.7 ± 384.1 g and 2534.8 ± 386.0 g, p < 0.001). Moreover, non-athletes presented lower bone mass content for lower limbs (740.6 ± 132.3 g, p < 0.001), trunk (539.7 ± 98.6 g, p < 0.001), ribs (138.2 ± 29.9 g, p < 0.001), pelvis (238.9 ± 54.6 g, p < 0.001), spine (152.8 ± 26.4 g, p < 0.001) and total bone mass (1987.5 ± 311.3 g, p < 0.001) than both handball and soccer players. Handball players also presented higher bone mass density values than soccer players for trunk, ribs and spine (p < 0.05) and handball and soccer players presented higher bone mass density than non-athletes for all measurements (p < 0.005). Finally, the non-athletes' lower limb lean mass was lower than soccer and handball players values (p < 0.05). CONCLUSION Adolescent females engaged in handball training for at least one year present higher bone mass contents than those who are engaged in soccer training, which, in turn, present higher bone mass contents than non-athletes. These results might be used by physicians and healthcare providers to justify the choice of a particular sport to enhance bone mass gain in female adolescents.
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Affiliation(s)
- Ulysses Fagundes
- Department of Physiology, Federal University of São Paulo, Brazil
| | - Rodrigo Luiz Vancini
- Center of Physical Education and Sports, Federal University of Espírito Santo, Brazil
| | - Aldo Seffrin
- Department of Physiology, Federal University of São Paulo, Brazil
| | | | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Beat Knechtle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland; Medbase St. Gallen Am Vadianplatz, St. Gallen, Switzerland.
| | | | - Claudio Andre Barbosa de Lira
- Human and Exercise Physiology Division, Faculty of Physical Education and Dance, Federal University of Goiás, Brazil
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3
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Barr RD, Inglis D, Athale U, Jaworski M, Farncombe T, Gordon CL. Bone health in long-term survivors of pediatric acute lymphoblastic leukemia. An assessment by peripheral quantitative computed tomography. Pediatr Blood Cancer 2021; 68:e29218. [PMID: 34264535 DOI: 10.1002/pbc.29218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/28/2021] [Accepted: 06/11/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Loss of bone mineral is a common concomitant of the treatment of acute lymphoblastic leukemia (ALL) due mainly to chemotherapy, especially with corticosteroids. Osteopenia/osteoporosis may be encountered long into survivorship. Measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry is limited to two-dimensionality and cannot distinguish trabecular from cortical bone. METHODS A sample of 74 subjects, ages 13.5-38.3 years more than 10 years from diagnosis, underwent peripheral quantitative computed tomography (pQCT) at metaphyseal (trabecular bone) and diaphyseal (cortical bone) sites in the radius and tibia. pQCT provides three-dimensional assessment of bone geometry, density, and architecture. RESULTS Average values in multiple metrics were similar to those in healthy individuals, but deficits in both trabecular and cortical bones were revealed by lower Z scores using an ethnically comparable sample of healthy individuals. Connectivity, a measure of bone architecture and a surrogate measure of bone strength, was lower in females than males. Survivors of standard-risk ALL had greater connectivity in and more compact trabecular bone than high-risk survivors who had received more intensive osteotoxic chemotherapy. There were no statistically significant differences in any of the metrics at any of the sites between subjects who had or had not a history of fracture, cranial irradiation, or use of a bisphosphonate. CONCLUSIONS These long-term survivors of ALL have somewhat compromised bone health, but data in comparable healthy populations are limited. Longitudinal studies in larger and more ethnically diverse cohorts will provide greater insight into bone health in this vulnerable population.
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Affiliation(s)
- Ronald D Barr
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Dean Inglis
- Canadian Longitudinal Study on Aging, Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Maciej Jaworski
- Department of Biochemistry, RadioImmunology and Experimental Medicine, The Children's Memorial Health Institute, Warsaw, Poland
| | - Troy Farncombe
- Department of Nuclear Medicine, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
| | - Christopher L Gordon
- Department of Nuclear Medicine, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
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4
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Thandrayen K, Kala UK, Lala N, Okudo G, Parbhoo KB, Moosa FY, Verwey C, Hauptfleisch M, Hajinicolaou C, Ambaram PR, Mistry BJ, Petersen KL, Pettifor JM. Bone mass and vertebral fractures in South African children on prolonged oral glucocorticoids for chronic non-malignant illnesses. Bone Rep 2021; 14:100751. [PMID: 33644265 PMCID: PMC7887385 DOI: 10.1016/j.bonr.2021.100751] [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: 09/04/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 12/05/2022] Open
Abstract
Introduction We hypothesized that the prevalence of vertebral fractures would be low and that bone mineral density (BMD) would be less severely affected in a black South African (SA) population treated with glucocorticoids (GCs) than that reported in mainly white populations. Methods All children aged 5–17.9 years with chronic non-malignant illnesses who were on GCs (intravenous or oral) for greater than 3 months duration were evaluated. DXA scans were performed using a Hologic Discovery machine (Software version Apex 4.0.2) and the Hologic paediatric reference database. Whole body less head (WBLH) and lumbar spine (LS) bone mineral content (BMC) and density (BMD) Z-scores unadjusted and adjusted for height were calculated using the Zemel equation calculator. Results Seventy-two patients (49% with renal, 24% with rheumatic, 14% with neurological, 11% with hepatic and 3% with respiratory conditions; mean age 11.6 ± 3.3 years, 57% boys, 92% SA black) were enrolled. The mean duration of GC treatment was 34.1 (±25.1) months. Mean WBLH and LS height adjusted BMD Z-scores were −1.2 ± 1.5 and −0.9 ± 1.0 respectively. Eleven percent of patients had a LS height adjusted BMD Z-score ≤ −2. The prevalence of vertebral fractures on lateral vertebral fracture assessment (VFA) was 15% (11 of 72 patients). Conclusion The prevalence of vertebral fractures (15%) in predominantly black children on GCs with chronic non-malignant illnesses is similar to that reported from North America suggesting that routine yearly DXA scans including VFA are warranted in this highly at-risk population. Prevalence of vertebral fractures in black South African children on GCs is 15%. Majority of patients had 25(OH)D levels >30 nmol/L. A quarter of the patients with vitamin D deficiency had a LS BMD Z score ≤ −2. None of the vitamin D deficient patients had vertebral fractures. Routine yearly DXA scans are thus warranted on all children treated with GCs.
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Affiliation(s)
- Kebashni Thandrayen
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Udai Keshav Kala
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nilesh Lala
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace Okudo
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kiran Bhagoo Parbhoo
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Fatima Yakoub Moosa
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Charl Verwey
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marc Hauptfleisch
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Christina Hajinicolaou
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Priya Ramanlal Ambaram
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Bhadrish Jayantkumar Mistry
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Karen Lavinia Petersen
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - John Morley Pettifor
- Department of Paediatrics, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.,Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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5
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Paruk F, Tsabasvi M, Kalla AA. Osteoporosis in Africa-where are we now. Clin Rheumatol 2020; 40:3419-3428. [PMID: 32797362 DOI: 10.1007/s10067-020-05335-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/20/2020] [Accepted: 08/08/2020] [Indexed: 02/07/2023]
Abstract
Africa is experiencing an exponential increase in the number of older persons. The number of persons surviving with human immunodeficiency virus is simultaneously increasing due to improved availability of anti-retroviral therapy. The burden of non-communicable diseases, in particular, osteoporosis and its consequent fragility fractures, is also predicted to increase. Osteoporosis, however, remains a neglected disease and there are no age-standardized reference data available to accurately screen and diagnose individuals with osteoporosis. Epidemiological studies reporting the incidence of hip fracture or vertebral fractures are limited from Africa, especially Sub-Saharan Africa. The studies are usually limited as they are based on a retrospective data and small study numbers and often from a single study site. However, compared with early initial studies, the more recent studies show that osteoporosis and fractures are increasing across the continent. The overall incidence rates for osteoporosis and fractures still vary greatly between different regions in Africa and ethnic groups. Predisposing factors are similar with those in developed countries, but awareness of osteoporosis is sorely lacking. There is a lack of awareness among the population as well as health authorities, making it extremely difficult to quantify the burden of disease. There is great potential for research into the need and availability of preventive strategies. The FRAX® tool needs to be developed for African populations and may circumvent the shortage of bone densitometry.
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Affiliation(s)
- F Paruk
- Department of Rheumatology, Inkosi Albert Luthuli Central Hospital, School of Clinical Medicine, College of Health Science, University of KwaZulu-Natal, 719 Umbilo Road, eThekwini, Congella, Durban, 4001, South Africa.
| | - M Tsabasvi
- Department of Surgery-Orthopaedics and Traumatology, Harare Central Hospital, Harare, Zimbabwe
| | - A A Kalla
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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6
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Morphometric analysis of the humerus in an adult South African cadaveric sample. Forensic Sci Int 2018; 289:451.e1-451.e9. [PMID: 29895429 DOI: 10.1016/j.forsciint.2018.04.037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 01/15/2018] [Accepted: 04/20/2018] [Indexed: 11/23/2022]
Abstract
Recent studies using geometric morphometrics have shown that estimations of demographic parameters can be made using skeletal elements previously not thought useful for such purposes. This study used geometric morphometrics to assess humeral morphological variation in an adult South African sample, and evaluated the accuracy of sex and ancestry estimations based on this variation. Humeri of 1046 adult South African individuals (464 females, 582 males) were digitized. Data sets were rotated and scaled to a common centroid using Generalized Procrustes Analysis. Mean centroid sizes between groups were compared using parametric tests, while morphological variation was evaluated using multivariate analyses. Discriminant Function Analysis coupled with leave-one-out cross-validation tests were used to assess the reliability of sex and ancestry classifications based on this variation. Male humeri were relatively larger and presented with morphological features indicative of larger muscle mass and smaller carrying angles than females. White individuals had relatively larger but morphologically less robust humeri than Black or Coloured individuals, likely a reflection of both genetic and socio-economic differences between the groups as enforced under Apartheid law. When sex and ancestry were assessed together, similar variations were detected than when either parameter was individually assessed. Classification accuracy was relatively low when sex was independently assessed (73.3%), but increased when considered in conjunction with ancestry, indicating greater variation between-groups (ancestry) than within-groups. Ancestry estimation accuracies exceeded 80%, even for the highly diverse Coloured group. Classification accuracies of sex-ancestry groups all exceeded 76%. These results show that humerus morphological variation is present and may be used to estimate parameters, such as sex and ancestry, even in complex groups such as the Coloured sample of this study.
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Beresheim AC, Pfeiffer SK, Grynpas MD, Alblas A. Sex-specific patterns in cortical and trabecular bone microstructure in the Kirsten Skeletal Collection, South Africa. Am J Hum Biol 2018; 30:e23108. [PMID: 29411454 DOI: 10.1002/ajhb.23108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 12/08/2017] [Accepted: 01/20/2018] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES The purpose of this study was to provide bone histomorphometric reference data for South Africans of the Western Cape who likely dealt with health issues under the apartheid regime. METHODS The 206 adult individuals (n female = 75, n male = 131, mean = 47.9 ± 15.8 years) from the Kirsten Skeletal Collection, U. Stellenbosch, lived in the Cape Town metropole from the late 1960s to the mid-1990s. To study age-related changes in cortical and trabecular bone microstructure, photomontages of mid-thoracic rib cross-sections were quantitatively examined. Variables include relative cortical area (Rt.Ct.Ar), osteon population density (OPD), osteon area (On.Ar), bone volume fraction (BV/TV), trabecular number (Tb.N), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp). RESULTS All cortical variables demonstrated significant relationships with age in both sexes, with women showing stronger overall age associations. Peak bone mass was compromised in some men, possibly reflecting poor nutritional quality and/or substance abuse issues throughout adolescence and early adulthood. In women, greater predicted decrements in On.Ar and Rt.Ct.Ar suggest a structural disadvantage with age, consistent with postmenopausal bone loss. Age-related patterns in trabecular bone microarchitecture are variable and difficult to explain. Except for Tb.Th, there are no statistically significant relationships with age in women. Men demonstrate significant negative correlations between BV/TV, Tb.N, and age, and a significant positive correlation between Tb.Sp and age. CONCLUSIONS This research highlights sex-specific differences in patterns of age-related bone loss, and provides context for discussion of contemporary South African bone health. While the study sample demonstrates indicators of poor bone quality, osteoporosis research continues to be under-prioritized in South Africa.
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Affiliation(s)
- Amy C Beresheim
- Department of Anthropology, University of Toronto, Toronto, M5S 2S2, Canada
| | - Susan K Pfeiffer
- Department of Anthropology, University of Toronto, Toronto, M5S 2S2, Canada.,Department of Archaeology, University of Cape Town, Rondebosch, 7701, South Africa
| | - Marc D Grynpas
- Department of Laboratory Medicine and Pathobiology and Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, M5T 3L9, Canada.,Mount Sinai Hospital, Lunenfeld-Tanenbaum Research Institute, Toronto, M5T 3H7, Canada
| | - Amanda Alblas
- Division of Anatomy and Histology, Department of Biomedical Sciences, Stellenbosch University, Cape Town, 8000, South Africa
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Schoenbuchner SM, Pettifor JM, Norris SA, Micklesfield LK, Prentice A, Ward KA. Ethnic Differences in Peripheral Skeletal Development Among Urban South African Adolescents: A Ten-Year Longitudinal pQCT Study. J Bone Miner Res 2017; 32:2355-2366. [PMID: 28834567 PMCID: PMC5947614 DOI: 10.1002/jbmr.3279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/15/2017] [Accepted: 08/22/2017] [Indexed: 11/10/2022]
Abstract
There are no longitudinal pQCT data of bone growth and development from sub-Saharan Africa, where rapid environmental, societal, and economic transitions are occurring, and where fracture rates are predicted to rise. The aim of this study was to compare skeletal development in black and white South African adolescents using longitudinal data from the Birth to Twenty study. The Birth to Twenty Bone Health subcohort consisted of 543 adolescents (261 [178 black] girls, 282 [201 black] boys). Annual pQCT measurements of the radial and tibial metaphysis and diaphysis were obtained between ages 12 and 22 years (distal metaphysis: cross-sectional area [CSA] and trabecular bone mineral density [BMD]; diaphysis: total and cortical CSA, cortical BMD, and polar stress-strain index [SSIp]). Age at peak height velocity (APHV) was calculated to account for differences in maturational timing between ethnic groups and sexes. Mixed-effects models were used to describe trajectories for each pQCT outcome. Likelihood-ratio tests were used to summarize the overall difference in trajectories between black and white participants within each sex. APHV (mean ± SD years) was similar in black (11.8 ± 0.8) and white (12.2 ± 1.0) girls, but delayed in black (14.2 ± 1.0) relative to white boys (13.3 ± 0.8). By 4 years post-APHV, white adolescents had significantly greater cortical CSA and SSIp than black adolescents at the radius. There were no significant differences at the radial metaphysis but there was some divergence, such that black adolescents had greater radial trabecular BMD by the end of follow-up. At the tibia, white adolescents had lower diaphyseal CSA and SSIp, and greater metaphyseal CSA. There was no ethnic difference in tibial trabecular BMD. There are ethnic differences in bone growth and development, independent of maturation, in South African adolescents. This work gives new insights into the possible etiology of childhood fractures, which occur most commonly as peripheral sites. © 2017 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.
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Affiliation(s)
- Simon M Schoenbuchner
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, UK.,South African Medical Research Council (SAMRC)/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - John M Pettifor
- South African Medical Research Council (SAMRC)/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- South African Medical Research Council (SAMRC)/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa K Micklesfield
- South African Medical Research Council (SAMRC)/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Ann Prentice
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, UK.,South African Medical Research Council (SAMRC)/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Kate A Ward
- Medical Research Council (MRC) Elsie Widdowson Laboratory, Cambridge, UK.,Medical Research Council (MRC) Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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9
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Meiring RM, Micklesfield LK, McVeigh JA. The effect of loading and ethnicity on annual changes in cortical bone of the radius and tibia in pre-pubertal children. Ann Hum Biol 2016; 43:520-526. [PMID: 26452753 DOI: 10.3109/03014460.2015.1106009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It is unclear what effect habitual physical activity or ethnicity has on annual changes in bone size and strength in pre-pubertal children. AIM To determine whether the annual relative change in bone size and strength differed between high and low bone loaders and also between black and white pre-pubertal children. SUBJECTS AND METHODS Peripheral quantitative computed tomography (pQCT) scans of the 65% radius and tibia were completed on 41 black and white children (15 boys, 26 girls) between the ages of 8-11 years, at baseline and 1 year later. Children were categorised into either a high or low bone loading group from a peak bone strain score obtained from a bone-specific physical activity questionnaire. Total area (ToA), cortical area (CoA), cortical density (CoD), strength-strain index (SSI), periosteal circumference (PC), endosteal circumference (EC) and cortical thickness (CT) were assessed. RESULTS There was no difference in annual relative change in radial or tibia bone size and strength between the low and high bone loaders. Black children had a greater annual relative change in CoD (p = 0.03) and SSI (p = 0.05) compared to the white children. CONCLUSION Children who performed high bone loading activities over a 1-year period had similar bone growth to children who did low bone loading activities over the same period. Rapid maturational growth over this period may have resulted in bone adapting to the strains of habitual physical activity placed on it. Black children may have greater tibial bone strength compared to white children due to a greater annual increase in cortical density.
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Affiliation(s)
- Rebecca M Meiring
- a Exercise Laboratory, School of Physiology, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa and
| | - Lisa K Micklesfield
- b MRC/WITS Developmental Pathways for Health Research Unit, Department of Pediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand , Johannesburg , South Africa
| | - Joanne A McVeigh
- a Exercise Laboratory, School of Physiology, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa and
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10
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Muia EN, Wright HH, Onywera VO, Kuria EN. Adolescent elite Kenyan runners are at risk for energy deficiency, menstrual dysfunction and disordered eating. J Sports Sci 2015; 34:598-606. [DOI: 10.1080/02640414.2015.1065340] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Sotunde OF, Kruger HS, Wright HH, Havemann-Nel L, Kruger IM, Wentzel-Viljoen E, Kruger A, Tieland M. Lean Mass Appears to Be More Strongly Associated with Bone Health than Fat Mass in Urban Black South African Women. J Nutr Health Aging 2015; 19:628-36. [PMID: 26054499 DOI: 10.1007/s12603-015-0492-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To examine the association between body composition (fat mass, lean mass and body mass index, BMI) and bone health (bone mineral density, BMD and fracture risk) in urban black South African women. DESIGN A cross sectional study examining associations between body composition, dietary intake (food frequency questionnaire), habitual physical activity (Activity energy expenditure (AEE) measured using an accelerometer with combined heart rate monitor and physical activity questionnaire) and bone health (BMD using dual-energy X ray absorptiometry, DXA and fracture risk). SETTING Urban community dwellers from Ikageng in the North-West Province of South Africa. PARTICIPANTS One hundred and eighty nine (189) healthy postmenopausal women aged ≥43 years. RESULTS Fat mass and lean mass were significantly associated with BMD and fracture risk when adjusted for potential confounders. However, lean mass and not fat mass remained significantly associated with femoral neck BMD (β = 0.49, p <0.001), spine BMD (β = 0.48, p< 0.0001) and hip BMD (β = 0.59, p< 0.0001). Lean mass was also negatively associated with fracture risk (β = -0.19 p =0.04) when both lean and fat mass were in the same model. CONCLUSION Lean mass and fat mass were positively associated with femoral neck, spine and hip BMDs and negatively associated with fracture risk in urban black South African women. Our finding suggests that increasing lean mass rather than fat mass is beneficial to bone health. Our study emphasises the importance of positive lifestyle changes, intake of calcium from dairy and adequate weight to maintain and improve bone health of postmenopausal women.
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Affiliation(s)
- O F Sotunde
- OF Sotunde, North-West University, Potchefstroom, Centre of Excellence for Nutrition, 1 Hoffman Street, , North-West 2520, South Africa, +27781532055,
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12
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Meiring RM, Avidon I, Norris SA, McVeigh JA. A two-year history of high bone loading physical activity attenuates ethnic differences in bone strength and geometry in pre-/early pubertal children from a low-middle income country. Bone 2013; 57:522-30. [PMID: 24012701 DOI: 10.1016/j.bone.2013.08.027] [Citation(s) in RCA: 14] [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: 04/15/2013] [Revised: 08/12/2013] [Accepted: 08/30/2013] [Indexed: 11/19/2022]
Abstract
We examined the interplay between ethnicity and weight-bearing physical activity on the content and volumetric properties of bone in a pre- to early pubertal South African Black and White population. Sixty six children [Black boys, 10.4 (1.4)yrs, n=15; Black girls, 10.1 (1.2)yrs, n=27; White boys, 10.1 (1.1)yrs, n=7; White girls, 9.6 (1.3)yrs, n=17] reported on all their physical activities over the past two years in an interviewer administered physical activity questionnaire (PAQ). All participants underwent a whole body and site-specific DXA scan and we also assessed bone structure and estimated bone strength with pQCT. Children were classified as being either high or low bone loaders based on the cohort's median peak bone strain score estimated from the PAQ. In the low bone loading group, Black children had greater femoral neck bone mineral content (BMC) (2.9 (0.08)g) than White children (2.4 (0.11)g; p=0.05). There were no ethnic differences in the high bone loaders for femoral neck BMC. At the cortical site, the Black low bone loaders had a greater radius area (97.3 (1.3) vs 88.8 (2.6)mm(2); p=0.05) and a greater tibia total area (475.5 (8.7) vs. 397.3 (14.0)mm(2); p=0.001) and strength (1633.7 (60.1) vs. 1271.8 (98.6)mm(3); p=0.04) compared to the White low bone loaders. These measures were not different between the Black low and high bone loaders or between the Black and White high bone loaders. In conclusion, the present study shows that there may be ethnic and physical activity associations in the bone health of Black and White pre-pubertal children and further prospective studies are required to determine the possible ethnic specific response to mechanical loading.
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Affiliation(s)
- Rebecca M Meiring
- Exercise Laboratory, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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13
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May A, Pettifor JM, Norris SA, Ramsay M, Lombard Z. Genetic factors influencing bone mineral content in a black South African population. J Bone Miner Metab 2013; 31:708-16. [PMID: 23475190 PMCID: PMC3825635 DOI: 10.1007/s00774-013-0431-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/24/2013] [Indexed: 11/30/2022]
Abstract
Bone mass differs according to ethnic classification, with individuals of African ancestry attaining the highest measurements across numerous skeletal sites. Elevated bone mass is even maintained in those individuals exposed to adverse environmental factors, suggesting a prominent genetic effect that may have clinical or therapeutic value. Using a candidate gene approach, we investigated associations of six candidate genes (ESR1, TNFRSF11A, TNFRSF11B, TNFSF11, SOST and SPP1) with bone mass at the hip and lumbar spine amongst pre-pubertal black South African children (mean age 10.6 years) who formed part of the longitudinal Birth to Twenty cohort. 151 black children were genotyped at 366 polymorphic loci, including 112 previously associated and 254 tagging single nucleotide polymorphisms (SNPs). Linear regression was used to highlight significant associations whilst adjusting for height, weight, sex and bone area. Twenty-seven markers (8 previously associated and 19 tag SNPs; P < 0.05) were found to be associated with either femoral neck (18) or lumbar spine (9) bone mineral content. These signals were derived from three genes, namely ESR1 (17), TNFRSF11B (9) and SPP1 (1). One marker (rs2485209) maintained its association with the femoral neck after correction for multiple testing (P = 0.038). When compared to results amongst Caucasian adults, we detected differences with respect to associated skeletal sites. Allele frequencies and linkage disequilibrium patterns were also significantly different between populations. Hence, our results support the existence of a strong genetic effect acting at the femoral neck in black South African children, whilst simultaneously highlighting possible causes that account for inter-ethnic bone mass diversity.
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Affiliation(s)
- Andrew May
- />Division of Human Genetics, School of Pathology, Faculty of Health Sciences, National Health Laboratory Service, University of the Witwatersrand, Watkins-Pitchford Building, Room 109, Cnr Hospital and De Korte Street, Braamfontein, 2000 Johannesburg South Africa
| | - John M. Pettifor
- />MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2000 South Africa
| | - Shane A. Norris
- />MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2000 South Africa
| | - Michèle Ramsay
- />Division of Human Genetics, School of Pathology, Faculty of Health Sciences, National Health Laboratory Service, University of the Witwatersrand, Watkins-Pitchford Building, Room 109, Cnr Hospital and De Korte Street, Braamfontein, 2000 Johannesburg South Africa
| | - Zané Lombard
- />Division of Human Genetics, School of Pathology, Faculty of Health Sciences, National Health Laboratory Service, University of the Witwatersrand, Watkins-Pitchford Building, Room 109, Cnr Hospital and De Korte Street, Braamfontein, 2000 Johannesburg South Africa
- />Wits Bioinformatics, University of the Witwatersrand, Private Bag 3, Wits, 2050 Johannesburg South Africa
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14
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Nam HS, Kweon SS, Choi JS, Zmuda JM, Leung PC, Lui LY, Hill DD, Patrick AL, Cauley JA. Racial/ethnic differences in bone mineral density among older women. J Bone Miner Metab 2013; 31:190-8. [PMID: 23143509 PMCID: PMC4109723 DOI: 10.1007/s00774-012-0402-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 10/15/2012] [Indexed: 12/26/2022]
Abstract
The epidemiologic information regarding international differences in bone mineral density (BMD) in women is currently insufficient. We compared BMD in older women across five racial/ethnic groups in four countries. The femoral neck, total hip, and lumbar spine BMD were measured in women (aged 65-74 years) from the Study of Osteoporotic Fractures (SOF) (5,035 Caucasian women and 256 African American women in the US), the Tobago Women's Health Study (116 Afro-Caribbean women), the Ms Os Hong Kong Study (794 Hong Kong Chinese women) and the Namwon Study (1,377 South Korean women). BMD was corrected according to the cross-site calibration results for all scanners. When compared with US Caucasian women, the age adjusted mean BMD measurements at the hip sites were 21-31 % higher among Tobago Afro-Caribbean women and 13-23 % higher among African American women. The total hip and spine BMD values were 4-5 % lower among Hong Kong Chinese women and 4-7 % lower among South Korean women compared to US Caucasians. The femoral neck BMD was similar in Hong Kong Chinese women, but higher among South Korean women compared to US Caucasians. Current/past estrogen use was a significant contributing factor to the difference in BMD between US versus non-US women. Differences in body weight partially explained the difference in BMD between Asian versus non-Asian women. These findings show substantial racial/ethnic differences in BMD even within African or Asian origin individuals, and highlight the contributing role of body weight and estrogen use to the geographic and racial/ethnic variation in BMD.
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Affiliation(s)
- Hae-Sung Nam
- Department of Preventive Medicine and Public Health, Research Institute for Medical Sciences, Chungnam National University School of Medicine, Daejeon, South Korea. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A524, Pittsburgh, PA 15261, USA
| | - Sun-Seog Kweon
- Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Jeollanam-do, South Korea. Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jin-Su Choi
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Joseph M. Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A524, Pittsburgh, PA 15261, USA
| | - P. C. Leung
- Jockey Club Centre for Osteoporosis Care and Control, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Li-Yung Lui
- San Francisco Coordinating Center, California Pacific Medical Center, San Francisco, CA, USA
| | - Deanna D. Hill
- Worldwide Epidemiology, GlaxoSmithKline Research & Development, Collegeville, PA, USA
| | - Alan L. Patrick
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A524, Pittsburgh, PA 15261, USA. Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A524, Pittsburgh, PA 15261, USA
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