Z-score discordance and contributing factors in healthy premenopausal women with low bone mineral density: the Korean National Health and Nutrition Examination Survey 2008-9

Association of osteoporosis and skeletal muscle loss with serum type I collagen carboxyl-terminal peptide β glypeptide: A cross-sectional study in elder Chinese population

Type I collagen carboxyl-terminal peptide β (β-CTX) increases in osteoporosis. The study aimed to explore the relationship between serum β-CTX and the risk of osteoporosis as well as sarcopenia in Chinese elderly inpatients. Around 228 patients whose age >65 years were recruited in this cross-sectional study. Dual-energy X-ray scanning was used to access skeletal muscle and bone mass. Serum concentration of β-CTX as well as the prevalence of osteoporosis were significantly higher in low skeletal muscle index (SMI) group than that in the normal SMI group (P < 0.05). Serum β-CTX levels negatively correlated with SMI and bone mass (P < 0.05). Total muscle mass, appendicular skeletal muscle mass, SMI, total bone mass, and bone mass at various sites including the limbs, spine, and pelvis decreased significantly, and the prevalence of low SMI increased with the increase of the quartiles of β-CTX. Higher serum β-CTX had an increased risk of low SMI and osteoporosis (P < 0.05). Summarily, with increasing serum β-CTX levels, both muscle and bone mass decreased in Chinese elderly inpatients. Serum β-CTX was positively associated with the risk of not only osteoporosis but also skeletal muscle loss.

Unravelling hip-spine bone mineral density discordance in people living with HIV

INTRODUCTION

In people living with HIV (PLWH), bone mineral density (BMD) discordance between the lumbar spine (LS) and femoral neck (FN) could be frequent given the high frequency of secondary osteoporosis, including HIV-related factors for bone disease.

MATERIALS AND METHODS

Retrospective cohort of PLWH with a dual X-ray absorptiometry scan. Hip-spine BMD discordance was defined as different T-score or Z-scores categories at LS and FN.

RESULTS

Overall, 865 individuals (mean 49.5 years, female 27%) were included. Osteoporosis diagnosis was four-to-seven times lower when both skeletal sites were affected than when considering the lowest T-score at any site (overall, 21% vs 4%). Hip-spine BMD discordance was observed in 381 (44%) individuals, it increased with age (from 43 to 52%, P = 0.032), and it was mainly due to lower LS-BMD. A lower FN-BMD was associated with older age, lower BMI (P < 0.01), and HIV-related factors, such as low CD4 + T-cell counts, duration of HIV infection, and time on antiretroviral therapy (ART). In a multivariate regression analysis, sex male (Odds Ratio, OR 4.901), hyperparathyroidism (OR, 2.364), and time on ART (OR 1.005 per month) were independently associated with discordance. A higher estimated fracture risk by FRAX equation was observed in individuals with BMD discordance due to lower FN-BMD compared to those with lower LS-BMD (+ 36% for major osteoporotic fracture, P = 0.04; + 135% for hip fracture, P < 0.01).

CONCLUSION

Hip-spine BMD discordance is highly prevalent in PLWH and it is associated with classical and HIV-related risk factors, modifying the rate of osteoporosis and fracture risk estimation.

Collagen Extract Derived from Yeonsan Ogye Chicken Increases Bone Microarchitecture by Suppressing the RANKL/OPG Ratio via the JNK Signaling Pathway

Yeonsan Ogye is a traditional Korean chicken breed (Gallus domesticus, GD), with a dominant gene for fibromelanosis, showing entirely black fluffy head feathers, ear lobes, and pupils. GD collagen extract (78.6 g per 100 g total protein) was derived from the flesh of Yeonsan Ogye. The effects of GD collagen on bone mass, microarchitecture, osteogenic, osteoclastogenic differentiations, and function factor expression were investigated in ovariectomized (OVX) rats. GD collagen stimulated osteogenesis in OVX rats and increased tibial bone strength and calcium content. Micro-computed tomography analysis of tibia cross-sections revealed that GD collagen attenuated the OVX-induced changes in trabecular thickness, spacing, and number. GD collagen stimulated alkaline phosphatase activity, bone-specific matrix proteins (alkaline phosphatase (ALP), osteocalcin, collagen type I (COL-I)) and mineralization by activating bone morphogenetic protein 2 (BMP-2)/mothers against decapentaplegic homolog 5 (SMAD5)/runt-related transcription factor 2 (Runx2). GD collagen inhibited osteoclast differentiation and function gene markers (TRAP, cathepsin K) by interfering with the Wnt signaling, increasing OPG production, and reducing the expression of RANKL, TRAP, and cathepsin K. GD collagen promoted osteogenesis by activating the p38 signal pathway and prevented osteoclastogenesis by lowering the RANKL/OPG ratio and blocking the JNK signaling pathway. Dietary supplementation with GD collagen might inhibit osteoclastogenesis, stimulate osteoblastogenesis, and regulate bone metabolism.

The role of using different reference population in the prevalence of low BMD in the thalassemia patients

Purpose

Prevalence of osteoporosis reported as high as 50% in thalassemia major patients. We compared bone density (BMD) of our patients with results of bone densitometry of participants of a national study, to find if BMD diagnosis is ethnicity sensitive or not.

Methods

In 177 adult beta thalassemia major patients and 490 normal subjects of 20-39 y/o range, dual-energy X-ray absorptiometry of the spine and femur performed. Normal subjects participated in Iranian Multi-center Osteoporosis Study (IMOS). Mean and standard deviation of normal ones achieved and Z-score of patients re-calculated based on normal Iranians. As BMD of normal participants and patients performed by devices of different brands, analyses done based on calculated standard BMD of all participants.

Results

BMD of patients was significantly lower than normal participants (P value <0.001). Frequency of Z-score ≤-2 found in 52% and 56% of patients in femur and spine regions, respectively. New Z-score of patients according to Iranian normal populations calculated. Frequency of this new Z-score ≤-2 found in 16% and 72% of patients in femur and spine regions, respectively.

Conclusions

We think in secondary osteoporosis, may be other cut-off points, especially according to BMD of normal population of that geographical region are needed.

Metabolically healthy/unhealthy components may modify bone mineral density in obese people

Link between obesity and bone health is controversial. It seems that maybe the difference in metabolic status leads to this difference. We studied relation between metabolically healthy/unhealthy components with bone mineral density. Results showed metabolically unhealthy obesity (MUHO) phenotypes have better bone status at hip site than metabolically healthy obesity (MHO). Also, component metabolic can effect on BMD in different sites.

PURPOSE/INTRODUCTION

This cross-sectional study aimed to compare total BMD and L-L4 BMD in MHO and MUHO base on Karelis criteria.

METHODS

We enrolled 272 Iranian obese women and men (BMI ≥ 30). According to Karelis criteria, the participants were grouped base to MHO and MUHO. The body composition and BMD were assessed for all cases. Serum HDL-C, LDL-C, total cholesterol, triglyceride (TG), fasting blood glucose, homeostatic model assessment-insulin resistance (HOMA-IR), and hypersensitive C-reactive protein (hs-CRP) levels were quantified by ELISA method.

RESULTS

Our results demonstrate MUHO phenotype have high total BMD more than MHO (P = 0.01, CI = 0.12 to 0.21). Also, the results of logistic regression analysis showed MUHO have strongly associated with total BMD (β = -0.42, CI = - 0.31 to - 0.04, P = 0.009), but did not affected L2-L4 BMD (β = - 0.09, CI = - 0.14 to 0.08, P = 0.578); this represents that there was discordance in MUHO subjects. Our evidence implicated that HOMA-IR, high level serum TG, hs-CRP, and low level serum HDL had mediatory effect on relationship between obesity and high BMD at the hip region in MUHO subjects (P < 0.05).

CONCLUSION

Present evidence indicates that, could be a novel link between difference in MUH phenotype and MH phenotype with bone status. Also, component metabolic can effect on BMD in different sites.

T-Score Discordance of Bone Mineral Density in Patients with Atypical Femoral Fracture

BACKGROUND

Although atypical femoral fracture (AFF) occurs more frequently in patients taking bisphosphonates and longer treatment is associated with higher risk, the causal relationship between AFF and bisphosphonates has not been established. Most patients with AFF have osteoporosis that is being treated with bisphosphonates, but we are not aware of any reports regarding the areal bone mineral density (aBMD) and discordance between the T-scores of the femur and spine in such patients. We investigated the prevalence of aBMD discordance and the characteristics of patients with AFF.

METHODS

Medical records for 63 consecutive patients treated for AFF were retrospectively evaluated, and 48 patients, all female, were eligible for the study. The average age at the time of fracture was 73.0 years, the average duration of bisphosphonate use was 68.5 months, and the average presumed age at bisphosphonate initiation was 67.2 years. We evaluated the prevalence of discordance, defined as a difference between the T-score categories of the femur and spine in the same individual as well as demographic differences between the discordance and concordance groups. We also compared the prevalence of discordance in patients with AFF with that in 114 female patients with intertrochanteric femoral fracture (ITFF).

RESULTS

T-score concordance, minor discordance, and major discordance were seen in 14 (29%), 32 (67%), and 2 (4%) of the patients with AFF, respectively. The prevalence of discordance was significantly higher in those with AFF (71%) than in those with ITFF (23%) (p < 0.001). The average age at bisphosphonate initiation in the AFF group was lower in the discordance group (65.7 years) than in the concordance group (70.7 years) (p = 0.04).

CONCLUSIONS

The prevalence of T-score discordance between the hip and lumbar spine was relatively high in patients with AFF, and the presumed age at the initiation of bisphosphonate therapy was younger in patients with discordant T-scores in this study.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Relationship between Bone-Specific Physical Activity Scores and Measures for Body Composition and Bone Mineral Density in Healthy Young College Women

OBJECTIVE

The purpose of this cross-sectional study was to investigate the relationship between bone-specific physical activity (BPAQ) scores, body composition, and bone mineral density (BMD) in healthy young college women.

METHODS

Seventy-three college women (21.7 ± 1.8 years; 162.1 ± 4.6 cm; 53.9 ± 5.8 kg) between the ages of 19 and 26 years were recruited from the universities in Seoul and Gyeonggi province, South Korea. We used dual energy X-ray absorptiometry to measure the lumbar spine (L2-L4) and proximal femur BMD (left side; total hip, femoral neck). The BPAQ scores (past, pBPAQ; current, cBPAQ; total, tBPAQ) were used to obtain a comprehensive account of lifetime physical activity related to bone health. We used X-scan plus II instrumentation to measure height (cm), weight (kg), fat free mass (FFM, kg), percent body fat (%), and body mass index (BMI). Participants were asked to record their 24-hour food intake in a questionnaire.

RESULTS

There were positive correlations between BPAQ scores and total hip (pBPAQ r = 0.308, p = 0.008; tBPAQ, r = 0.286, p = 0.014) and FN BMD (pBPAQ r = 0.309, p = 0.008; tBPAQ, r = 0.311, p = 0.007), while no significant relationships were found in cBPAQ (p > 0.05). When FFM, Vitamin D intake, cBPAQ, pBPAQ, and tBPAQ were included in a stepwise multiple linear regression analysis, FFM and pBPAQ were predictors of total hip, accounting for 16% (p = 0.024), while FFM and tBPAQ predicted 14% of the variance in FN (p = 0.015). Only FFM predicted 15% of the variance in L2-L4 (p = 0.004). There was a positive correlation between Vitamin D intake and L2-L4 (p = 0.025), but other dietary intakes variables were not significant (p > 0.05).

CONCLUSIONS

BPAQ-derived physical activity scores and FFM were positively associated with total hip and FN BMD in healthy young college women. Our study suggests that osteoporosis awareness and effective bone healthy behaviors for college women are required to prevent serious bone diseases later in life.

Muscle mass is a strong correlation factor of total hip BMD among Korean premenopausal women

Objectives

This study was to investigate mean Z-score of BMD of Korean premenopausal women and also to investigate the relationship between BMD and body composition, such as skeletal muscle (SM) mass, body fat mass, and abdominal adiposity among healthy Korean premenopausal women in their forties.

Methods

A total of 2711 premenopausal women in her forties (40-49 years) who had taken dual energy X-ray absorptiometry (DXA) for BMD screening and body composition analyser (InBody J10^®) from 2012 to 2013 at health promotion center of Ewha Womans university Mokdong hospital were analyzed retrospectively. Demographic data such as body mass index (BMI), waist circumference (WC), hip circumference (HC), waist hip ratio (WHR), SM mass, body fat mass, and serum lipid profile were included in this study. The Pearson's correlation coefficient (CC) was used to identify co-efficiency between BMD and other parameters.

Results

The mean age was 44.2 ± 4.44 (years) and mean BMI was 22.43 ± 2.99 (kg/m²). Mean Z-score of BMD-lumbar 1-4 (BMD-L) and BMD-femur total hip (BMD-F) was 0.33 ± 1.14 and -0.19 ± 0.85. Mean of BMD-L and BMD-F were 1.18 ± 0.16 (g/cm²) and 0.96 ± 0.12 (g/cm²). Skeletal muscle mass showed a strong significant correlation coefficient (CC) only with BMD-F (CC = 0.13, p-value = 4.78 × 10^-11). However serum lipid profile, body fat mass, and WHR did not show significant CC with mean Z-score of BMD-F and BMD-L.

Conclusions

Skeletal muscle mass measured by body composition analyzer of BIA method is a strong correlation factor for BMD especially of hip bone among healthy Korean premenopausal women in their forties.