Development and validation of a novel screening tool for osteoporosis in older US adults: The NHANES cross-sectional study

Association between dietary inflammatory index and all-cause mortality in patients with osteopenia or osteoporosis: A retrospective cohort study from the NHANES 2007-2018

Objective

Osteoporosis is an inflammatory disease that causes a large disease burden worldwide. Dietary inflammation index (DII), a comprehensive assessment index that reflects the pro-inflammatory/anti-inflammatory level of diet was related to multiple inflammatory diseases. This study aimed to explore the association between DII and all-cause mortality in patients with osteoporosis or osteopenia.

Methods

In this retrospective cohort study, data of patients aged ≥ 45 years diagnosed as osteopenia or osteoporosis and had complete dietary intake information were extracted from the National Health and Nutrition Examination Survey (NHANES 2007-2010, 2013-2014, 2017-2018). Dietary intake information was obtained from 24-h dietary recall interviews and was used to calculate the DII score. Weighted univariate and multivariate Cox proportional hazard models were utilized to explore the association between DII and all-cause mortality in patients with osteoporosis or osteopenia, with hazard ratios (HRs) and 95 % confidence intervals (CIs). Subgroup analyses based on different age, gender and complications were further assessed this association.

Results

A total of 5,381 patients were included. Until December 31, 2019, 1,286 all-cause deaths occurred. After adjusting all covariates, high DII was associated with the high odds of all-cause mortality among patients with osteoporosis or osteopenia (HR=1.28, 95 %CI: 1.10-1.48), especially in the male (HR=1.38, 95 %CI: 1.06-1.78), aged < 65 years (HR=1.49, 95 %CI: 1.09-2.02), and without the history the cardiovascular disease (HR=1.30, 95 %CI: 1.03-1.65), diabetes mellitus (HR=1.27, 95 %CI: 1.06-1.52) and chronic kidney disease (HR=1.28, 95 %CI: 1.03-1.58).

Conclusion

A pro-inflammatory diet may have an adverse effect on the prognosis of osteoporosis patients.

Prediction of Osteoporotic Hip Fracture Outcome: Comparative Accuracy of 27 Immune-Inflammatory-Metabolic Markers and Related Conceptual Issues

Objectives: This study, based on the concept of immuno-inflammatory-metabolic (IIM) dysregulation, investigated and compared the prognostic impact of 27 indices at admission for prediction of postoperative myocardial injury (PMI) and/or hospital death in hip fracture (HF) patients. Methods: In consecutive HF patient (n = 1273, mean age 82.9 ± 8.7 years, 73.5% females) demographics, medical history, laboratory parameters, and outcomes were recorded prospectively. Multiple logistic regression and receiver-operating characteristic analyses (the area under the curve, AUC) were used to establish the predictive role for each biomarker. Results: Among 27 IIM biomarkers, 10 indices were significantly associated with development of PMI and 16 were indicative of a fatal outcome; in the subset of patients aged >80 years with ischaemic heart disease (IHD, the highest risk group: 90.2% of all deaths), the corresponding figures were 26 and 20. In the latter group, the five strongest preoperative predictors for PMI were anaemia (AUC 0.7879), monocyte/eosinophil ratio > 13.0 (AUC 0.7814), neutrophil/lymphocyte ratio > 7.5 (AUC 0.7784), eosinophil count < 1.1 × 109/L (AUC 0.7780), and neutrophil/albumin × 10 > 2.4 (AUC 0.7732); additionally, sensitivity was 83.1-75.4% and specificity was 82.1-75.0%. The highest predictors of in-hospital death were platelet/lymphocyte ratio > 280.0 (AUC 0.8390), lymphocyte/monocyte ratio < 1.1 (AUC 0.8375), albumin < 33 g/L (AUC 0.7889), red cell distribution width > 14.5% (AUC 0.7739), and anaemia (AUC 0.7604), sensitivity 88.2% and above, and specificity 85.1-79.3%. Internal validation confirmed the predictive value of the models. Conclusions: Comparison of 27 IIM indices in HF patients identified several simple, widely available, and inexpensive parameters highly predictive for PMI and/or in-hospital death. The applicability of IIM biomarkers to diagnose and predict risks for chronic diseases, including OP/OF, in the preclinical stages is discussed.

Enhancing Behavioural Changes: A Narrative Review on the Effectiveness of a Multifactorial APP-Based Intervention Integrating Physical Activity

The rapid evolution of technologies is a key innovation in the organisation and management of physical activities (PA) and sports. The increase in benefits and opportunities related to the adoption of technologies for both the promotion of a healthy lifestyle and the management of chronic diseases is evident. In the field of telehealth, these devices provide personalised recommendations, workout monitoring and injury prevention. The study aimed to provide an overview of the landscape of technology application to PA organised to promote active lifestyles and improve chronic disease management. This review identified specific areas of focus for the selection of articles: the utilisation of mobile APPs and technological devices for enhancing weight loss, improving cardiovascular health, managing diabetes and cancer and preventing osteoporosis and cognitive decline. A multifactorial intervention delivered via mobile APPs, which integrates PA while managing diet or promoting social interaction, is unquestionably more effective than a singular intervention. The main finding related to promoting PA and a healthy lifestyle through app usage is associated with "behaviour change techniques". Even when individuals stop using the APP, they often maintain the structured or suggested lifestyle habits initially provided by the APP. Various concerns regarding the excessive use of APPs need to be addressed.

A novel primary osteoporosis screening tool (POST) for adults aged 50 years and over

PURPOSE

This study aimed to develop and validate a simple primary osteoporosis screening tool (POST) based on adults aged 50 years and older.

METHODS

This study included participants aged ≥50 from the National Health and Nutrition Examination Survey. Osteoporosis was defined according to bone mineral density values. The POST was developed based on methods from previous studies. Moreover, we plotted the receiver operating characteristic curves to calculate the area under the curve (AUC) and determine the optimal cut-off value according to the weighted Youden index. In addition, we compared the performances in identifying individuals with osteoporosis between the POST and the Osteoporosis Self-assessment Tool (OST). Finally, we also assessed the performance of the POST in the Chinese population.

RESULTS

Finally, a total of 6665 individuals were included in this study. The AUC values of the POST for identifying individuals with osteoporosis in the development cohort and the validation cohort were 0.81 (95% CI: 0.79-0.83) and 0.81 (95% CI: 0.77-0.84), respectively. Moreover, a POST-score ≥7 was determined as the threshold to identify individuals with osteoporosis, in which the sensitivity was greater than 90%. In addition, the POST showed significantly higher sensitivity than the OST. Finally, the POST showed an AUC of 0.75 (95% CI: 0.65-0.85) among 94 Chinese subjects aged ≥50 years old.

CONCLUSIONS

POST is a convenient and effective tool for osteoporosis screening among adults aged 50 years and over, which might provide new methodological support for future osteoporosis screening.

Associations between weight-adjusted waist index and fractures: a population-based study

INTRODUCTION

The weight-adjusted waist circumference index (WWI) is a novel obesity evaluation indicator that appears to be superior to body mass index (BMI) and waist circumference (WC) in evaluating muscle and fat mass. The purpose of this study was to investigate the association between WWI and fractures among adults.

METHODS

In this cross-sectional study, multivariate logistic regression and smoothed curve fitting were used to investigate linear and nonlinear associations between WWI and fractures, based on data from 28,679 adult participants in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018.

RESULTS

After adjusting for all covariates, the prevalence of hip/wrist/spine fractures among all participants was 1.09%, 8.87%, and 1.97%, respectively. A 1-unit increase in WWI was associated with a 5% increase in the odds of hip fractures [1.05 (1.01, 1.10)], and a 9% increase in the odds of spine fractures [1.09 (1.06, 1.13)], but not with the prevalence of wrist fractures [0.97 (0.94, 1.06)].

CONCLUSIONS

Higher WWI was associated with an increased prevalence of hip fracture and spine fracture, but not wrist fracture.