1
|
Madrid DA, Beavers KM, Walkup MP, Ambrosius WT, Rejeski WJ, Marsh AP, Weaver AA. Effect of exercise modality and weight loss on changes in muscle and bone quality in older adults with obesity. Exp Gerontol 2023; 174:112126. [PMID: 36796657 PMCID: PMC10033433 DOI: 10.1016/j.exger.2023.112126] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Little is known about the effect of exercise modality during a dietary weight loss program on muscle size and quality, as measured by computed tomography (CT). Even less is known about how CT-derived changes in muscle track with changes in volumetric bone mineral density (vBMD) and bone strength. METHODS Older adults (66 ± 5 years, 64 % women) were randomized to 18-months of diet-induced weight loss (WL), WL with aerobic training (WL + AT), or WL with resistance training (WL + RT). CT-derived muscle area, radio-attenuation and intermuscular fat percentage at the trunk and mid-thigh were determined at baseline (n = 55) and 18-month follow-up (n = 22-34), and changes were adjusted for sex, baseline value, and weight lost. Lumbar spine and hip vBMD and finite element-derived bone strength were also measured. RESULTS After adjustment for the weight lost, muscle area losses at the trunk were -7.82 cm2 [-12.30, -3.35] for WL, -7.72 cm2 [-11.36, -4.07] for WL + AT, and -5.14 cm2 [-8.65, -1.63] for WL + RT (p < 0.001 for group differences). At the mid-thigh, decreases were -6.20 cm2 [-10.39, -2.02] for WL, -7.84 cm2 [-11.19, -4.48] for WL + AT, and -0.60 cm2 [-4.14, 2.94] for WL + RT; this difference between WL + AT and WL + RT was significant in post-hoc testing (p = 0.01). Change in trunk muscle radio-attenuation was positively associated with change in lumbar bone strength (r = 0.41, p = 0.04). CONCLUSIONS WL + RT better preserved muscle area and improved muscle quality more consistently than WL + AT or WL alone. More research is needed to characterize the associations between muscle and bone quality in older adults undertaking weight loss interventions.
Collapse
Affiliation(s)
- Diana A Madrid
- Department of Biomedical Engineering, Wake Forest University School of Medicine, United States
| | - Kristen M Beavers
- Department of Health and Exercise Science, Wake Forest University, United States
| | - Michael P Walkup
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, United States
| | - Walter T Ambrosius
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, United States
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, United States
| | - Anthony P Marsh
- Department of Health and Exercise Science, Wake Forest University, United States
| | - Ashley A Weaver
- Department of Biomedical Engineering, Wake Forest University School of Medicine, United States.
| |
Collapse
|
2
|
Amariti J, McGuire BD, Ogilvie AR, Beavers KM, Hansen KE, Schlussel Y, Walkup MP, Shapses SA. Older Women who are Overweight or Obese Have Vertebral Abnormalities, Partially Degraded TBS, and BMD that Worsen with Weight Loss. Calcif Tissue Int 2022; 111:137-144. [PMID: 35385982 DOI: 10.1007/s00223-022-00973-1] [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: 01/07/2022] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
Obesity is a risk factor for chronic diseases and moderate weight loss is generally recommended. Energy restriction results in the loss of hip bone mineral density (BMD) in older adults, but there is no consistent decline at the lumbar spine (LS), possibly due to vertebral abnormalities although this may also be dependent on the amount of weight loss. In this secondary analysis of weight loss trials investigating BMD and trabecular bone score (TBS) changes over 12-18 months, 92 postmenopausal women (60.8 ± 5.8 years; body mass index 32.7 ± 4.4 kg/m2) without osteoporosis, were divided into two groups: those who lost < 5% body weight (minimal) or ≥ 5% (moderate). Hip and LS-BMD and TBS were measured at baseline, 6 and 12-18 months. Exclusion of vertebral abnormalities (VE) was used to calculate BMD at the spine (LS-BMD-VE) using standard guidelines. Women lost 2.3 ± 2.4% and 8.5 ± 4.7% weight in the minimal and moderate weight loss groups, respectively. Over one third of the women had at least one vertebral abnormality or partially degraded TBS at baseline that worsened after weight loss, increasing to over 50% in this population (p < 0.05). TBS and hip BMD decreased with weight loss (p < 0.05), but LS-BMD did not decrease significantly. However, after excluding vertebral abnormalities, the LS-BMD-VE decreased in the entire population (p < 0.01), and by 1.7 ± 4.3% in the moderate weight loss group. This study suggests that older women without osteoporosis have vertebral abnormalities that obfuscated declines in BMD with weight loss, indicating that bone at the spine is further compromised.
Collapse
Affiliation(s)
- Julia Amariti
- Department of Nutritional Sciences, and the NJ Institute of Food, Health and Nutrition, Rutgers University, New Brunswick, NJ, 08901, USA
| | - Brandon D McGuire
- Department of Nutritional Sciences, and the NJ Institute of Food, Health and Nutrition, Rutgers University, New Brunswick, NJ, 08901, USA
| | - Anna R Ogilvie
- Department of Nutritional Sciences, and the NJ Institute of Food, Health and Nutrition, Rutgers University, New Brunswick, NJ, 08901, USA
| | - Kristen M Beavers
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Karen E Hansen
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Yvette Schlussel
- Department of Nutritional Sciences, and the NJ Institute of Food, Health and Nutrition, Rutgers University, New Brunswick, NJ, 08901, USA
| | - Michael P Walkup
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Sue A Shapses
- Department of Nutritional Sciences, and the NJ Institute of Food, Health and Nutrition, Rutgers University, New Brunswick, NJ, 08901, USA.
- Department of Medicine, Rutgers-Robert Wood Johnson University Hospital, Rutgers University, 59 Dudley Rd, New Brunswick, NJ, 08901, USA.
| |
Collapse
|
3
|
Flores LE, Mack L, Wichman C, Weaver AA, Kothari V, Bilek LD. Protocol for a pilot randomised controlled trial of zoledronic acid to prevent bone loss following sleeve gastrectomy surgery. BMJ Open 2021; 11:e057483. [PMID: 34887285 PMCID: PMC8663101 DOI: 10.1136/bmjopen-2021-057483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Sleeve gastrectomy (SG) is an increasingly used and effective treatment for obesity; however, the rapid weight loss associated with SG adversely affects bone metabolism predisposing patients to skeletal fragility. Bisphosphonate medications have been evaluated for safety and efficacy in combating bone loss in patients with osteoporosis, but their use in SG-induced bone loss is limited. The goal of this study is to investigate how a one-time infusion of zoledronic acid compares to placebo, in its ability to combat SG-associated bone loss. METHODS AND ANALYSIS This research protocol is a 9-month, pilot randomized controlled trial (RCT) involving 30 adult SG patients randomised to receive an infusion of either 5 mg of zoledronic acid or placebo, 6 weeks following surgery. To be included participants must be <350 lbs/158.8 kg, free of bone-impacting pathologies or medications, and must have adequate serum calcium and vitamin D levels at baseline. The primary outcome is change in areal bone mineral density (aBMD) at the total hip. Secondary outcomes include change in aBMD of the femoral neck, and lumbar spine, and change in volumetric BMD at the lumbar spine. The primary aim will be tested using a linear mixed model fit with total hip aBMD at 9 months as the outcome. Treatment, participant sex and menopausal status will be considered in analysis. Groups will be compared using contrast statements at 9 months, with change over 9 months being the primary comparison. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board of the University of Nebraska Medical Center (IRB820-19). Written consent will be obtained from participants at enrolment by trained staff. Careful and thorough explanation are used in obtainment of consent and voluntariness is emphasised throughout the trial. The findings of this study will be presented locally, nationally, and published in peer-reviewed journals. Additional details will be reported on ClinicalTrials.gov. TRIAL REGISTRATION NUMBER NCT04279392.
Collapse
Affiliation(s)
- Laura E Flores
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Lynn Mack
- Diabetes, Endocrinology, & Metabolism, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christopher Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ashley A Weaver
- Department of Biomedical Engineering, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Vishal Kothari
- Department of Minimally Invasive Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Laura D Bilek
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
4
|
Dogru SC, Arslan YZ. Effect of Model Parameters on the Biomechanical Behavior of the Finite Element Cervical Spine Model. Appl Bionics Biomech 2021; 2021:5593037. [PMID: 34257704 PMCID: PMC8257375 DOI: 10.1155/2021/5593037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/11/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
Finite element (FE) models have frequently been used to analyze spine biomechanics. Material parameters assigned to FE spine models are generally uncertain, and their effect on the characterization of the spinal components is not clear. In this study, we aimed to analyze the effect of model parameters on the range of motion, stress, and strain responses of a FE cervical spine model. To do so, we created a computed tomography-based FE model that consisted of C2-C3 vertebrae, intervertebral disc, facet joints, and ligaments. A total of 32 FE analyses were carried out for two different elastic modulus equations and four different bone layer numbers under four different loading conditions. We evaluated the effects of elastic modulus equations and layer number on the biomechanical behavior of the FE spine model by taking the range of angular motion, stress, and strain responses into account. We found that the angular motions of the one- and two-layer models had a greater variation than those in the models with four and eight layers. The angular motions obtained for the four- and eight-layer models were almost the same, indicating that the use of a four-layer model would be sufficient to achieve a stress value converging to a certain level as the number of layers increases. We also observed that the equation proposed by Gupta and Dan (2004) agreed well with the experimental angular motion data. The outcomes of this study are expected to contribute to the determination of the model parameters used in FE spine models.
Collapse
Affiliation(s)
- Suzan Cansel Dogru
- Department of Mechanical Engineering, Faculty of Engineering, Istanbul University-Cerrahpasa, Turkey
| | - Yunus Ziya Arslan
- Department of Robotics and Intelligent Systems, Institute of Graduate Studies in Science and Engineering, Turkish-German University, Turkey
| |
Collapse
|
5
|
The relationship between orthopedic clinical imaging and bone strength prediction. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
|
6
|
Lenchik L, Weaver AA, Ward RJ, Boone JM, Boutin RD. Opportunistic Screening for Osteoporosis Using Computed Tomography: State of the Art and Argument for Paradigm Shift. Curr Rheumatol Rep 2018; 20:74. [PMID: 30317448 DOI: 10.1007/s11926-018-0784-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Osteoporosis is disproportionately common in rheumatology patients. For the past three decades, the diagnosis of osteoporosis has benefited from well-established practice guidelines that emphasized the use of dual x-ray absorptiometry (DXA). Despite these guidelines and the wide availability of DXA, approximately two thirds of eligible patients do not undergo testing. One strategy to improve osteoporosis testing is to employ computed tomography (CT) examinations obtained as part of routine patient care to "opportunistically" screen for osteoporosis, without additional cost or radiation exposure to patients. This review examines the role of opportunistic CT in the evaluation of osteoporosis. RECENT FINDINGS Recent evidence suggests that opportunistic measurement of bone attenuation (radiodensity) using CT has sensitivity comparable to DXA. More importantly, such an approach has been shown to predict osteoporotic fractures. The paradigm shift of using CTs obtained for other reasons to opportunistically screen for osteoporosis promises to substantially improve patient care.
Collapse
Affiliation(s)
- Leon Lenchik
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Ashley A Weaver
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Robert J Ward
- Tufts University School of Medicine, 800 Washington Street, Boston, MA, 02111, USA
| | - John M Boone
- University of California Davis Medical Center, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| | - Robert D Boutin
- University of California Davis School of Medicine, 4860 Y Street, Suite 3100, Sacramento, CA, 95817, USA
| |
Collapse
|