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Tan YQ, Ng DX, Gunasekaran K, Lim WL, Tan NC. Clinical characteristics and risk factors of osteoporosis among older Asian men with type-2 diabetes mellitus, hypertension, or hyperlipidaemia. Arch Osteoporos 2024; 19:83. [PMID: 39235564 PMCID: PMC11377474 DOI: 10.1007/s11657-024-01442-y] [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: 05/16/2024] [Accepted: 08/21/2024] [Indexed: 09/06/2024]
Abstract
This study investigated osteoporosis risk factors among older Asian men with type-2 diabetes mellitus, hypertension, or hyperlipidaemia in primary care. Advanced age, dementia, depression, and polypharmacy were associated with higher risks for osteoporosis. Screening strategies targeting these factors are crucial for improving bone health as part of comprehensive preventive care. PURPOSE Asian patients with type-2 diabetes mellitus (T2DM), hypertension, or hyperlipidaemia (DHL) are predominantly managed in primary care. They are also at risk of osteoporosis, but men are often under-screened and under-treated for this preventable bone disorder. This study aimed to identify the clinical characteristics and risk factors of osteoporosis among older men with DHL in primary care for early intervention. METHODS This retrospective study included men aged 65 years and older managed in public primary care clinics for their DHL between 1st July 2017 and 30th June 2018. Demographic, clinical, laboratory, and imaging data were extracted from their electronic medical records based on their International Classification of Diseases-10 (ICD-10) diagnosis codes. Descriptive statistical analyses, with statistical significance set at p < 0.05, were conducted, followed by generalized estimating equation (GEE) modelling. RESULTS Medical records of 17,644 men (83.1% Chinese, 16.9% minority ethnic groups, median age 71 years) were analysed. 2.3% of them had diagnosis of osteoporosis, 0.15% had fragility fracture, and 26.0% of those diagnosed with osteoporosis were treated with bisphosphonates. Their mean HbA1c was 6.9%; mean systolic and diastolic blood pressure were 133 and 69 mmHg. The GEE model showed that age (OR = 1.07, 95%CI = 1.05-1.09, p < 0.001), dementia (OR = 2.24, 95%CI = 1.33-3.77, p = 0.002), depression (OR = 2.38, 95%CI = 1.03-5.50, p = 0.043), and polypharmacy (OR = 6.85, 95%CI = 3.07-15.26, p < 0.001) were significantly associated with higher risks for osteoporosis. CONCLUSION Age, dementia, depression, and polypharmacy are associated with osteoporosis risks in men with DHL. Strategies to incorporate osteoporosis screening among older men with these risk factors are needed to improve their bone health.
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Affiliation(s)
- Yu Quan Tan
- SingHealth Polyclinics, 167 Jalan Bukit Merah, Connection One (Tower 5), #15-10, Singapore, 150167, Singapore.
| | - Ding Xuan Ng
- SingHealth Polyclinics, 167 Jalan Bukit Merah, Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
| | - Kalaipriya Gunasekaran
- SingHealth Polyclinics, 167 Jalan Bukit Merah, Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
| | - Weai Ling Lim
- SingHealth Polyclinics, 167 Jalan Bukit Merah, Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
| | - Ngiap Chuan Tan
- SingHealth Polyclinics, 167 Jalan Bukit Merah, Connection One (Tower 5), #15-10, Singapore, 150167, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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Chandran M, Brind'Amour K, Fujiwara S, Ha YC, Tang H, Hwang JS, Tinker J, Eisman JA. Prevalence of osteoporosis and incidence of related fractures in developed economies in the Asia Pacific region: a systematic review. Osteoporos Int 2023; 34:1037-1053. [PMID: 36735053 DOI: 10.1007/s00198-022-06657-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/21/2022] [Indexed: 02/04/2023]
Abstract
UNLABELLED Robust data on osteoporosis in the Asia Pacific region could improve healthcare decision-making. Osteoporosis affects 10-30% of women aged 40 + , and up to 10% of men in 7 developed economies in Asia Pacific. Fractures affect 500-1000 adults aged 50 + per 100,000 person-years. Policymakers and clinicians must address this problem. PURPOSE Osteoporosis and associated fractures result in considerable morbidity, loss of productivity, early mortality, and increased healthcare expenses. Many countries in the Asia Pacific (AP) region, especially middle- and higher-income economies, are faced with aging and increasingly sedentary populations. It is critical to consolidate and analyze the available information on the prevalence and incidence of the disease in these countries. METHODS We systematically reviewed articles and gray literature for Australia, China, Hong Kong, Japan, Singapore, South Korea, and Taiwan. We searched PubMed, ScienceDirect, JSTOR, Cochrane, Google Scholar, and other databases for data published 2009-2018. We included articles with prevalence or incidence estimates for adults with osteoporosis or related fractures. RESULTS All locations had data available, but of widely varying quantity and quality. Most estimates for osteoporosis prevalence ranged from 10 to 30% for women ages 40 and older, and up to 10% for men. Osteoporotic fracture incidence typically ranged between 500 and 1000 per 100,000 person-years among adults aged 50 and older. Both outcomes typically increased with age and were more common among women. CONCLUSION Osteoporosis and associated fractures affect significant portions of the adult population in developed economies in the AP region. Governments and healthcare systems must consider how best to prevent and diagnose osteoporosis, and manage affected individuals, to reduce healthcare costs and mortality associated with fractures.
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Affiliation(s)
- Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore.
| | | | - Saeko Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul, South Korea
| | - Hai Tang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, Republic of China
| | - Jawl-Shan Hwang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | | | - John A Eisman
- UNSW Sydney and School of Medicine Sydney, Garvan Institute of Medical Research, St Vincent's Hospital, University of Notre Dame Australia, Sydney, NSW, Australia
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Kolbasi EN, Demirdag F, Yildiz K, Murat S, Balkaya G. Determinants of Bone Health in Older Adults. Medeni Med J 2020; 35:23-28. [PMID: 32733746 PMCID: PMC7384495 DOI: 10.5222/mmj.2020.50133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/06/2020] [Indexed: 11/12/2022] Open
Abstract
Objective: The objective of this study was to determine the predictors of bone health in older adults. Methods: A total of 313 subjects older than 65 years (mean age 74.2±6.4 years, 70.6% female) were included in the study. Demographic characteristics of participants such as gait speed, handgrip strength, level of physical activity (using Rapid Assessment of Physical Activity-RAPA scale), vitamin D levels, T scores of femur neck (FN) and lumbar spine (LS) were recorded. Results: Based on FN, 40.7% of participants had normal T scores whereas 46.2% and 13.1% of them were osteopenic and osteoporotic, respectively. FN was correlated with age (r:-0.184, p<0.001), BMI (r:0.269, p<0.001), and handgrip strength (r:0.149, p:0.009) in addition to the aerobic subscale of RAPA (RAPA-aerobic) (r:-0.133, p:0.02). Similarly, the LS was correlated with female gender (r:-0.207, p<0.001), age (r:0.136, p:0.016), body mass index (BMI) (r:0.246, p<0.001) and handgrip strength (r:0.217, p<0.001). The predictors of bone health were decided upon using multiple logistic regression analysis. The deterministic model consisted of age, gender, BMI, height, weight, handgrip strength, gait speed, RAPA-aerobic and vitamin D. For LS dependent variable, the overall model was significant (F:10.149, p<0.001). However, only two variables were significant predictors in the model ie. weight (β:0.389, p<0.001) and handgrip strength (β=0.186, p<0.001). Similarly for independent variable of FN, the overall model was significant (F:6.525, p<0.001) and only two variables were significant predictors: weight (β:0.371, p<0.001) and RAPA-Aerobic (β:0.148, p:0.009). Conclusion: Lower levels of body weight, participation in aerobic activity and handgrip strength might be risk factors for deterioration of bone health in older adults.
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Affiliation(s)
- Esma Nur Kolbasi
- Istanbul Medeniyet University, Department of Physiotherapy and Rehabilitation, Istanbul - Turkey
| | - Filiz Demirdag
- Istanbul Medeniyet University Göztepe Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
| | - Kubra Yildiz
- Istanbul Medeniyet University, Department of Nutrition and Dietetics, Istanbul, Turkey
| | - Sadiye Murat
- Istanbul Medeniyet University Göztepe Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Istanbul, Turkey
| | - Gozde Balkaya
- Istanbul Medeniyet University Göztepe Training and Research Hospital, Department of Internal Medicine, Istanbul, Turkey
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Guebeli A, Platz EA, Paller CJ, McGlynn KA, Rohrmann S. Relationship of sex steroid hormones with bone mineral density of the lumbar spine in adult men. Bone Joint Res 2020; 9:139-145. [PMID: 32435466 PMCID: PMC7229310 DOI: 10.1302/2046-3758.93.bjr-2019-0141.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims To examine the relationship of sex steroid hormones with osteopenia in a nationally representative sample of men in the USA. Methods Data on bone mineral density (BMD), serum sex hormones, dairy consumption, smoking status, and body composition were available for 806 adult male participants of the cross-sectional National Health and Nutrition Examination Survey (NHANES, 1999-2004). We estimated associations between quartiles of total and estimated free oestradiol (E2) and testosterone (T) and osteopenia (defined as 1 to 2.5 SD below the mean BMD for healthy 20- to 29-year-old men) by applying sampling weights and using multivariate-adjusted logistic regression. We then estimated the association between serum hormone concentrations and osteopenia by percentage of body fat, frequency of dairy intake, cigarette smoking status, age, and race/ethnicity. Results Men in the lowest quartile of total E2 concentrations (< 21.52 pg/ml) had greater odds of osteopenia compared with men in the highest quartile (odds ratio (OR) 2.29, 95% confidence interval (CI) 1.11 to 4.73; p-trend = 0.030). Total and free T were not associated with osteopenia. Low total E2 concentrations were associated with greater odds of osteopenia among non-daily dairy consumers (p-trend = 0.046), current or former smokers (p-trend = 0.032), and younger men (p-trend = 0.031). No differences were observed by race/ethnicity and obesity. Conclusion In this nationally representative study of the USA, men with lower total E2 were more likely to have osteopenia, which was particularly evident among younger men, men with less-than-daily dairy consumption, and current or former smokers. Cite this article:Bone Joint Res. 2020;9(3):139–145.
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Affiliation(s)
- Alissa Guebeli
- Department of Orthopaedic Surgery, Cantonal Hospital of Baselland, Liestal, Switzerland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; James Buchanan Brady Urological Institute, and Department of Urology, Johns Hopkins University School of Medicine, and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Channing J Paller
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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McMillan LB, Aitken D, Ebeling P, Jones G, Scott D. The relationship between objectively assessed physical activity and bone health in older adults differs by sex and is mediated by lean mass. Osteoporos Int 2018. [PMID: 29532131 DOI: 10.1007/s00198-018-4446-4] [Citation(s) in RCA: 16] [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] [Indexed: 02/03/2023]
Abstract
UNLABELLED Relationships between objectively assessed free-living physical activity (PA) and changes in bone health over time are poorly understood in older adults. This study suggests these relationships are sex-specific and that body composition may influence the mechanical loading benefits of PA. INTRODUCTION To investigate associations of objectively assessed PA and bone health in community-dwelling older adults. METHODS This secondary analysis of a subset of the Tasmanian Older Adult Cohort study included participants with PA assessed utilising ActiGraph GT1M accelerometers over 7 days (N = 209 participants, 53% female; mean ± SD age 64.5 ± 7.2 years). Steps/day and PA intensity were estimated via established thresholds. Bone mineral content (BMC) was acquired at the total hip, lumbar spine, legs and whole body by DXA at baseline and approximately 2.2 years later. Relationships between PA and BMC were assessed by multivariable linear regression analyses adjusted for age, smoking status, height and total lean mass. RESULTS Men with above-median total hip BMC completed significantly less steps per day, but there was no significant difference in PA intensity compared with those with below-median BMC. There were no significant differences in PA in women stratified by median BMC. In women, steps/day were positively associated with leg BMC (B = 0.178; P = 0.017), and sedentary behaviour was negatively associated with leg BMC (- 0.165; 0.016) at baseline. After adjustment for confounders including lean mass and height, higher sedentary behaviour at baseline was associated with declines in femoral neck BMC (- 0.286; 0.011) but also with increases in pelvic BMC (0.246; 0.030) in men and increases in total hip BMC (0.215; 0.032) in women, over 2.2 years. No other significant longitudinal associations were observed after adjustment for body composition. CONCLUSIONS Associations of accelerometer-determined sedentary behaviour and PA with bone health in older adults differ by sex and anatomical site and are mediated by body composition.
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Affiliation(s)
- L B McMillan
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia.
| | - D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - P Ebeling
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Australian Institute of Musculoskeletal Science (AIMSS), Melbourne Medical School (Western Campus), Sunshine Hospital, The University of Melbourne, St Albans, Melbourne, VIC, 3021, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
| | - D Scott
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, 7000, Australia
- Australian Institute of Musculoskeletal Science (AIMSS), Melbourne Medical School (Western Campus), Sunshine Hospital, The University of Melbourne, St Albans, Melbourne, VIC, 3021, Australia
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