Preferred skeletal site for osteoporosis screening in high-risk populations

The Prevalence and risk factors of osteoporosis among the elderly in Hamadan province: A cross sectional study

Background: Osteoporosis is the most common metabolic bone disease and is a public health issue, particularly among the elderly, across the world. Given the significance of the disease in causing disability and, in particular, its dangers in old age, we aimed to examine osteoporosis and its determinant factors among the elderly. Methods: We conducted a cross sectional study in the province of Hamadan from September 2015 to March 2016 on all the elderly men and women covered by 'Integrated and Comprehensive Elderly Care Program'. The data required for this study was collected through an aging health care checklist. To estimate the adjusted association of potential risk factors and other confounding variables of osteoporosis, multiple logistic regression was used at a significance level of 5%. Results: In this cross sectional study, 1779 elderly men and women aged 6o years and over were studied. The prevalence of osteoporosis was 7.99% (95%CI:7.79-8.18), which was higher among women than in men (8.08% vs. 7.83%). The factors that raised the probability of osteoporosis were as follow: aging (OR= 1.05, 95% CI: 1.02-1.07, p<0.001), low education (OR=1.96, 95% CI:1.02-3.84, p=0.04), living in urban areas (OR=2.82, 95% CI:1.93-4.11, p<0.001), smoking (OR=2.39, 95% CI:1.42-4.04, p<0.001), and family history of osteoporosis (OR=1.95, 95% CI:1.07-3.54, p=0.03). Conclusion: Based on our results, aging, low education level, living in urban areas, being a cigarette smoker, and having a family history of osteoporosis were all predicting factors for osteoporosis among the elderly.

Increased Bone Mineral Density after Abstinence in Male Patients with Alcohol Dependence

Objective

This study aimed to compare the bone mineral density of male patients with alcohol dependence with that in healthy controls and to assess changes in bone density after abstinence.

Methods

Forty-four inpatients with confirmed the Diagnostic and Statistical Manual of Mental Disorders, fourth edition diagnosis of alcohol abuse and 42 controls were recruited. Bone density was determined with dual-energy X-ray absorptiometry in the lumbar spine as well as in the femoral neck, trochanter, and Ward’s triangle regions of the proximal right femur.

Results

There were no significant differences in age and body mass index between patients with alcohol dependence and healthy controls. In the alcohol dependence group, osteopenia and osteoporosis were found in 54.5% and 34.1% of the patients, respectively, whereas in the control group, the corresponding values were 45.2% and 11.9% (p=0.001). Although the actual bone density in the femur and the corresponding T-scores were significantly lower in the alcohol dependence group, no significant differences were found in the lumbar spine. In both groups, body mass index showed a significant correlation with bone mineral density in all areas. After 3 to 4 years of abstinence, bone density significantly increased in the lumbar and femur.

Conclusion

We conclude that bone mineral density in patients with alcohol dependence was significantly lower than that in healthy controls, and the rates of osteopenia and osteoporosis are higher. Importantly, abstinence from alcohol increases bone density.

Dietary patterns in relation to bone mineral density among menopausal Iranian women

The association of dietary patterns and bone health is not yet well known, and findings from the rare previous studies conducted on this issue are contradictory. We assessed the dietary patterns in relation to bone mineral density (BMD) in a sample of menopausal Iranian women. In this cross-sectional study, 160 menopausal women aged 50-85 were studied and their femoral neck and lumbar spine BMDs were measured by dual-energy X-ray absorptiometry. Dietary intakes were assessed with a validated 168-item food frequency questionnaire, and dietary patterns were identified by a principal component factor analysis method. Overall, six dietary patterns emerged, two of which had a significant association with BMD. After adjusting for potential confounders, women who had higher scores for the first (high in high-fat dairy products, organ meats, red or processed meats and nonrefined cereals) and the second (high in French fries, mayonnaise, sweets and desserts and vegetable oils) dietary patterns we identified were more likely to have BMD below the median in the lumbar spine (odds ratio 2.29; 95 % confidence interval 1.05-4.96; p = 0.04) and the femoral neck (odds ratio 2.83, 95 % confidence interval 1.31-6.09; p < 0.01), respectively, compared to women with lower scores. Dietary patterns abundant in foods with high content of saturated fatty acids (similar to factor 1) or with low density of nutrients (similar to factor 2) are detrimental to bone health in menopausal Iranian women. These findings highlight the importance of proper food selection for maintaining bone health.

Osteoporotic fractures, DXA, and fracture risk assessment: meeting future challenges in the Eastern Mediterranean Region

The purpose was to report on the burden of osteoporotic fractures in the Eastern Mediterranean Region (EMR) and the use of bone mineral density (BMD) dual-energy X-ray absorptiometry (DXA) databases for osteoporosis diagnosis. PubMed electronic database was reviewed using the following MeSH terms: "Hip fractures," "Fractures, Compression," "Radius Fractures," "Osteoporosis," "Bone density," and "Middle East" up to July 2009. Incidence of hip fractures varied across the EMR between 100 and 295 per 100,000 person-years in women and 71 and 200 per 100,000 person-years in men. No data were found on other nonvertebral osteoporotic fractures. Prevalence of radiographic vertebral fractures older than 65 yr ranged between 15% and 25% in women and 7.3% and 18% in men. By 2020, the number of hip fractures older than 50 yr would increase by 20%. DXA manufacturer's reference curves for the spine were higher than population-specific ones. At the hip, National Health and Nutrition Examination Survey (NHANES) and population-based curves were comparable. Estimates of the relative risk of vertebral fracture per SD decrease in BMD using NHANES and local data set were similar, that is, 1.61 (1.17-2.23) and 1.49 (1.14-1.95), respectively. The EMR is similar to southern Europe regarding incidence rates of hip fracture, suggesting the health burden to be significant. Using DXA at the hip, population-specific reference databases did not perform better than NHANES on which the FRAX model has been developed highlighting the need for reviewing fracture risk assessment strategies in the EMR.

The relationship between plasma homocysteine levels and bone mineral density in post-menopausal women

BACKGROUND

Whether or not mild hyperhomocysteinemia and low serum levels of folates or vitamin B12 are risk factors for osteoporosis in the elderly is controversial.

AIMS AND METHODS

To investigate whether or not plasma levels of total homocysteine (tHcy) and serum levels of folates and vitamin B12 are associated with bone mineral density (BMD), we carried out a cross-sectional study on 446 post-menopausal women (mean age: 65.1+/-9.4 years), consecutively seen at the Siena Unit (Tuscany region, Central Italy) for BMD evaluation over a two-year period. BMD of the total femur, femoral neck and lumbar spine was detected by dual-energy X-ray absorptiometry.

RESULTS

The age-adjusted geometric mean of plasma tHcy levels (micromol/L) was 9.96+/-1.29 in women with normal BMD, 11.06+/-1.32 in those with osteopenia and 11.88+/-1.35 in those with osteoporosis (p<0.0001). On multiple linear regression analysis, adjusting for age, body mass index, folates, vitamin B12, creatinine clearance, smoking habit and alcohol intake, tHcy was negatively related to BMD of the total femur [beta estimate for log-homocysteine: -0.050 (95% CI: -0.100 to -0.001, p=0.048; R(2)=0.02)], but not of femoral neck or lumbar spine. There was no significant association between BMD and serum levels of folates and vitamin B12.

CONCLUSIONS

tHcy is negatively associated with BMD of the total femur. The contribution of tHcy to explain the variance of BMD is small (2% of the total variance) but clinically relevant, considering the high prevalence of osteoporosis among post-menopausal women and the possibility to lower tHcy by vitamin supplementation.

[Differences in the frequency of osteoporosis according to the skeletal site evaluated. Analysis in 987 Spanish postmenopausal women referred to a bone densitometry unit]

OBJECTIVE

To analyze the differences in the frequency of osteoporosis according to the skeletal site evaluated in a group of Spanish postmenopausal women.

METHODS

We reviewed the data of 987 postmenopausal women (mean age, 53.8±5.5 years). BMD status was evaluated by DXA. We used the WHO thresholds to classify the patients. T-score was obtained from the single evaluation of each lumbar vertebra (L2, L3 and L4), the mean value of lumbar spine (L2-L4), femoral neck and total hip.

RESULTS

In 144 (14.7%) women, discrepancies were observed when we considered the single vertebral analysis versus the L2-L4 analysis; 62 (6%) women who presented osteoporosis in at least one vertebra would have been due to the osteopenia category when L2-L4 value was selected. In 271 (27.8%) women, discrepancies were observed when we considered the total hip analysis versus the femoral neck analysis. The frequency of osteoporosis ranged from 3% when only the analysis of the total hip was considered to 16% when the results of L2-L4 and proximal femur (total hip or femoral neck) measurements were selected.

CONCLUSIONS

Frequency of osteoporosis varies notably according to the skeletal zone considered.

Osteoporosis diagnosis and screening

Osteoporosis and osteoporotic fracture are major causes of morbidity and mortality in the United States and worldwide. Nearly half of all women and one quarter of men >50 years of age will experience an osteoporosis-related fracture during their lifetime. The diagnosis of osteoporosis in postmenopausal women and older men can be made definitively by comparing bone mineral density (BMD) measurements from dual-energy x-ray absorptiometry (DXA) to mean peak bone mass in young adults. Efforts to increase access to DXA and improve the sensitivity and specificity of osteoporosis risk assessment instruments may help ensure that individuals with osteoporosis are diagnosed early. The early identification of individuals with low BMD and/or clinical risk factors, accurate diagnosis of osteoporosis and osteopenia, and initiation of appropriate treatment are crucial to reducing the incidence of vertebral and nonvertebral fractures. The World Health Organization is moving toward absolute risk assessment and this may help to better identify patients for screening and treatment in the future.