Association between body mass index and osteoporosis in women from northwestern Rio Grande do Sul

Prevalence of osteopenic syndrome and osteoporosis among residents of the older age group of Kyrgyzstan

Osteoporosis is the most common metabolic bone disease. However, because it is asymptomatic, it cannot be diagnosed until a clinical event such as a fracture occurs. It is osteoporotic fractures, not osteoporosis itself, that lead to noticeable clinical and economic consequences.

The aim. To study the frequency of osteopenia and osteoporosis in the older age group of the population of Kyrgyzstan using ultrasound bone densitometry.

Materials and methods. A total of 1988 people were examined – 1105 women, 883 men. By age, the patients were divided into three age groups: 40–59, 60–74 and 75–90 years old. A portable ultrasonic bone densitometer SONOST-3000 (South Korea) was used to measure bone mineral density.

Results. The prevalence of osteoporosis, osteopenia, and normal bone mineral density in the first age group was 20.9 %, 40.0 % and 39.1 %; in the second group – 30.2 %, 38.9 % and 30.9 %, and in the third group – 39.9 %, 34.9 % and 25.2 %, respectively. The incidence of osteoporosis increased with age and was gender-dependent – more common in women (p < 0.05 and p < 0.041, respectively). The probability of developing osteoporosis was lower in patients with a higher body weight (p < 0.002). Smoking had a bad effect on bone density (p < 0.001), physical exercise, on the contrary, inhibited the development of osteoporosis (p < 0.001). The use of alcohol and tea had no effect on the development of osteoporosis in our study (p = 0.421, p = 0.387, respectively).

Conclusions. The study of osteoporosis from an epidemiological point of view in Kyrgyz residents revealed a higher-than-expected incidence of osteoporosis according to densitometry. Further large-scale studies are needed throughout the country, which will help to understand the outcome of low bone mineral density in the population of Kyrgyz residents.

The circadian rhythm of calcium and bone homeostasis in Maasai

OBJECTIVES

Ethnic groups differ in prevalence of calcium-related diseases. Differences in the physiology and the endogenous circadian rhythm (CR) of calcium and bone homeostasis may play a role. Thus, we aimed to investigate details of CR pattern in calcium and bone homeostasis in East African Maasai.

METHODS

Ten clinically healthy adult Maasai men and women from Tanzania were examined. Blood samples were collected every 2nd hour for 24 h. Serum levels of total calcium, albumin, parathyroid hormone (PTH), 25(OH)D, creatinine, C-terminal telopeptide (CTX), bone-specific alkaline phosphatase (BSAP), procollagen type 1 N-terminal propeptide (P1NP), and osteocalcin were measured. Circadian patterns were derived from graphic curves of medians, and rhythmicity was assessed with Fourier analysis.

RESULTS

PTH-levels varied over the 24 h exhibiting a bimodal pattern. Nadir level corresponded to 65% of total 24-h mean. CTX and P1NP showed 24-h variations with a morning nadir and nocturnal peak with nadir levels corresponding to 23% and 79% of the 24-h mean, respectively. Albumin-corrected calcium level was held in a narrow range and alterations were corresponding to alterations in PTH. There was no distinct pattern in 24-h variations of 25(OH)D, creatinine, osteocalcin, or BSAP.

CONCLUSIONS

All participants showed pronounced 24-h variations in PTH and bone turnover markers CTX and P1NP. These findings support that Maasai participants included in this study have typical patterns of CR in calcium and bone homeostasis consistent with findings from other ethnic populations.

Increased Glycemic Variability Evaluated by Continuous Glucose Monitoring is Associated with Osteoporosis in Type 2 Diabetic Patients

BACKGROUND

Subjects with type 2 diabetes mellitus (T2DM) are susceptible to osteoporosis. This study was conducted to evaluate the association between glycemic variability evaluated by continuous glucose monitoring (CGM) and osteoporosis in type 2 diabetic patient.

METHODS

A total of 362 type 2 diabetic subjects who underwent bone mineral density (BMD) measurement and were monitored by a CGM system from Jan 2019 to May 2020 were enrolled in this cross-sectional study. Glycemic variability was calculated with the Easy GV software, including 24-hour mean blood glucose (24-h MBG), the standard deviation of 24-h MBG (SDBG), coefficient of variation (CV), mean amplitude of glycemic excursions (MAGE), and time in range between 3.9 and 10.0 mmol/L (TIR). Other potential influence factors for osteoporosis were also examined.

RESULTS

Based on the T-scores of BMD measurement, there were 190 patients with normal bone mass, 132 patients with osteopenia and 40 patients with osteoporosis. T2DM patients with osteoporosis showed a higher 24-h MBG, SDBG, CV, and MAGE, but a lower TIR (all p < 0.05). Multivariate logistic regression analysis revealed that age, female gender, body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), serum uric acid (SUA) and MAGE independently contribute to osteoporosis, and corresponding odds ratio [95% confidence interval (CI)] was 1.129 (1.072-1.190), 4.215 (1.613-11.012), 0.801 (0.712-0.901), 2.743 (1.385-5.431), 0.993 (0.988-0.999), and 1.380 (1.026-1.857), respectively. Further receiver operating characteristic analysis with Youden index indicated that the area under the curve and its 95% CI were 0.673 and 0.604-0.742, with the optimal cut-off value of MAGE predicting osteoporosis being 4.31 mmol/L.

CONCLUSION

In addition to conventional influence factors including age, female gender, BMI, LDL-C and SUA, increased glycemic variability assessed by MAGE is associated with osteoporosis in type 2 diabetic patients.

Nutrition, Physical Activity, and Dietary Supplementation to Prevent Bone Mineral Density Loss: A Food Pyramid

Bone is a nutritionally modulated tissue. Given this background, aim of this review is to evaluate the latest data regarding ideal dietary approach in order to reduce bone mineral density loss and to construct a food pyramid that allows osteopenia/osteoporosis patients to easily figure out what to eat. The pyramid shows that carbohydrates should be consumed every day (3 portions of whole grains), together with fruits and vegetables (5 portions; orange-colored fruits and vegetables and green leafy vegetables are to be preferred), light yogurt (125 mL), skim milk (200 mL,) extra virgin olive oil (almost 20 mg/day), and calcium water (almost 1 l/day); weekly portions should include fish (4 portions), white meat (3 portions), legumes (2 portions), eggs (2 portions), cheeses (2 portions), and red or processed meats (once/week). At the top of the pyramid, there are two pennants: one green means that osteopenia/osteoporosis subjects need some personalized supplementation (if daily requirements cannot be satisfied through diet, calcium, vitamin D, boron, omega 3, and isoflavones supplementation could be an effective strategy with a great benefit/cost ratio), and one red means that there are some foods that are banned (salt, sugar, inorganic phosphate additives). Finally, three to four times per week of 30-40 min of aerobic and resistance exercises must be performed.

Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis

BACKGROUND

The association between obesity and fracture risk may be skeletal site- and sex-specific but results among studies are inconsistent. Whilst several studies reported higher bone mineral density (BMD) in patients with obesity, altered bone quality could be a major determinant of bone fragility in this population.

OBJECTIVES

This systematic review and meta-analysis aimed to compare, in men, premenopausal women and postmenopausal women with obesity vs. individuals without obesity: 1) the incidence of fractures overall and by site; 2) BMD; and 3) bone quality parameters (circulating bone turnover markers and bone microarchitecture and strength by advanced imaging techniques).

DATA SOURCES

PubMed (MEDLINE), EMBASE, Cochrane Library and Web of Science were searched from inception of databases until the 13th of January 2021.

DATA SYNTHESIS

Each outcome was stratified by sex and menopausal status in women. The meta-analysis was performed using a random-effect model with inverse-variance method. The risks of hip and wrist fracture were reduced by 25% (n = 8: RR = 0.75, 95% CI: 0.62, 0.91, P = 0.003, I2 = 95%) and 15% (n = 2 studies: RR = 0.85, 95% CI: 0.81, 0.88), respectively, while ankle fracture risk was increased by 60% (n = 2 studies: RR = 1.60, 95% CI: 1.52, 1.68) in postmenopausal women with obesity compared with those without obesity. In men with obesity, hip fracture risk was decreased by 41% (n = 5 studies: RR = 0.59, 95% CI: 0.44, 0.79). Obesity was associated with increased BMD, better bone microarchitecture and strength, and generally lower or unchanged circulating bone resorption, formation and osteocyte markers. However, heterogeneity among studies was high for most outcomes, and overall quality of evidence was very low to low for all outcomes.

CONCLUSIONS

This meta-analysis highlights areas for future research including the need for site-specific fracture studies, especially in men and premenopausal women, and studies comparing bone microarchitecture between individuals with and without obesity.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42020159189.

Serum resistin levels as predictor of low bone mineral density in postmenopausal women

Resistin, a novel adipokine may play an important role in bone metabolism. The study is designed to discover the association of bone mineral density (BMD) with serum resistin levels, anthropometric measures and to elucidate serum resistin as a predictor of BMD in postmenopausal women. Postmenopausal women (n = 160) were recruited and divided into two groups, non-osteoporotic (n = 70) and osteoporotic (n = 90). BMD was evaluated by DXA scan. High serum resistin levels and low weight are independent contributors to low BMD and can influence BMD at lumbar spine, right femoral neck, right hip, left femoral neck, and left hip in postmenopausal women.

Dietary Pattern and Bone Health in Pre and Post-menopausal Obese Women

BACKGROUND AND OBJECTIVE

Obesity and osteoporosis are worldwide health problems that interact with each other. There are also affected by the menopause and dietary pattern. So, this study aimed to find the relation between osteoporosis, body weight and intake of protein, calcium and vitamin D in obese pre and post-menopausal women.

MATERIALS AND METHODS

One hundred and sixteen shared as volunteers in a cross-section study lasted for 2 years. They were divided into 2 groups, pre and post-menopausal women. All women were subjected to, clinical examination, anthropometric measurements and 24 dietary recalls. They were evaluated for bone mass density, biochemical analysis for serum lipids, calcium and vitamin D.

RESULTS

Osteopenia and osteoporosis were higher among normal-weight and overweight (non-obese) women compared to obese as well weakly associated with their serum lipids. The mean daily protein consumption was high as compared to recommended daily allowances (RDAs), especially among osteoporotic women. The mean daily intake of vitamin D and calcium was low as the lower level was noticed among the osteoporotic premenopausal patients. The means serum concentration of calcium and vitamin D were adequate.

CONCLUSION

Data revealed that the prevalence of osteoporosis was lower among obese patients compared to non-obese women. Inadequate daily dietary intake of calcium and vitamin D was reported, however, physiological compensation maintained their optimal normal serum levels.

The Relation Between Calcaneus Stiffness Index as a Measure of Bone Density and Body Mass Index in an Egyptian Cohort

BACKGROUND

Obesity and osteoporosis are two conditions that are associated with morbidity and mortality; there is contradictory evidence regarding this association.

PURPOSE

The aim of the current study was to explore further the association between obesity and calcaneus stiffness index (CSI), as a measure of bone density, in a community-based cross-sectional study in an Egyptian population.

METHODS

A cross-sectional study was conducted among active subjects, aged ≥20 years old, over one year. CSI was measured by Quantitative ultrasound (QUS), in addition; QUS T-score and Z-score of the non-dominant heel scan were recorded.

RESULTS

Two hundred and eighty participants were recruited; 7 subjects were excluded because of Z score more than -2, mean age was 61 (± 11.9) years, and mean BMI was 29.7 (±5.6). Female participants were 77.7%, with mean of age 60.3 (± 11.6); and age range 20-82 years. Male participants were 22.3%, with mean of age 63.6 (± 12.7); and age range 30-80 years. Older subjects (>55 years) had significantly lower CSI and worse T-score than the younger subjects (P < 0.001 for both). In the younger age group, BMI was not significantly associated with CSI, even after adjustment for gender (P= 0.52). However, in the older age group, BMI was significantly associated with stiffness index (P= 0.049, O.R.= 1.73), even after adjustment for gender (P= 0.041, O.R.= 1.7).

CONCLUSION

Compared to young subjects, older subjects (≥55 years) had significantly lower bone strength as measured by CSI, and their BMI was significantly positively associated with bone density. In younger people (<55 years), BMI was not associated with bone strength.

A novel quantitative method for estimating bone mineral density using B-mode ultrasound and radiofrequency signals-a pilot study on patients with rheumatoid arthritis

The objective of the present study was to evaluate whether an innovative quantitative ultrasound (QUS) technique, Radiofrequency Echographic Multi Spectromety, which combines B-mode ultrasound and radiofrequency signals, is reliable in typical Romanian patients compared to previous results obtained using dual-energy X-ray absorptiometry (DXA). The study prospectively included previously unscreened post-menopausal females with rheumatoid arthritis (RA) and age-matched healthy controls. Bone mineral density (BMD) measurements were performed with an EchoS machine (Echolight^®), which combines B-mode ultrasound and radiofrequency signals. The study included 106 RA patients, with a median disease duration of 3.2 (0.5–22) years and 119 controls. RA patients had a significantly lower body weight, body mass index (BMI) and basal metabolic rate (BMR) than the controls, while the prevalence of obesity and body fat differed insignificantly. RA patients had a significantly lower spine and hip BMD, higher fracture risk and higher prevalence of osteoporosis. Compared to RA patients without osteoporosis, those with osteoporosis were significantly older and had a longer menopause duration, but they had a significantly lower BMI, body fat, BMR and prevalence of obesity. Among the controls and RA patients, the median spine and hip BMD became significantly higher as the BMI increased from underweight to obesity. In conclusion, osteoporosis is prevalent among RA patients, as a part of a complex transformation of body mass composition, involving BMI and fat mass. The novel QUS scanning technique was able to replicate the results of the established DXA measurement of BMD and is potentially suitable for screening wide populations for osteoporosis.

Association between 25-Hydroxyvitamin D, Parathyroid Hormone, Vitamin D and Calcium Intake, and Bone Density in Healthy Adult Women: A Cross-Sectional Analysis from the D-SOL Study

There is still limited data on the association between 25-hydroxyvitamin D (25(OH)D), parathyroid hormone (PTH), and bone health in healthy younger adults, particularly in Latin America. This cross-sectional analysis aimed to investigate the associations of 25(OH)D and plasma PTH concentrations with bone parameters, and potential confounders, in women living in a high (England) or low (Brazil) latitude country. Bone was assessed by either peripheral quantitative computed tomography (pQCT) (England) or dual-energy x-ray absorptiometry (DXA) scan (Brazil), serum 25(OH)D concentrations by high performance liquid chromatography tandem mass spectrometry (HPLC-MS) and PTH by the chemiluminescent method. In participants living in England, total volumetric bone mineral density (vBMD) was significantly higher in women <29 years compared to ≥30 years, and total and cortical vBMD values at the 66% site were negatively correlated with weight and body mass index (BMI). In participants living in Brazil, age was positively correlated with bone mineral density (BMD) at the femur and bone mineral content (BMC), and weight, BMI, and body fat were correlated with BMD (lumbar spine and femur) and BMC. PTH concentrations were negatively correlated with 25(OH)D concentrations, and the prevalence of secondary hyperparathyroidism was 28.6% (n = 14) in participants with concentrations <25 nmol/L and 12.2% (n = 41) with concentrations between 25 and 49.9 nmol/L, compared to 6.3% (n = 79) in those with concentrations ≥50 nmol/L. In conclusion, weight and BMI were significantly correlated with bone parameters in both groups and age was significantly correlated with BMD at the femoral neck for women living in Brazil only. Although 25(OH)D concentrations were not correlated to bone parameters at any sites, in either country, PTH concentrations showed a significant correlation with total vBMD at the 66% site for women living in England. Secondary hyperparathyroidism was more common amongst those with deficient and insufficient vitamin D status.

Association of Lifestyle and Food Consumption with Bone Mineral Density among People Aged 50 Years and Above Attending the Hospitals of Kathmandu, Nepal

BACKGROUND

Bone mineral density (BMD) is the measure of the minerals, mostly calcium and phosphorous, contained in certain volume of bone to diagnose osteoporosis. The aim of the study was to find out the association of lifestyle and food consumption with BMD.

METHODS

An analytical cross-sectional study was conducted among 169 people of age 50 years and above who underwent Dual Energy X-Ray Absorptiometry (DEXA or DXA) scan in the hospitals of Kathmandu valley of Nepal. Food frequency questionnaire and 24-hour recall methods were followed. The DXA reports of the participants were observed to identify osteoporosis. Chi-square test, independent sample t-test, and binary logistic regression were applied to explore the association of BMD with different variables.

RESULT

The prevalence of osteoporosis, osteopenia, and normal BMD was 37.3%, 38.5%, and 24.2%, respectively. The prevalence of osteoporosis increased with sex and age (AOR 3.339, CI: 1.240-8.995, p-value 0.017; AOR 3.756, CI: 1.745-8.085, p-value 0.001), respectively. Higher BMI was associated with lower odds of osteoporosis (AOR 0.428, CI: 0.209-0.877, p-value 0.020). Smoking had bad effect on the health of bone (AOR 3.848, CI: 1.179-12.558, p-value 0.026). Daily dietary calcium intake had negative association with osteoporosis with the p-value of 0.003; however, the daily consumption of vitamin D rich food had no association with osteoporosis.

CONCLUSION

High prevalence of osteoporosis and osteopenia was found in older people. Osteoporosis was found to be significantly associated with sex, age, lower BMI, smoking habit, and daily calcium consumption. Further research can be conducted by making the relationship of calcium consumption with the numerical T-value of scanned body parts.