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Kumar A, Ghosh R. A review on experimental and numerical investigations of cortical bone fracture. Proc Inst Mech Eng H 2022; 236:297-319. [DOI: 10.1177/09544119211070347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper comprehensively reviews the various experimental and numerical techniques, which were considered to determine the fracture characteristics of the cortical bone. This study also provides some recommendations along with the critical review, which would be beneficial for future research of fracture analysis of cortical bone. Cortical bone fractures due to sports activities, climbing, running, and engagement in transport or industrial accidents. Individuals having different diseases are also at high risk of cortical bone fracture. It has been observed that osteon orientation influences cortical bone fracture toughness and fracture mechanisms. Apart from this, recent studies indicate that fracture parameters of cortical bone also depend on many factors such as age, sex, temperature, osteoporosis, orientation, location, loading condition, strain rate, and storage facility, etc. The cortical bone regains its fracture toughness due to various toughening mechanisms. Owing to these factors, several experimental, clinical, and numerical investigations have been carried out to determine the fracture parameters of the cortical bone. Cortical bone is the dense outer surface of the bone and contributes to 80%–82% of the skeleton mass. Cortical bone experiences load far exceeding body weight due to muscle contraction and the dynamics of motion. It is very important to know the fracture pattern, direction of fracture, location of the fracture, and toughening mechanism of cortical bone. A basic understanding of the different factors that affect the fracture parameters and fracture mechanisms of the cortical bone is necessary to prevent the failure and fracture of cortical bone. This review has summarized the advancement considered in the various experimental techniques and numerical methods to get complete information about the fracture mechanisms of cortical bone.
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Affiliation(s)
- Ajay Kumar
- School of Engineering, Indian Institute of Technology Mandi (IIT Mandi), Kamand, Mandi 175005, Himachal Pradesh, India
| | - Rajesh Ghosh
- School of Engineering, Indian Institute of Technology Mandi (IIT Mandi), Kamand, Mandi 175005, Himachal Pradesh, India
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2
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Basketball players possess a higher bone mineral density than matched non-athletes, swimming, soccer, and volleyball athletes: a systematic review and meta-analysis. Arch Osteoporos 2020; 15:123. [PMID: 32761271 DOI: 10.1007/s11657-020-00803-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/29/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Basketball athletes possess a higher bone mineral density (BMD) than matched non-athletes and swimming, soccer, and volleyball athletes. Differences appear to be exacerbated with continued training and competition beyond adolescence. The greater BMD in basketball athletes compared to non-athletes, swimming, and soccer athletes is more pronounced in males than females. PURPOSE The aim of this study was to examine differences in total and regional bone mineral density (BMD) between basketball athletes, non-athletes, and athletes competing in swimming, soccer, and volleyball, considering age and sex. METHODS PubMed, MEDLINE, ERIC, Google Scholar, and Science Direct were searched. Included studies consisted of basketball players and at least one group of non-athletes, swimming, soccer, or volleyball athletes. BMD data were meta-analyzed. Cohen's d effect sizes [95% confidence intervals (CI)] were interpreted as: trivial ≤ 0.20, small = 0.20-0.59, moderate = 0.60-1.19, large = 1.20-1.99, and very large ≥ 2.00. RESULTS Basketball athletes exhibited significantly (p < 0.05) higher BMD compared to non-athletes (small-moderate effect in total-body: d = 1.06, CI 0.55, 1.56; spine: d = 0.67, CI 0.40, 0.93; lumbar spine: d = 0.96, CI 0.57, 1.35; upper limbs: d = 0.70, CI 0.29, 1.10; lower limbs: d = 1.14, CI 0.60, 1.68; pelvis: d = 1.16, CI 0.05, 2.26; trunk: d = 1.00, CI 0.65, 1.35; and femoral neck: d = 0.57, CI 0.16, 0.99), swimming athletes (moderate-very large effect in total-body: d = 1.33, CI 0.59, 2.08; spine: d = 1.04, CI 0.60, 1.48; upper limbs: d = 1.19, CI 0.16, 2.22; lower limbs: d = 2.76, CI 1.45, 4.06; pelvis d = 1.72, CI 0.63, 2.81; and trunk: d = 1.61, CI 1.19, 2.04), soccer athletes (small effect in total-body: d = 0.58, CI 0.18, 0.97), and volleyball athletes (small effect in total-body: d = 0.32, CI 0.00, 0.65; and pelvis: d = 0.48, CI 0.07, 0.88). Differences in total and regional BMD between groups increased with age and appeared greater in males than in females. CONCLUSION Basketball athletes exhibit a greater BMD compared to non-athletes, as well as athletes involved in swimming, soccer, and volleyball.
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Dole NS, Yee CS, Mazur CM, Acevedo C, Alliston T. TGFβ Regulation of Perilacunar/Canalicular Remodeling Is Sexually Dimorphic. J Bone Miner Res 2020; 35:1549-1561. [PMID: 32282961 PMCID: PMC9126317 DOI: 10.1002/jbmr.4023] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 03/14/2020] [Accepted: 03/21/2020] [Indexed: 12/12/2022]
Abstract
Bone fragility is the product of defects in bone mass and bone quality, both of which show sex-specific differences. Despite this, the cellular and molecular mechanisms underpinning the sexually dimorphic control of bone quality remain unclear, limiting our ability to effectively prevent fractures, especially in postmenopausal osteoporosis. Recently, using male mice, we found that systemic or osteocyte-intrinsic inhibition of TGFβ signaling, achieved using the 9.6-kb DMP1 promoter-driven Cre recombinase (TβRIIocy-/- mice), suppresses osteocyte perilacunar/canalicular remodeling (PLR) and compromises bone quality. Because systemic TGFβ inhibition more robustly increases bone mass in female than male mice, we postulated that sex-specific differences in bone quality could likewise result, in part, from dimorphic regulation of PLR by TGFβ. Moreover, because lactation induces PLR, we examined the effect of TGFβ inhibition on the female skeleton during lactation. In contrast to males, female mice that possess an osteocyte-intrinsic defect in TGFβ signaling were protected from TGFβ-dependent defects in PLR and bone quality. The expression of requisite PLR enzymes, the lacunocanalicular network (LCN), and the flexural strength of female TβRIIocy-/- bone was intact. With lactation, however, bone loss and induction in PLR and osteocytic parathyroid hormone type I receptor (PTHR1) expression, were suppressed in TβRIIocy-/- bone, relative to the control littermates. Indeed, differential control of PTHR1 expression, by TGFβ and other factors, may contribute to dimorphism in PLR regulation in male and female TβRIIocy-/- mice. These findings provide key insights into the sex-based differences in osteocyte PLR that underlie bone quality and highlight TGFβ signaling as a crucial regulator of lactation-induced PLR. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Neha S Dole
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Cristal S Yee
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Courtney M Mazur
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, CA, USA.,University of California (UC) Berkeley-UCSF Graduate Program in Bioengineering, San Francisco, CA, USA
| | - Claire Acevedo
- Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Tamara Alliston
- Department of Orthopaedic Surgery, University of California, San Francisco (UCSF), San Francisco, CA, USA
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4
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Korpinen N, Oura P, Väre T, Niskanen M, Niinimäki J, Karppinen J, Junno JA. Temporal Trends in Vertebral Dimensions - a case study from Finland. Sci Rep 2020; 10:1635. [PMID: 32005864 PMCID: PMC6994481 DOI: 10.1038/s41598-020-58340-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 01/03/2020] [Indexed: 11/16/2022] Open
Abstract
Vertebral fractures and other back problems represent a major, increasing worldwide health problem. This has increased the need to better understand the reasons behind this phenomenon. In addition to a reduction in bone mineral density and overall size of the vertebral body, research has indicated a possible association between the shape of the endplate and spinal disorders. As one previous study has shown changes in vertebral body dimensions between contemporary people and their medieval counterparts, we wanted to examine the potential temporal trends in vertebral size and dimensions in Finnish samples of archaeological and contemporary individuals. To conduct this study, we utilized three archaeological populations from the 16th–19th century and clinical materials from two population-based Finnish birth cohorts. As the average height of people has increased greatly since the first time period, we also height-adjusted the dimensions to provide a clearer picture of the dimensional changes that have occurred in the later temporal group. Our results were in agreement with those of the earlier study. The archaeological samples had a larger vertebral size than the contemporary population when height was adjusted for. Vertebral mediolateral width in particular had decreased, and the shape of the vertebral body had changed.
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Affiliation(s)
- Niina Korpinen
- Faculty of Humanities, Department of Archaeology, University of Oulu, Oulu, Finland.
| | - Petteri Oura
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Faculty of Medicine, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Tiina Väre
- Faculty of Humanities, Department of Archaeology, University of Oulu, Oulu, Finland
| | - Markku Niskanen
- Faculty of Humanities, Department of Archaeology, University of Oulu, Oulu, Finland
| | - Jaakko Niinimäki
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Faculty of Medicine, Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Jaro Karppinen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Finnish Institute of Occupational Health, Oulu, Finland
| | - Juho-Antti Junno
- Faculty of Humanities, Department of Archaeology, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Faculty of Medicine, Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Faculty of Medicine, Cancer and Translational Medicine Research Unit, University of Oulu, Oulu, Finland
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5
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Greenwood C, Clement J, Dicken A, Evans P, Lyburn I, Martin RM, Stone N, Zioupos P, Rogers K. Age-Related Changes in Femoral Head Trabecular Microarchitecture. Aging Dis 2018; 9:976-987. [PMID: 30574411 PMCID: PMC6284768 DOI: 10.14336/ad.2018.0124] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/24/2018] [Indexed: 11/20/2022] Open
Abstract
Osteoporosis is a prevalent bone condition, characterised by low bone mineral density and increased fracture risk. Currently, the gold standard for identifying osteoporosis and increased fracture risk is through quantification of bone mineral density using dual energy X-ray absorption. However, many studies have shown that bone strength, and consequently the probability of fracture, is a combination of both bone mass and bone 'quality' (architecture and material chemistry). Although the microarchitecture of both non-fracture and osteoporotic bone has been previously investigated, many of the osteoporotic studies are constrained by factors such as limited sample number, use of ovariectomised animal models, and lack of male and female discrimination. This study reports significant differences in bone quality with respect to the microarchitecture between fractured and non-fractured human femur specimens. Micro-computed tomography was utilised to investigate the microarchitecture of femoral head trabecular bone from a relatively large cohort of non-fracture and fracture human donors. Various microarchitectural parameters have been determined for both groups, providing an understanding of the differences between fracture and non -fracture material. The microarchitecture of non-fracture and fracture bone tissue is shown to be significantly different for many parameters. Differences between sexes also exist, suggesting differences in remodelling between males and females in the fracture group. The results from this study will, in the future, be applied to develop a fracture model which encompasses bone density, architecture and material chemical properties for both female and male tissues.
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Affiliation(s)
| | - John Clement
- Melbourne Dental School, University of Melbourne, Melbourne, Australia.
| | - Anthony Dicken
- The Imaging Science Group, Nottingham Trent University, Nottingham, UK.
| | - Paul Evans
- The Imaging Science Group, Nottingham Trent University, Nottingham, UK.
| | | | | | - Nick Stone
- Physics and Astronomy, Exeter University, Exeter, UK.
| | - Peter Zioupos
- Cranfield Forensic Institute, Cranfield University, Shrivenham, UK.
| | - Keith Rogers
- Cranfield Forensic Institute, Cranfield University, Shrivenham, UK.
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Self-reported protein intake and properties of bone in community-dwelling older individuals. Arch Osteoporos 2018; 13:10. [PMID: 29388047 PMCID: PMC5846856 DOI: 10.1007/s11657-018-0421-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 12/21/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study revealed that a quick and simple estimation of protein intake was related to measures of bone density and area in 70-year-old individuals. Furthermore, these associations were mediated by muscle mass when investigating peripheral measurement sites such as arms and legs. PURPOSE Recent evidence suggests that dietary protein is beneficial for bone health in older individuals, but less is known about the influence of muscle mass on this relationship. This cross-sectional study aimed to investigate associations among protein intake, bone health, and muscle mass in 2332 men and women aged 70 years. METHODS Volumetric bone mineral density of the radius and tibia was measured using peripheral quantitative computed tomography. Using dual-energy X-ray absorptiometry, we measured areal bone mineral density (aBMD) at the L1-L4 vertebrae, radius, and femoral neck, together with appendicular lean mass. Participants reported their average meal size and proportion of meat/fish intake. Associations were investigated using multiple linear regression models, adjusted for multiple covariates. RESULTS Self-reported protein intake was associated with aBMD of the femoral neck (β = 0.082) and L1-L4 vertebrae (β = 0.063) in men (both p < 0.05) after adjusting for multiple covariates, including appendicular muscle mass. No significant association was detected among women. In addition, protein intake was associated with tibial cortical area (β = 0.08), periosteal circumference (β = 0.072), radial aBMD (β = 0.064), and trabecular area (β = 0.078) in men (all p < 0.05), although these associations were attenuated after adjustment for appendicular muscle mass (all p > 0.05). CONCLUSION Self-reported protein intake was associated with bone properties in 70-year-old men. The strength of these associations in peripheral bone sites may be partially mediated by muscle mass from protein intake.
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Burke ÉA, Carroll R, O’Dwyer M, Walsh JB, McCallion P, McCarron M. Osteoporosis and People with Down Syndrome: A Preliminary Descriptive Examination of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing Wave 1 Results. Health (London) 2018. [DOI: 10.4236/health.2018.109095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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8
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Doria C, Leali PT, Solla F, Maestretti G, Balsano M, Scarpa RM. Denosumab is really effective in the treatment of osteoporosis secondary to hypogonadism in prostate carcinoma patients? A prospective randomized multicenter international study. ACTA ACUST UNITED AC 2017; 13:195-199. [PMID: 28228781 DOI: 10.11138/ccmbm/2016.13.3.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Osteoporosis is a complication of androgen deprivation therapy (ADT) in men with prostate carcinoma. The best defense against osteoporosis in prostate cancer is to identify patients with a high risk for fracture during the first clinical visit, select an effective anti-osteoporosis agent, and advise the patient to change his lifestyle and diet to prevent further bone loss. New agents include denosumab, a human monoclonal antibody that inhibits the RANK ligand (RANKL). RANKL promotes the formation, activity, and survival of osteoclasts and, thus, supports the breakdown of bone. PURPOSE This is a multicenter, randomized, double-blind prospective study on use of denosumab versus alendronate in the therapy of secondary osteoporosis related to ADT in prostate cancer patients in three European countries (Italy, France, Switzerland). PATIENTS AND METHODS In this 24-month observation study we enrolled 234 patients with diagnosis of osteoporosis underwent ADT for prostate cancer. All patients aged ≥55 years and had a dual-energy X-ray absorptiometry (DEXA) T-score <-1.0 (hip or spine, measured within last 2 years) and ≥ 1 fragility fracture. Patients were randomly assigned 1:1 to receive denosumab 60 mg subcutaneously every 6 months or alendronate (70 mg weekly) for 2 years. All patient received supplemental vitamin D (600 IU per day) and supplemental calcium to maintain a calcium intake of 1200 mg per day. Effectiveness of therapy in both groups (denosumab group and alendronate group) was assessed by changes in bone turnover markers (BTMs), Bone Mineral Density (BMD), fracture incidence, Visual Analogue Scale (VAS) score for back pain, and Short Form-8 (SF-8TM) health survey score for health-related quality of life (HRQoL). Percent changes from baseline in BTMs and BMD were assessed using the paired t test; a P-value 0.05). Mean changes in BMD at final follow-up differed significantly between two groups. BMD changes at the lumbar spine at 24 months were 5.6% with denosumab vs -1.1% with alendronate (P<0.001). New vertebral fractures developed in fewer patients in the denosumab group than in the alendronate group during the 24-month period, although this difference was not significant (P=0.10). Back pain significantly (P<0.001) improved from baseline at all time points during the study in both study groups. SF-8 health survey scores significantly improved following treatment with both drugs. Incidence of adverse drug reactions were similar in both groups. CONCLUSION In our study denosumab and alendronate showed similar clinical efficacy in the therapy of ADT-related osteoporosis in men with prostate carcinoma; both drugs provided significant improvements in back pain and general health conditions. Denosumab showed significant increase of BTMs and BMD than alendronate with lower rate of new vertebral fractures.
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Affiliation(s)
- Carlo Doria
- Orthopaedic Department, University of Sassari, Italy
| | | | - Federico Solla
- Orthopaedic Department, Paediatric Hospital Nice CHU-Lenval, France
| | | | - Massimo Balsano
- Orthopaedic Department, Santorso Hospital AUSSL 4 Schio, Italy
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Johansson J, Nordström A, Nordström P. Objectively measured physical activity is associated with parameters of bone in 70-year-old men and women. Bone 2015; 81:72-79. [PMID: 26151120 DOI: 10.1016/j.bone.2015.07.001] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 06/25/2015] [Accepted: 07/01/2015] [Indexed: 11/22/2022]
Abstract
As the world's population ages, the occurrence of osteoporosis-related fractures is projected to increase. Low areal bone mineral density (aBMD), a well-known risk factor for fractures, may be influenced by physical activity (PA). In this cross-sectional study, we aimed to investigate potential associations between objective measures of PA and bone properties, in a population-based cohort of 1228 70-year-old men and women. We measured volumetric BMD (vBMD, mg/cm(3)) together with cross-sectional area (CSA, mm(2)) by peripheral quantitative computed tomography at sites located 4% and 66% in the distal-proximal trajectory at the tibia and radius. We also measured aBMD (g/cm(2)) by dual energy X-ray absorptiometry at the femoral neck, lumbar spine (L1-L4) and radius. Participants wore triaxial accelerometers for 7 consecutive days to obtain objective estimates of PA. The intensity of the objective PA was divided into light (100-1951 counts/min [CPM]), moderate (1952-5724 cpm) and vigorous (≥ 5725 cpm). Maximal accelerations for the anterior-posterior (z), medio-lateral (x), and vertical (y) axes were also separately assessed. Associations were investigated using bivariate correlations and multiple linear regression, adjusted for height, weight and sex. Vigorous PA showed the strongest association with femoral neck aBMD (β=0.09, p<0.001), while both moderate and vigorous PAs were associated with cortical area and trabecular vBMD in the weight-bearing tibia (all p<0.05). Peak vertical accelerations were associated significantly with cortical area (β=0.09, p<0.001) and trabecular vBMD (β=0.09, p=0.001) of the tibia, whereas peak anterior-posterior accelerations showed no correlation with these properties. No positive association was found between objectively measured PA and bone parameters of the radius. In conclusion, vertical accelerations and moderate to vigorous PA independently predict bone properties, especially in the weight-bearing tibia, in 70-year-old men and women.
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Affiliation(s)
- Jonas Johansson
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden; Department of Community Medicine and Rehabilitation, Sports Medicine, Umeå University, Umeå, Sweden
| | - Anna Nordström
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
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Junno JA, Paananen M, Karppinen J, Niinimäki J, Niskanen M, Maijanen H, Väre T, Järvelin MR, Nieminen MT, Tuukkanen J, Ruff C. Age-related trends in vertebral dimensions. J Anat 2015; 226:434-9. [PMID: 25913516 DOI: 10.1111/joa.12295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2015] [Indexed: 11/29/2022] Open
Abstract
Several studies have demonstrated age-related changes in vertebral dimensions. Vertebral size has been reported to increase among elderly adults, with periosteal apposition resulting in increased cross-sectional area (CSA) of the vertebral corpus combined with reduction in bone mineral density. These changes in CSA are observed to be sex-specific, as the pronounced increase of vertebral CSA is found only in elderly males. However, the reduction in bone mineral density in old age is apparent within both sexes. It is thus hypothesized that higher fracture risk in elderly women is a result of their incapacity to increase vertebral size and thus adapt to bone mineral reduction. In this study, our aim was to explore whether the onset of these changes could be ascribed to specific age intervals and whether the proposed differences between the sexes are as great as previously suggested. To conduct this study we utilized two large early 20th century skeletal collections known as Terry and Bass (n = 181). We also utilized data from two lumbar spine magnetic resonance imaging samples as a modern-day reference (n = 497). Age, sex and ethnicity of all individuals were known. Vertebral CSA was determined by measuring three width and length dimensions from the corpus of the fourth lumbar vertebra (L4). Our results indicate only a moderate association between age and vertebral CSA. This association was observed to be relatively similar in both sexes, and we thus conclude that there is no clear sex-specific compensatory mechanism for age-related bone loss in vertebral size.
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Affiliation(s)
- Juho-Antti Junno
- Department of Anatomy and Cell Biology, Medical Research Center Oulu, University of Oulu, Oulu, Finland.,Department of Archaeology, University of Oulu, Oulu, Finland.,Center for Functional Anatomy and Evolution, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Markus Paananen
- Centre for Life Course Epidemiology and Systems Medicine, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jaro Karppinen
- Centre for Life Course Epidemiology and Systems Medicine, Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.,Finnish Institute of Occupational Health, Work and Health Ability and Disability Prevention Centre, Oulu, Finland
| | - Jaakko Niinimäki
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Center for Medical Imaging, Physics and Technology Research, University of Oulu, Oulu, Finland
| | - Markku Niskanen
- Department of Archaeology, University of Oulu, Oulu, Finland
| | - Heli Maijanen
- Department of Archaeology, University of Oulu, Oulu, Finland
| | - Tiina Väre
- Department of Archaeology, University of Oulu, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Institute of Health Sciences, Public Health and General Practice, University of Oulu, Oulu, Finland.,Biocenter Oulu, University of Oulu, Oulu, Finland.,National Institute of Health and Welfare, Oulu, Finland.,Department of Biostatistics and Epidemiology, Faculty of Medicine, School of Public Health, Imperial College, London, UK
| | - Miika T Nieminen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.,Center for Medical Imaging, Physics and Technology Research, University of Oulu, Oulu, Finland
| | - Juha Tuukkanen
- Department of Anatomy and Cell Biology, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Christopher Ruff
- Center for Functional Anatomy and Evolution, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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González-Cerón F, Rekaya R, Aggrey SE. Genetic analysis of bone quality traits and growth in a random mating broiler population. Poult Sci 2015; 94:883-9. [PMID: 25784765 DOI: 10.3382/ps/pev056] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 11/20/2022] Open
Abstract
We report the genetic relationship between growth and bone quality traits in a random mating broiler control population. Traits studied were growth rates from week 0 to 4 [body weight gain (BWG) 0 to 4], from week 0 to 6 (BWG 0 to 6), and residual feed intake (RFI) from week 5 to 6 (RFI 5 to 6). Bone quality traits were obtained at 6 weeks of age. These traits were shank weight (SW), shank length (SL), shank diameter (SDIAM), tibia weight (TW), tibia length (TL), and tibia diameter (TDIAM). Likewise, tibia was used to obtain the tibia density (TDEN), tibia breaking strength (TBS), tibia mineral density (TMD), tibia mineral content (TMC), and tibia ash content (TAC). At the phenotypic level, growth traits were positively correlated with most of the bone quality traits except with TDEN and TAC which tended to show unfavorable associations (-0.04 to -0.31). Heritability of bone quality traits ranged from 0.08 to 0.54. The additive genetic associations of growth traits with weight, length, and diameter of shank and tibia were positive (0.37 to 0.80). A similar pattern was observed with TMD and TMC (0.06 to 0.65). In contrast, growth traits showed unfavorable genetic associations with TDEN, TBS, and TAC (-0.03 to -0.18). It was concluded that bone quality traits have an additive genetic background and they can be improved by means of genetic tools. It appears that selection for growth is negatively correlated with some traits involved in the integrity, health, and maturity of leg bones.
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Affiliation(s)
- F González-Cerón
- NutriGenomics Laboratory, Department of Poultry Science, University of Georgia, Athens, GA 30602
| | - R Rekaya
- Department of Animal and Dairy Science, University of Georgia, Athens, GA, 30602
| | - S E Aggrey
- NutriGenomics Laboratory, Department of Poultry Science, University of Georgia, Athens, GA 30602
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12
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Morgans AK, Fan KH, Koyama T, Albertsen PC, Goodman M, Hamilton AS, Hoffman RM, Stanford JL, Stroup AM, Penson DF. Bone complications among prostate cancer survivors: long-term follow-up from the prostate cancer outcomes study. Prostate Cancer Prostatic Dis 2014; 17:338-42. [PMID: 25134939 PMCID: PMC4227957 DOI: 10.1038/pcan.2014.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/27/2014] [Accepted: 07/15/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND To assess the relationship between androgen deprivation therapy (ADT) exposure and self-reported bone complications among men in a population-based cohort of prostate cancer survivors followed for 15 years after diagnosis. METHODS The Prostate Cancer Outcomes Study enrolled 3533 patients diagnosed with prostate cancer between 1994 and 1995. This analysis included participants with non-metastatic disease at the time of diagnosis who completed 15-year follow-up surveys to report development of fracture, and use of bone-related medications. The relationship between ADT duration and bone complications was assessed using multivariable logistic regression models. RESULTS Among 961 surviving men, 157 (16.3%) received prolonged ADT (>1 year), 120 (12.5%) received short-term ADT (⩽ 1 year) and 684 (71.2%) did not receive ADT. Men receiving prolonged ADT had higher odds of fracture (OR 2.5; 95% confidence interval (CI): 1.1-5.7), bone mineral density testing (OR 5.9; 95% CI: 3.0-12) and bone medication use (OR 4.3; 95% CI: 2.3-8.0) than untreated men. Men receiving short-term ADT reported rates of fracture similar to untreated men. Half of men treated with prolonged ADT reported bone medication use. CONCLUSIONS In this population-based cohort study with long-term follow-up, prolonged ADT use was associated with substantial risks of fracture, whereas short-term use was not. This information should be considered when weighing the advantages and disadvantages of ADT in men with prostate cancer.
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Affiliation(s)
- A K Morgans
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - K-H Fan
- 1] Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA [2] Vanderbilt University Center for Quantitative Sciences and Department of Biostatistics, Nashville, TN, USA
| | - T Koyama
- 1] Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA [2] Vanderbilt University Center for Quantitative Sciences and Department of Biostatistics, Nashville, TN, USA
| | - P C Albertsen
- University of Connecticut Health Center, Farmington, CT, USA
| | | | - A S Hamilton
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R M Hoffman
- University of New Mexico, Albuquerque, NM, USA
| | - J L Stanford
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - A M Stroup
- University of Utah, Salt Lake City, UT, USA
| | - D F Penson
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN, USA
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13
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Rizzoli R, Branco J, Brandi ML, Boonen S, Bruyère O, Cacoub P, Cooper C, Diez-Perez A, Duder J, Fielding RA, Harvey NC, Hiligsmann M, Kanis JA, Petermans J, Ringe JD, Tsouderos Y, Weinman J, Reginster JY. Management of osteoporosis of the oldest old. Osteoporos Int 2014; 25:2507-29. [PMID: 25023900 DOI: 10.1007/s00198-014-2755-9] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/16/2014] [Indexed: 12/25/2022]
Abstract
UNLABELLED This consensus article reviews the diagnosis and treatment of osteoporosis in geriatric populations. Specifically, it reviews the risk assessment and intervention thresholds, the impact of nutritional deficiencies, fall prevention strategies, pharmacological treatments and their safety considerations, the risks of sub-optimal treatment adherence and strategies for its improvement. INTRODUCTION This consensus article reviews the therapeutic strategies and management options for the treatment of osteoporosis of the oldest old. This vulnerable segment (persons over 80 years of age) stands to gain substantially from effective anti-osteoporosis treatment, but the under-prescription of these treatments is frequent. METHODS This report is the result of an ESCEO (European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis) expert working group, which explores some of the reasons for this and presents the arguments to counter these beliefs. The risk assessment of older individuals is briefly reviewed along with the differences between some intervention guidelines. The current evidence on the impact of nutritional deficiencies (i.e. calcium, protein and vitamin D) is presented, as are strategies to prevent falls. One possible reason for the under-prescription of pharmacological treatments for osteoporosis in the oldest old is the perception that anti-fracture efficacy requires long-term treatment. However, a review of the data shows convincing anti-fracture efficacy already by 12 months. RESULTS The safety profiles of these pharmacological agents are generally satisfactory in this patient segment provided a few precautions are followed. CONCLUSION These patients should be considered for particular consultation/follow-up procedures in the effort to convince on the benefits of treatment and to allay fears of adverse drug reactions, since poor adherence is a major problem for the success of a strategy for osteoporosis and limits cost-effectiveness.
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Affiliation(s)
- R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland,
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14
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BRANDOLINI NICOLA, CRISTOFOLINI LUCA, VICECONTI MARCO. EXPERIMENTAL METHODS FOR THE BIOMECHANICAL INVESTIGATION OF THE HUMAN SPINE: A REVIEW. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414300026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In vitro mechanical testing of spinal specimens is extremely important to better understand the biomechanics of the healthy and diseased spine, fracture, and to test/optimize surgical treatment. While spinal testing has extensively been carried out in the past four decades, testing methods are quite diverse. This paper aims to provide a critical overview of the in vitro methods for mechanical testing the human spine at different scales. Specimens of different type are used, according to the aim of the study: spine segments (two or more adjacent vertebrae) are used both to investigate the spine kinematics, and the mechanical properties of the spine components (vertebrae, ligaments, discs); single vertebrae (whole vertebra, isolated vertebral body, or vertebral body without endplates) are used to investigate the structural properties of the vertebra itself; core specimens are extracted to test the mechanical properties of the trabecular bone at the tissue-level; mechanical properties of spine soft tissue (discs, ligaments, spinal cord) are measured on isolated elements, or on tissue specimens. Identification of consistent reference frames is still a debated issue. Testing conditions feature different pre-conditioning and loading rates, depending on the simulated action. Tissue specimen preservation is a very critical issue, affecting test results. Animal models are often used as a surrogate. However, because of different structure and anatomy, extreme caution is required when extrapolating to the human spine. In vitro loading conditions should be based on reliable in vivo data. Because of the high complexity of the spine, such information (either through instrumented implants or through numerical modeling) is currently unsatisfactory. Because of the increasing ability of computational models in predicting biomechanical properties of musculoskeletal structures, a synergy is possible (and desirable) between in vitro experiments and numerical modeling. Future perspectives in spine testing include integration of mechanical and structural properties at different dimensional scales (from the whole-body-level down to the tissue-level) so that organ-level models (which are used to predict the most relevant phenomena such as fracture) include information from all dimensional scales.
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Affiliation(s)
- NICOLA BRANDOLINI
- Laboratory for Medical Technology, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
- School of Mechanical Engineering, University of Leeds, Woodhouse Lane, LS2 9JT Leeds, UK
| | - LUCA CRISTOFOLINI
- Department of Industrial Engineering, School of Engineering and Architecture, University of Bologna, Viale Risorgimento 2, 40136 Bologna, Italy
| | - MARCO VICECONTI
- Laboratory for Medical Technology, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136 Bologna, Italy
- Department of Mechanical Engineering, University of Sheffield, Sheffield, UK
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15
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Vale AC, Aleixo IP, Lúcio M, Saraiva A, Caetano-Lopes J, Rodrigues A, Amaral PM, Rosa LG, Monteiro J, Fonseca JE, Vaz MF, Canhão H. At the moment of occurrence of a fragility hip fracture, men have higher mechanical properties values in comparison with women. BMC Musculoskelet Disord 2013; 14:295. [PMID: 24131745 PMCID: PMC4015558 DOI: 10.1186/1471-2474-14-295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 10/01/2013] [Indexed: 02/04/2023] Open
Abstract
Background It is well established that males have lower fracture risk in comparison with females, which suggests a higher bone resistance in men. The aim of our study was to find out if in older patients with hip fragility fractures, gender has also an impact on trabecular bone material behaviour, specifically to determine whether trabecular mechanical properties under compressive loading differ between men and women who suffered a fragility hip fracture. Methods Femoral epiphyses were consecutively collected during hip replacement surgery due to proximal femur fragility fracture. Trabecular bone cylinders were drilled and submitted to uniaxial compression tests and mechanical properties were assessed. Results Seventy-three patients, 55 women (mean age 81 years and standard deviation of 7 years) and 18 men (mean age 81 years and standard deviation of 8 years) were evaluated. The ultimate stress of trabecular bone was significantly higher in men than in women: the median values and the interquartile range (IQR) were respectively 8.04(5.35-10.90) MPa vs. 4.46(3.02-7.73) MPa, (p-value = 0.005). The same difference between male and female was observed in the Young’s modulus: 293.68(166.67-538.18) MPa vs. 174.26(73.07-322.28) MPa, (p-value = 0.028), and also in the energy to failure: 0.25(0.07-0.42) MJ/m3 vs. 0.11(0.05-0.25) MJ/m3, (p-value = 0.058). These differences were also verified after adjusting the analysis for age in a multivariate model analysis. Conclusions Our observations demonstrated that, even in a population who suffered a fragility hip fracture, men still have higher trabecular bone mechanical properties in comparison with women.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - João E Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
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16
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Smith MR, Morton RA, Barnette KG, Sieber PR, Malkowicz SB, Rodriguez D, Hancock ML, Steiner MS. Toremifene to reduce fracture risk in men receiving androgen deprivation therapy for prostate cancer. J Urol 2013; 189:S45-50. [PMID: 23234631 DOI: 10.1016/j.juro.2012.11.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE Androgen deprivation therapy is associated with fracture risk in men with prostate cancer. We assessed the effects of toremifene, a selective estrogen receptor modulator, on fracture incidence in men receiving androgen deprivation therapy during a 2-year period. MATERIALS AND METHODS In this double-blind, placebo controlled phase III study 646 men receiving androgen deprivation therapy for prostate cancer were assigned to toremifene (80 mg by mouth daily) and 638 were assigned to placebo. Subjects were followed for 2 years. The primary study end point was new vertebral fractures. Secondary end points included fragility fractures, bone mineral density and lipid changes. RESULTS The 2-year incidence of new vertebral fractures was 4.9% in the placebo group vs 2.5% in the toremifene group, a significant relative risk reduction of 50% (95% CI -1.5 to 75.0, p = 0.05). Toremifene significantly increased bone mineral density at the lumbar spine, hip and femoral neck vs placebo (p <0.0001 for all comparisons). There was a concomitant decrease in markers of bone turnover (p <0.05 for all comparisons). Toremifene also significantly improved lipid profiles. Venous thromboembolic events occurred more frequently with toremifene than placebo with 7 subjects (1.1%) in the placebo group experiencing a venous thromboembolic event vs 17 (2.6%) in the toremifene group. Other adverse events were similar between the groups. CONCLUSIONS Toremifene significantly decreased the incidence of new vertebral fractures in men receiving androgen deprivation therapy for prostate cancer. It also significantly improved bone mineral density, bone turnover markers and serum lipid profiles.
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Affiliation(s)
- Matthew R Smith
- Massachusetts General Hospital Cancer Center, 55 Fruit St., Boston, MA 02114, USA.
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17
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Rodrigues AM, Caetano-Lopes J, Vale AC, Aleixo I, Pena AS, Faustino A, Sepriano A, Polido-Pereira J, Vieira-Sousa E, Lucas R, Romeu JC, Monteiro J, Vaz MF, Fonseca JE, Canhão H. Smoking is a predictor of worse trabecular mechanical performance in hip fragility fracture patients. J Bone Miner Metab 2012; 30:692-9. [PMID: 22886402 DOI: 10.1007/s00774-012-0370-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/21/2012] [Indexed: 10/28/2022]
Abstract
Clinical risk factors (CRFs) are established predictors of fracture events. However, the influence of individual CRFs on trabecular mechanical fragility is still a subject of debate. In this study, we aimed to assess differences, adjusted for CRFs, between bone macrostructural parameters measured in ex-vivo specimens from hip fragility fracture patients and osteoarthritis patients, and to determine whether individual CRFs could predict trabecular bone mechanical behavior in hip fragility fractures. Additionally, we also looked for associations between the 10-year risk of major and hip fracture calculated by FRAX and trabecular bone mechanical performance. In this case-control study, a group of fragility fracture patients were compared with a group of osteoarthritis patients, both having undergone hip replacement surgery. A clinical protocol was applied in order to collect CRFs [body mass index (BMI), prior fragility fracture, parental history of hip fracture, long-term use of oral glucocorticoids, rheumatoid arthritis, current smoking, alcohol consumption, age and gender]. The 10-year probability of fracture was calculated. Serum bone turnover markers were determined and dual X-ray absorptiometry performed. Femoral head diameter was evaluated and trabecular bone cylinders were drilled for mechanical testing to determine bone strength, stiffness and toughness. We evaluated 40 hip fragility fracture and 52 osteoarthritis patients. Trabecular bone stiffness was significantly lower (p = 0.042) in hip fragility fracture patients when compared to osteoarthritic individuals, adjusted for age, gender and BMI. No other macrostructural parameter was statistically different between the groups. In hip fragility fracture patients, smoking habits (β = -0.403; p = 0.018) and female gender (β = -0.416; p = 0.008) were independently associated with lower stiffness. In addition, smoking was also independently associated with worse trabecular strength (β = -0.323; p = 0.045), and toughness (β = -0.403; p = 0.018). In these patients, the 10-year risk of major (r = -0.550; p = 0.012) and hip fracture (r = -0.513; p = 0.021) calculated using only CRFs was strongly correlated with femoral neck bone mineral density but not with mechanical performance. Our data showed that among fragility fracture patients active smoking is a predictor of worse intrinsic trabecular mechanical performance, and female gender is also independently associated with lower stiffness. In this population, the 10-year risk of fracture using CRFs with different weights only reflects bone mass loss but not trabecular mechanical properties.
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Affiliation(s)
- Ana Maria Rodrigues
- Rheumatology Research Unit, Instituto de Medicina Molecular, Lisbon, Portugal
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18
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Griffith JF, Genant HK. New advances in imaging osteoporosis and its complications. Endocrine 2012; 42:39-51. [PMID: 22618377 DOI: 10.1007/s12020-012-9691-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/30/2012] [Indexed: 01/08/2023]
Abstract
Tremendous advances have been made over the past several decades in assessing osteoporosis and its complications. High resolution imaging combined with sophisticated computational techniques now provide a detailed analysis of bone structure and a much more accurate prediction of bone strength. These techniques have shown how different mechanisms of age-related bone weakening exist in males and females. Limitations peculiar to these more advanced imaging techniques currently hinder their adoption into mainstream clinical practice. As such, the ultimate quest remains a readily available, safe, high resolution technique capable of fully predicting bone strength, capable of showing how bone strength is faltering and precisely monitoring treatment effect. Whether this technique will be based on acquisition of spine/hip data or data obtained at peripheral sites reflective of changes happening in the spine and hip regions is still not clear. In the meantime, mainstream imaging will continue to improve the detection of osteoporosis related insufficiency fracture in the clinical setting. We, as clinicians, should aim to increase awareness of this fracture type both as a frequent and varied source of pain in patients with osteoporosis and as the ultimate marker of severely impaired bone strength.
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Affiliation(s)
- James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong.
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19
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Abdulameer SA, Syed Sulaiman SA, Hassali MAA, Subramaniam K, Sahib MN. Is there a link between osteoporosis and type 1 diabetes? Findings from a systematic review of the literature. Diabetol Int 2012. [DOI: 10.1007/s13340-012-0083-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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20
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Pedone C, Napoli N, Pozzilli P, Rossi FF, Lauretani F, Bandinelli S, Ferrucci L, Antonelli-Incalzi R. Dietary pattern and bone density changes in elderly women: a longitudinal study. J Am Coll Nutr 2011; 30:149-54. [PMID: 21730223 DOI: 10.1080/07315724.2011.10719954] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Few data are available on the effect of the diet in general on bone health. The objective of this study was to identify dietary patterns and to evaluate the association between such patterns and bone mineral density (BMD) changes over time. METHODS We analyzed a sample of women aged ≥65 years participating in the InCHIANTI Study. BMD was evaluated using computed tomography of the tibia and nutritional intake using the EPIC questionnaire. We used a cluster analysis to identify patterns of dietary intake. The clusters were compared with respect to nutritional intake; risk factors for osteoporosis; comorbidity; total, trabecular, and cortical BMD; and BMD changes over 6 years. RESULTS The sample size was 434, with a mean age of 75.2 years (SD, 7.01 years; range, 65-94 years). Based on dietary variables, 2 clusters were identified with a marked difference in energy intake (30 kcal/kg of ideal body weight [IBW] in cluster 1 vs 44 kcal/kg IBW in cluster 2). We found no meaningful differences between clusters with regard to nondietary risk factors for osteoporosis, BMD measured at baseline, and changes in BMD over the 6-year follow-up; cluster 2 showed a greater increase in cortical BMD (+30.2 mg/cm(3) vs +16.7 mg/cm(3)). Members of cluster 2 were less likely to have a lower cortical BMD increase (adjusted odds ratio, 0.452; 95% confidence interval, 0.215-0.950). CONCLUSIONS Cortical BMD increases more in participants eating a diet exceeding the RDA for macronutrients. Cortical BMD may be more sensitive to diet and dietary interventions than trabecular bone.
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Affiliation(s)
- Claudio Pedone
- Area di Geriatria, Università Campus Biomedico, Rome, Italy.
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21
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Lu Y, Liu YZ, Liu PY, Dvornyk V, Deng HW. A bootstrap-based regression method for comprehensive discovery of differential gene expressions: an application to the osteoporosis study. Eur J Med Genet 2011; 54:e560-4. [PMID: 21843665 DOI: 10.1016/j.ejmg.2011.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 07/08/2011] [Indexed: 10/17/2022]
Abstract
UNLABELLED A common purpose of microarray experiments is to study the variation in gene expression across the categories of an experimental factor such as tissue types and drug treatments. However, it is not uncommon that the studied experimental factor is a quantitative variable rather than categorical variable. Loss of information would occur by comparing gene-expression levels between groups that are factitiously defined according to the quantitative threshold values of an experimental factor. Additionally, lack of control for some sensitive clinical factors may bring serious false positive or negative findings. In the present study, we described a bootstrap-based regression method for analyzing gene-expression data from the non-categorical microarray experiments. To illustrate the utility of this method, we applied it to our recent gene-expression study of circulating monocytes in subjects with a wide range of variations in bone mineral density (BMD). This method allows a comprehensive discovery of gene expressions associated with osteoporosis-related traits while controlling other common confounding factors such as height, weight and age. Several genes identified in our study are involved in osteoblast and osteoclast functions and bone remodeling and/or menopause-associated estrogen-dependent pathways, which provide important clues to understand the etiology of osteoporosis. AVAILABILITY SAS code is available from the authors upon request.
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Affiliation(s)
- Yan Lu
- College of Life Sciences and Bioengineering, Beijing Jiaotong University, Beijing 100044, PR China
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22
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Morgans AK, Smith MR. RANKL-Targeted Therapies: The Next Frontier in the Treatment of Male Osteoporosis. J Osteoporos 2011; 2011:941310. [PMID: 22013547 PMCID: PMC3196262 DOI: 10.4061/2011/941310] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 07/13/2011] [Indexed: 11/20/2022] Open
Abstract
Male osteoporosis is an increasingly recognized problem in aging men. A common cause of male osteoporosis is hypogonadism. Thousands of men with prostate cancer are treated with androgen deprivation therapy, a treatment that dramatically reduces serum testosterone and causes severe hypogonadism. Men treated with androgen deprivation therapy experience a decline in bone mineral density and have an increased rate of fracture. This paper describes prostate cancer survivors as a model of hypogonadal osteoporosis and discusses the use of RANKL-targeted therapies in osteoporosis. Denosumab, the only RANKL-targeted therapy currently available, increases bone mineral density and decreases fracture rate in men with prostate cancer. Denosumab is also associated with delayed time to first skeletal-related event and an increase in bone metastasis-free survival in these men. It is reasonable to investigate the use of RANKL-targeted therapy in male osteoporosis in the general population.
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Smith MR, Morton RA, Barnette KG, Sieber PR, Malkowicz SB, Rodriguez D, Hancock ML, Steiner MS. Toremifene to reduce fracture risk in men receiving androgen deprivation therapy for prostate cancer. J Urol 2010; 184:1316-21. [PMID: 20723926 PMCID: PMC3047407 DOI: 10.1016/j.juro.2010.06.022] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE Androgen deprivation therapy is associated with fracture risk in men with prostate cancer. We assessed the effects of toremifene, a selective estrogen receptor modulator, on fracture incidence in men receiving androgen deprivation therapy during a 2-year period. MATERIALS AND METHODS In this double-blind, placebo controlled phase III study 646 men receiving androgen deprivation therapy for prostate cancer were assigned to toremifene (80 mg by mouth daily) and 638 were assigned to placebo. Subjects were followed for 2 years. The primary study end point was new vertebral fractures. Secondary end points included fragility fractures, bone mineral density and lipid changes. RESULTS The 2-year incidence of new vertebral fractures was 4.9% in the placebo group vs 2.5% in the toremifene group, a significant relative risk reduction of 50% (95% CI -1.5 to 75.0, p = 0.05). Toremifene significantly increased bone mineral density at the lumbar spine, hip and femoral neck vs placebo (p <0.0001 for all comparisons). There was a concomitant decrease in markers of bone turnover (p <0.05 for all comparisons). Toremifene also significantly improved lipid profiles. Venous thromboembolic events occurred more frequently with toremifene than placebo with 7 subjects (1.1%) in the placebo group experiencing a venous thromboembolic event vs 17 (2.6%) in the toremifene group. Other adverse events were similar between the groups. CONCLUSIONS Toremifene significantly decreased the incidence of new vertebral fractures in men receiving androgen deprivation therapy for prostate cancer. It also significantly improved bone mineral density, bone turnover markers and serum lipid profiles.
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Affiliation(s)
- Matthew R Smith
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114, USA.
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24
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Zhang Y, Kuipers AL, Yerges-Armstrong LM, Nestlerode CS, Jin Z, Wheeler VW, Patrick AL, Bunker CH, Zmuda JM. Functional and association analysis of frizzled 1 (FZD1) promoter haplotypes with femoral neck geometry. Bone 2010; 46:1131-7. [PMID: 20051274 PMCID: PMC2842476 DOI: 10.1016/j.bone.2009.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 12/22/2009] [Accepted: 12/22/2009] [Indexed: 11/27/2022]
Abstract
Frizzleds are receptors for Wnt signaling and are involved in skeletal morphogenesis. Little is known about the transcriptional regulation of frizzleds in bone cells. In the current study, we determined if two common and potentially functional genetic variants (rs2232157, rs2232158) in the frizzled-1 (FZD1) promoter region and their haplotypes influence FZD1 promoter activity in human osteoblast-like cells. We also determined if these variants are associated with femoral neck bone mineral density (BMD) and geometry in 1319 African ancestry men aged > or =40 years. Real-time quantitative PCR and western blot analysis demonstrated FZD1 mRNA and protein expression in the human osteoblast-like cell lines, MG63 and SaOS-2. Promoter activity was next assessed by transient expression of haplotype specific FZD1 promoter reporter plasmids in these cells. In comparison to the common GG haplotype, promoter activity was 3-fold higher for the TC haplotype in both cell lines (p<0.05). We previously demonstrated that rs2232158 is associated with differential FZD1 promoter activity and Egr1 binding and thus focused further functional analyses on the rs2232157 G-to-T polymorphism. Electrophoretic mobility shift assay demonstrated that distinct nuclear protein complexes were associated with rs2232157 in an allele specific manner. Bioinformatics analysis predicted that the G to T transversion creates an E2F1 binding site, further supporting the functional significance of rs2232157 in FZD1 promoter regulation. Individual SNPs and haplotypes were not associated with femoral neck BMD. The TC haplotype was associated with larger subperiosteal width and greater CSMI (p<0.05). These results suggest that FZD1 expression is regulated in a haplotype-dependent manner in osteoblasts and that these same haplotypes may be associated with biomechanical indices of bone strength.
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Affiliation(s)
- Yingze Zhang
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA
- Dorothy P. & Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Zhao Jin
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Joseph M. Zmuda
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, PA
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25
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Prostate cancer survivorship: prevention and treatment of the adverse effects of androgen deprivation therapy. J Gen Intern Med 2009; 24 Suppl 2:S389-94. [PMID: 19838837 PMCID: PMC2763167 DOI: 10.1007/s11606-009-0968-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND More than one-third of the estimated 2 million prostate cancer survivors in the United States receive androgen deprivation therapy (ADT). This population of mostly older men is medically vulnerable to a variety of treatment-associated adverse effects. MEASUREMENTS AND RESULTS Androgen-deprivation therapy (ADT) causes loss of libido, vasomotor flushing, anemia, and fatigue. More recently, ADT has been shown to accelerate bone loss, increase fat mass, increase cholesterol and triglycerides, and decrease insulin sensitivity. Consistent with these adverse metabolic effects, ADT has also recently been associated with greater risks for fractures, diabetes and cardiovascular disease. CONCLUSION Primary care clinicians and patients should be aware of the potential benefits and harms of ADT. Screening and intervention to prevent treatment-related morbidity should be incorporated into the routine care of prostate cancer survivors. Evidence-based guidelines to prevent fractures, diabetes, and cardiovascular disease in prostate cancer survivors represent an important unmet need. We recommend the adapted use of established practice guidelines designed for the general population.
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Junno JA, Niskanen M, Nieminen MT, Maijanen H, Niinimäki J, Bloigu R, Tuukkanen J. Temporal trends in vertebral size and shape from medieval to modern-day. PLoS One 2009; 4:e4836. [PMID: 19279681 PMCID: PMC2652716 DOI: 10.1371/journal.pone.0004836] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Accepted: 02/03/2009] [Indexed: 11/18/2022] Open
Abstract
Human lumbar vertebrae support the weight of the upper body. Loads lifted and carried by the upper extremities cause significant loading stress to the vertebral bodies. It is well established that trauma-induced vertebral fractures are common especially among elderly people. The aim of this study was to investigate the morphological factors that could have affected the prevalence of trauma-related vertebral fractures from medieval times to the present day. To determine if morphological differences existed in the size and shape of the vertebral body between medieval times and the present day, the vertebral body size and shape was measured from the 4th lumbar vertebra using magnetic resonance imaging (MRI) and standard osteometric calipers. The modern samples consisted of modern Finns and the medieval samples were from archaeological collections in Sweden and Britain. The results show that the shape and size of the 4th lumbar vertebra has changed significantly from medieval times in a way that markedly affects the biomechanical characteristics of the lumbar vertebral column. These changes may have influenced the incidence of trauma- induced spinal fractures in modern populations.
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Affiliation(s)
- Juho-Antti Junno
- Department of Anatomy and Cell Biology, University of Oulu, Oulu, Finland.
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Ostertag A, Cohen-Solal M, Audran M, Legrand E, Marty C, Chappard D, de Vernejoul MC. Vertebral fractures are associated with increased cortical porosity in iliac crest bone biopsy of men with idiopathic osteoporosis. Bone 2009; 44:413-7. [PMID: 19071239 DOI: 10.1016/j.bone.2008.11.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Revised: 09/05/2008] [Accepted: 11/06/2008] [Indexed: 11/30/2022]
Abstract
In men, vertebral fractures are poorly associated with bone density, and both cortical and trabecular micro-architectural changes could contribute to bone fragility. Bone histomorphometry makes it possible to investigate both the thickness and porosity of cortical bone, which has been reported to have a major impact on the biomechanical properties of bone. We therefore conducted a cross sectional study using iliac crest biopsies to investigate the trabecular and cortical bone structure in men with or without vertebral fractures. We selected 93 bone biopsies from men with idiopathic osteoporosis (defined as a T-score <-2.5), between 40 and 70 years of age. Patients were divided into two groups on the basis of the presence (n=46) or absence (n=47) of prevalent vertebral fracture (VFX). We measured micro-architectural indices in trabecular and cortical bone by histomorphometry at the iliac crest. Patients with VFX had lower trabecular bone volume (BV/TV: 12.4+/-3.8 versus 14.7+/-3.1 % (m+/-SD)), p<0.01), higher trabecular separation (Tb.Sp: 871+/-279 versus 719+/-151 microm, p<0.01), and higher marrow star volume (V*(m.space): 1.617+/-1.257 versus 0.945+/-0.466 mm(3), p<0.01). Cortical thickness (Ct.Th) was the same in patients with or without VFX, whereas cortical porosity (Ct.Po) was higher in patients with VFX (6.5+/-2.6 versus 5.0+/-2.0 %, p<0.01), because their Haversian canals had higher mean areas (8291+/-4135 versus 5438+/-2809 microm(2), p<0.001). There was no correlation between any trabecular and cortical micro-architectural parameters. Using a logistic regression model, we evaluated the VFX as a function of the V*(m.space) and Ct.Po, adjusted for age. The odds-ratio of having a VFX was 3.89 (95% CI 1.19-12.7, p=0.02) for the third tertile of V*(m.space) (adjusted on age and Ct.Po), and 4.07 (95% CI 1.25-13.3, p=0.02) for the third tertile of Ct.Po (adjusted on age and V*(m.space)). Our data show that both trabecular and cortical bone microarchitecture contribute independently to vertebral fractures in men with idiopathic osteoporosis. In contrast to data reported in women, in men it is cortical porosity, and not cortical width, that is associated with vertebral fractures. This suggests that the cortical deficit is different in men and in women with fragility fractures.
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Affiliation(s)
- Agnès Ostertag
- INSERM, U606, and Université Paris Diderot, Centre Viggo Petersen, Hôpital Lariboisière, Paris, France.
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Efstathiou JA, Bae K, Shipley WU, Hanks GE, Pilepich MV, Sandler HM, Smith MR. Cardiovascular mortality after androgen deprivation therapy for locally advanced prostate cancer: RTOG 85-31. J Clin Oncol 2008; 27:92-9. [PMID: 19047297 DOI: 10.1200/jco.2007.12.3752] [Citation(s) in RCA: 185] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Gonadotropin-releasing hormone (GnRH) agonists are associated with greater risk of coronary heart disease and myocardial infarction in men with prostate cancer, but little is known about potential impact on cardiovascular mortality. We assessed the relationship between GnRH agonists and cardiovascular mortality in a large randomized phase III trial of men treated with or without adjuvant goserelin after radiation therapy (RT) for locally advanced prostate cancer. PATIENTS AND METHODS Between 1987 and 1992, 945 men with locally advanced prostate cancer were randomly assigned to RT and adjuvant goserelin or RT alone. Fine and Gray's regression was used to evaluate treatment effect on cardiovascular mortality. Covariates included age, prevalent cardiovascular disease (CVD), hypertension, diabetes mellitus (DM), body mass index, race, Gleason score, stage, acid phosphatase level, prostatectomy history, and nodal involvement. RESULTS After a median follow-up of 8.1 years, there were 117 cardiovascular-related deaths but no treatment-related increase in cardiovascular mortality. At 9 years, cardiovascular mortality for men receiving adjuvant goserelin was 8.4% v 11.4% for men treated without adjuvant goserelin (Gray's P = .17). In multiple regression analyses, treatment arm was not significantly associated with increased risk of cardiovascular mortality (adjusted hazard ratio [HR] = 0.73; 95% CI, 0.47 to 1.15; P = .16; when censoring at time of salvage goserelin therapy, HR = 0.99; 95% CI, 0.58 to 1.69; P = .97). Traditional cardiac risk factors, including prevalent CVD and DM, were significantly associated with greater cardiovascular mortality. CONCLUSION GnRH agonists do not seem to increase cardiovascular mortality in men with locally advanced prostate cancer. Further studies are warranted to evaluate adverse effects of GnRH agonists in men with lower cancer-specific mortality.
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Affiliation(s)
- Jason A Efstathiou
- Department of Radiation Oncology and Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA 02114, USA
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Abstract
About one in three osteoporotic fractures occur in men, and the consequences of fractures are more severe in men. However, only too few men at high risk of fracture are detected and treated. There is no consensus definition of osteoporosis in men based on bone mineral density (BMD), and therapeutic decisions should be based on absolute fracture risk as estimated from age, BMD, fracture history, and additional clinical risk factors. In men, secondary osteoporosis deserves particular attention. Genetically determined alterations of bone mass acquisition during growth are involved in idiopathic osteoporosis in the young, whereas senile osteoporosis involves progressive bone loss throughout adult life. Estradiol appears to be the predominant sex steroid involved in regulation of bone maturation and metabolism. The evidence base for the long-term efficacy and safety of therapies for osteoporosis in men, including the bone-active agents (i.e. bisphosphonates and teriparatide), is limited, so that they should be applied with discernment based on clinical judgement and careful estimation of fracture risk.
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Affiliation(s)
- Jean M Kaufman
- Ghent University Hospital, Department of Endocrinology, Gent, Belgium.
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Efstathiou JA, Bae K, Shipley WU, Hanks GE, Pilepich MV, Sandler HM, Smith MR. Cardiovascular mortality and duration of androgen deprivation for locally advanced prostate cancer: analysis of RTOG 92-02. Eur Urol 2008; 54:816-23. [PMID: 18243498 DOI: 10.1016/j.eururo.2008.01.021] [Citation(s) in RCA: 151] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 01/04/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Gonadotropin-releasing hormone agonists (GnRHa) are associated with greater risk of coronary heart disease and myocardial infarction in men with prostate cancer, but little is known about their potential effects on cardiovascular mortality. We assessed the relationship between duration of GnRHa therapy and cardiovascular mortality in a large randomized trial of men treated with short-term versus longer-term adjuvant goserelin and radiation therapy (RT) for locally advanced prostate cancer. METHODS From 1992 to 1995, 1554 men with locally advanced prostate cancer (T2c-4, prostate-specific antigen [PSA] <150 ng/ml) received RT and 4 mo of goserelin and then were randomized to no additional therapy (arm 1) or 24 mo adjuvant goserelin (arm 2) in a phase 3 trial (Radiation Therapy Oncology Group [RTOG] 92-02). Cox regression analyses were performed to evaluate the relationship between treatment arm and cardiovascular mortality. Covariates included age, prevalent cardiovascular disease (CVD), hypertension, diabetes (DM), race, PSA, Gleason score, and stage. RESULTS After median follow-up of 8.1 yr, 185 cardiovascular-related deaths had occurred. No increase in cardiovascular mortality occurred for men receiving a longer duration of goserelin. At 5 yr, cardiovascular mortality for men receiving longer-term adjuvant goserelin was 5.9% versus 4.8% with short-term goserelin (Gray's p=0.16). In multivariate analyses, treatment arm was not significantly associated with increased risk of cardiovascular mortality (adjusted hazard ratio [HR]=1.09; 95% confidence interval [CI], 0.81-1.47; p=0.58; when censoring at time of salvage goserelin, HR=1.02, 95%CI, 0.73-1.43; p=0.9). Traditional cardiac risk factors, including age, prevalent CVD, and DM, were significantly associated with greater cardiovascular mortality. CONCLUSIONS Longer duration of adjuvant GnRHa therapy does not appear to increase cardiovascular mortality in men with locally advanced prostate cancer.
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Affiliation(s)
- Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, 100 Blossom Street, Boston, MA 02114, USA.
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Abstract
PURPOSE OF REVIEW Androgen deprivation therapy remains the cornerstone of treatment for advanced prostate cancer. There are significant adverse effects associated with prolonged androgen deprivation therapy, with recent findings associating it with the metabolic syndrome and its associated health risks. RECENT FINDINGS A review of the adverse pathologic effects of testosterone deprivation is performed. Recent findings associate androgen deprivation therapy with endocrine and metabolic disarray, specifically the metabolic syndrome, resulting in increased rates of diabetes and myocardial infarction in patients on testosterone deprivation. SUMMARY The increased incidence of the metabolic syndrome in patients receiving androgen deprivation therapy and the associated morbidity and possibly mortality require significant investigation into alternatives to complete testosterone deprivation and ways to counteract these adverse effects.
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Bone architecture of the hominin second proximal pedal phalanx: a preliminary investigation. J Hum Evol 2007; 54:162-8. [PMID: 18031789 DOI: 10.1016/j.jhevol.2007.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Revised: 08/26/2007] [Accepted: 09/18/2007] [Indexed: 11/24/2022]
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Herrmann M, Wildemann B, Claes L, Klohs S, Ohnmacht M, Taban-Shomal O, Hübner U, Pexa A, Umanskaya N, Herrmann W. Experimental hyperhomocysteinemia reduces bone quality in rats. Clin Chem 2007; 53:1455-61. [PMID: 17586593 DOI: 10.1373/clinchem.2007.086272] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Recently, hyperhomocysteinemia (HHCY) has been suggested as a new risk factor for osteoporosis. This study investigated if HHCY is a causal osteoporotic factor in vivo. METHODS We used 3 groups of rats: a control group (n = 20), a moderate HHCY group (induced by a 2.4% methionine-enriched diet, n = 10), and an intermediate HHCY group (induced by a 2% homocystine-enriched diet, n = 10). We measured bone fragility [maximum force of an axial compression test (F(max))], bone area as percentage of total area (BAr/TAr, histomorphometry), and biochemical bone turnover markers [osteocalcin (OC) and collagen I C-terminal crosslaps (CTx)]. RESULTS Compared with controls, 3 months of moderate or intermediate HHCY increased mean (SD) bone fragility at the femoral neck by 18% (6%) in methionine-fed (P = 0.001) and 36% (13%) in homocystine-fed rats (P <0.001). Mean (SD) BAr/TAr at the distal femur in methionine and homocystine groups was decreased by 45% (21%; P = 0.001) and 93% (9%; P = 0.001), respectively. At the femoral neck, BAr/TAr was decreased by 19% (11%; P <0.001) and 55% (19%; P <0.001). At the lumbar spine, the reduction of BAr/TAr was 17% (23%; P = 0.099) and 44% (19%; P <0.001). Plasma OC (bone formation marker) was decreased by 23% (20%; P = 0.006) and 34% (21%; P <0.001). Plasma CTx (bone resorption marker) did not differ between groups. CONCLUSION Bone quality is consistently decreased in the presence of increased circulating homocysteine. The results provide evidence that HHCY is a causal osteoporotic factor.
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Affiliation(s)
- Markus Herrmann
- Department of Clinical Chemistry and Laboratory Medicine, University Hospital of Saarland, Homburg/Saar, Germany
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Abstract
PURPOSE OF REVIEW The aim of this review is to summarize new concepts and concerns regarding treatment-related osteoporosis, diabetes, and cardiovascular disease in men receiving androgen deprivation therapy for prostate cancer. RECENT FINDINGS Gonadotropin-releasing hormone agonists increase bone turnover, decrease bone mineral density, and increase fracture risk. Bisphosphonates, selective and estrogen receptor modulators significantly increase bone mineral density during androgen deprivation therapy. Ongoing randomized controlled trials will assess efficacy of denosumab, toremifene, and zoledronic acid to prevent fractures in this setting. Gonadotropin-releasing hormone agonists also increase fat mass, decrease insulin sensitivity, and increase serum lipoproteins. In contrast to the classical metabolic syndrome, however, the phenotype of men during androgen deprivation therapy is characterized by increased high-density lipoprotein cholesterol and preferential accumulation of subcutaneous fat. Gonadotropin-releasing hormone agonists are associated with greater risk of incident diabetes and cardiovascular disease in men with prostate cancer. SUMMARY Androgen therapy increases risk of fractures, diabetes mellitus, and cardiovascular disease in men with prostate cancer. Current and planned studies will evaluate strategies to prevent these treatment-related adverse effects.
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Affiliation(s)
- Matthew R Smith
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114, USA.
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35
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Tommasini SM, Nasser P, Jepsen KJ. Sexual dimorphism affects tibia size and shape but not tissue-level mechanical properties. Bone 2007; 40:498-505. [PMID: 17035111 DOI: 10.1016/j.bone.2006.08.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 08/02/2006] [Accepted: 08/16/2006] [Indexed: 11/23/2022]
Abstract
Understanding how growth influences adult bone morphology and tissue quality should provide important insight into why females show a greater incidence of stress fractures early in life and fragility fractures later in life compared to males. The objective of this study was to test whether females acquire similar tissue-level mechanical properties as males by the time peak bone properties are established. Standardized beams of bone were machined from the tibial diaphyses of 14 young, adult females ranging in age from 22 to 46 years. Data for males (n=17, age=17-46 years) were taken from a prior study. Measures of tissue-level mechanical properties, including stiffness, strength, ductility, toughness, and damageability, were compared between sexes using t-tests. The relationship between cross-sectional morphology and tissue-level mechanical properties was also examined. Males and females showed nearly identical tissue-level mechanical properties. Both sexes also showed similar age-related degradation of mechanical properties and a similar relationship between cross-sectional morphology and tissue quality. However, for all body sizes, female tibiae were smaller relative to body size (i.e., less robust) compared to males. The results indicated that sex-specific growth patterns affected transverse bone size, but did not affect tissue-level mechanical properties. This, combined with the observation that young, adult female long bones are undersized relative to body size, suggests that adult females would be expected to accumulate more damage under intense loading compared to males. This may be a contributing factor to the greater incidence of stress fractures observed for female military recruits.
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Affiliation(s)
- Steven M Tommasini
- New York Center for Biomedical Engineering, CUNY Graduate School, Department of Biomedical Engineering, City College of New York, New York, NY, USA
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36
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Abstract
The intended therapeutic effect of gonadotropin-releasing hormone (GnRH) agonists is hypogonadism, a major cause of acquired osteoporosis in men. Consistent with this observation, GnRH agonists increase bone turnover and decrease bone mineral density, a surrogate for fracture risk. Large claims-based analyses and other retrospective studies provide compelling evidence that GnRH agonists increase risk of clinical fractures. Estrogens play a central role in homeostasis of the normal male skeleton, and estrogen deficiency rather than testosterone deficiency seems to be primarily responsible for the adverse skeletal effects of GnRH agonists. In randomized controlled trials, bisphosphonates (pamidronate and zoledronic acid) and selective estrogen receptor modulators (raloxifene and toremifene) increased bone mineral density in GnRH agonist-treated men. Two ongoing large randomized placebo-controlled studies will prospectively define fracture outcomes in men with prostate cancer and assess the efficacy of novel pharmacologic interventions (AMG162, toremifene) during GnRH agonist treatment.
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Affiliation(s)
- Matthew R Smith
- Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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37
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Abstract
This article describes the state of knowledge regarding gender differences with respect to hip fracture and its subsequent outcomes. Most of the work to date investigating hip fracture patients has been done with women, yet some evidence from a few studies with a significant number of male hip fracture patients and from nonfracture samples suggests that women and men may be different at the time of fracture and will have a different course of recovery.
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Pothiwala P, Evans EM, Chapman-Novakofski KM. Ethnic Variation in Risk for Osteoporosis among Women: A Review of Biological and Behavioral Factors. J Womens Health (Larchmt) 2006; 15:709-19. [PMID: 16910903 DOI: 10.1089/jwh.2006.15.709] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Most studies of risk factors for osteoporosis and nontraumatic fracture involve white women, although more research is being geared toward bone health among various ethnic groups. The purpose of this review is to provide an overview of health disparity in osteoporosis, including assessment of bone mineral density (BMD), bone health screening, lifestyle risk factors, and treatment involving white, black, Hispanic, Asian, and Native American women. This review summarizes evidence that white, Asian, Hispanic, and Native American women are more at risk for osteoporosis than black women. These conclusions are supported by the disparity in BMD between white and black women, although the reason for this biological difference is not well characterized. Additional research is needed to determine if there is a significant difference in BMD among Hispanic, Asian, and Native American women independent of body weight and size. Similarly, there is also disparity in fracture rates, with the causes presumed to be multifactorial. Calcium intake is lower than recommended in all females at all ages; however, it is much lower in black and Native American women and highest in white and Hispanic women. Black women also have a lower vitamin D status than white women, with mean vitamin D status of Hispanic American women lying between that of black and white women. Similarly, although white women are more active than black and Hispanic women at all ages, data are lacking about physical activity habits of women of other ethnic backgrounds and how this impacts bone health. Finally, screening protocols for women of various ethnicities and effectiveness of treatments are not well established and remain a priority in women's health.
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Affiliation(s)
- Pooja Pothiwala
- Department of Internal Medicine, University of Illinois, College of Medicine at Urbana, Illinois 61801, USA
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Kastelan D, Giljevic Z, Kraljevic I, Korsic M. Selective estrogen receptor modulators: A possible new treatment of osteoporosis in males. Med Hypotheses 2006; 67:1052-3. [PMID: 16790322 DOI: 10.1016/j.mehy.2006.04.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 04/04/2006] [Indexed: 10/24/2022]
Abstract
More recently, osteoporosis in men has been recognized as an important public health problem. Bone loss begins in mid life and is associated with the decline of the sex steroids production. Although there is no equivalent of the menopause, gonadal function in men is affected in a slow progressive way leading to hypogonadism. Testosterone, the major androgen in men, exerts its effect on bone by local conversion to 5alpha-dihydrotestosterone or by aromatization to estrogens. Several studies have found that estrogen, rather than testosterone, levels are more closely correlated with BMD in elderly men. Selective estrogen receptor modulator (SERM) raloxifene binds to estrogen receptors and exhibit estrogenic effect in bone, but, contrary to estrogen, without feminizing effect. There are limited numbers of studies investigating the effects of SERMs in males. Animal studies demonstrated that SERMs inhibit bone turnover and prevent bone loss in orchidectomised adult male rats. Raloxifene has been shown to increase bone mineral density of the hip in men receiving androgen deprivation therapy for prostate cancer. Moreover, experimental data demonstrated dramatic increase in cell death in human prostate cancer cell lines after the treatment with raloxifene. All these observations suggest that SERMs may be useful for the prevention and treatment of osteoporosis not only in postmenopausal women but also in elderly men. However, our hypothesis should be tested in a proper designed clinical trial. Several important issues have to be addressed. Does the same drug dose that has been shown to be effective in postmenopausal women should be used in men, too? Does treatment with SERMs reduce the fracture risk in men and is it comparable to that observed in women? Does treatment with SERMs have any beneficial effect on cardiovascular system and prostate cancer? And finally, do men experience adverse events other than women treated with SERMs? Answering to these questions will have great impact in getting the decision of possible SERMs usage in the treatment of osteoporosis in elderly males.
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Affiliation(s)
- Darko Kastelan
- Division of Endocrinology, Department of Internal Medicine, University Hospital Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
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Chappard D, Pascaretti-Grizon F, Gallois Y, Mercier P, Baslé MF, Audran M. Medullar fat influences texture analysis of trabecular microarchitecture on X-ray radiographs. Eur J Radiol 2006; 58:404-10. [PMID: 16443344 DOI: 10.1016/j.ejrad.2005.12.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2005] [Revised: 12/20/2005] [Accepted: 12/27/2005] [Indexed: 11/25/2022]
Abstract
Alteration of trabecular architecture is a predictor of fracture risk in osteoporosis. Until now, microarchitecture analysis is difficult to evaluate in routine clinical practice for osteoporosis. Texture analysis on X-ray images has been advocated to be a suitable method to assess microarchitecture in bone diseases. The X-ray acquisition conditions have been often taken into consideration; however, the influence of anatomical conditions on texture parameters has received little interest. Because fat is a well-known problem with computed tomography and densitometry, we have designed a cadaver study to compare the influence of marrow lipids on numerous texture parameters. Twenty-one human distal radii were obtained, radiographed, and analyzed using a software that measures: heterogeneity, skeletonized parameters, run-lengths and fractal dimensions. Texture parameters were measured before, and after an extensive delipidation period lasting 3 weeks. Quality of the radiographs was improved after defatting. Delipidation had a very significant effect on measurements: afterwards defatting, the images were less blurred, and a better delineation of trabeculae and marrow cavities was obtained. This provoked an increase of parameters based on the grey level distribution but had no influence on parameters describing the reticulated honeycomb microarchitecture of the trabeculae (i.e., fractal dimension). Some parameters appeared anisotropy-sensitive, due to the different constitution and size of the trabeculae. The fat content of bone marrow induces noise that can modify some texture parameters. One should take into account the fat content of the marrow when using texture analysis to compare patients with osteoporosis due to various etiologies.
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Affiliation(s)
- Daniel Chappard
- INSERM, EMI 0335, LHEA, Faculté de Médecine, 49045 Angers Cédex, France.
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Kindblom JM, Lorentzon M, Norjavaara E, Hellqvist A, Nilsson S, Mellström D, Ohlsson C. Pubertal timing predicts previous fractures and BMD in young adult men: the GOOD study. J Bone Miner Res 2006; 21:790-5. [PMID: 16734395 DOI: 10.1359/jbmr.020602] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED The importance of pubertal timing for adult BMD in males was studied through association of pubertal timing with young adult bone phenotype. Pubertal timing was found to predict both cortical and trabecular volumetric BMD and previous fractures in young adult men. Thus, late puberty is a risk factor for low BMD and previous fractures in young adult men. INTRODUCTION Peak bone mass (PBM), achieved during puberty, is a determinant of the risk for osteoporosis and future fractures. The role of variations within the normal range in pubertal timing for fractures during pubertal development and for adult bone mass in men is unknown. MATERIALS AND METHODS The aim of this study was to investigate the importance of pubertal timing for adult BMD and for fractures before achievement of PBM in men. The population-based Gothenburg Osteoporosis and Obesity Determinants (GOOD) study is a well-characterized cohort of young adult Swedish males 18-20 years of age. Detailed growth charts from birth to 18-20 years of age were retrieved for 642 men participating in the GOOD study. Age at peak height velocity (PHV) was estimated and used as an assessment of pubertal timing. The skeletal phenotype was analyzed at young adult age using DXA and pQCT and previous fractures were assessed by questionnaires. RESULTS Age at PHV was a negative independent predictor of both adult cortical and trabecular volumetric BMD and of total body and radius areal BMD. Moreover, age at PHV was associated with previous fractures in a logistic regression analysis. The OR for cortical osteopenia was 2.49 (95% CI, 1.91-3.24; p < 0.001) and for previous upper limb fractures was 1.35 (95% CI, 1.04-1.75; p < 0.05) per year increment in age at PHV. CONCLUSIONS Age at PHV is a negative independent predictor of BMD and a positive predictor of previous fractures in young adult men. Longitudinal studies to determine if pubertal timing also predicts BMD and fractures in elderly men are required.
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Affiliation(s)
- Jenny M Kindblom
- Bone Research Center, Department of Medicine, The Sahlgrenska Academy at Gothenburg University, Sweden.
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Smith MR. Therapy Insight: osteoporosis during hormone therapy for prostate cancer. ACTA ACUST UNITED AC 2006; 2:608-15; quiz 628. [PMID: 16474548 DOI: 10.1038/ncpuro0326] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2005] [Accepted: 09/23/2005] [Indexed: 11/08/2022]
Abstract
The intended therapeutic effect of gonadotropin-releasing-hormone (GnRH) agonists is hypogonadism, which is a leading cause of osteoporosis in men. Observations are consistent with this effect: GnRH agonists decrease bone mineral density and increase fracture risk in men with prostate cancer. Estrogens play a central role in homeostasis of the normal male skeleton and evidence suggests that estrogen deficiency is primarily responsible for the adverse skeletal effects of GnRH agonists. The mechanism of treatment-related bone loss involves acceleration of physiologic bone turnover. In small, randomized, controlled trials, bisphosphonates (pamidronate, zoledronic acid) and selective estrogen-receptor modulators (raloxifene, toremifene) increased bone mineral density in GnRH-agonist-treated men. Two ongoing large, randomized, placebo-controlled studies will prospectively define fracture outcomes in men with prostate cancer and assess the efficacy of novel pharmacologic interventions (AMG 162, toremifene) in GnRH-agonist-treated men.
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Karasik D, Demissie S, Cupples LA, Kiel DP. Disentangling the genetic determinants of human aging: biological age as an alternative to the use of survival measures. J Gerontol A Biol Sci Med Sci 2005; 60:574-87. [PMID: 15972604 PMCID: PMC1361266 DOI: 10.1093/gerona/60.5.574] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The choice of a phenotype is critical for the study of a complex genetically regulated process, such as aging. To date, most of the twin and family studies have focused on broad survival measures, primarily age at death or exceptional longevity. However, on the basis of recent studies of twins and families, biological age has also been shown to have a strong genetic component, with heritability estimates ranging from 27% to 57%. The aim of this review is twofold: first, to summarize growing consensus on reliable methods of biological age assessment, and second, to demonstrate validity of this phenotype for research in the genetics of aging in humans.
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Affiliation(s)
- David Karasik
- Hebrew Rehabilitation Center for Aged, Research and Training Institute, 1200 Centre Street, Boston, MA 02131, USA.
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Abstract
Rheumatic diseases are expressed in all ethnic populations, but differ in prevalence, genetic associations, clinical features, and responses to interventions. Most data describing these differences do so in reference to and comparisons with white populations. These are sparse data that evaluate differences within minority populations where there is more homogeneity of external factors, such as social, cultural, and behavioral attitudes. This article reviews the features that are unique to various rheumatic diseases within minority populations.
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Affiliation(s)
- Gail S Kerr
- Rheumatology Section, Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC 20422, USA.
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Panagiotopoulos E, Kostopoulos V, Tsantzalis S, Fortis AP, Doulalas A. Impact energy absorption by specimens from the upper end of the human femur. Injury 2005; 36:613-7. [PMID: 15826619 DOI: 10.1016/j.injury.2004.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2004] [Indexed: 02/02/2023]
Abstract
A cadaveric biomechanical study was performed to investigate the fracture energy absorbed by strips of bone from the proximal femur in relation to age and gender, under impact loading conditions. Four groups (young male, young female, old male, old female) of four cadaveric proximal femurs were used in each case. Four bone strips were taken from the neck and four from the subtrochanteric area and these were tested under dynamic-impact conditions using the Charpy impact test. The fracture energy was calculated as the energy needed to achieve fracture per unit area, and expressed in J/m2. Bone specimens from young males are significantly tougher under impact conditions to those of females (p = 0.001), whereas between the old male and female groups, fracture energy does not significantly differ (p = 0.165). There was also significant difference (p < 0.0005) between the young and the old groups in both genders. The fracture energy absorption of the subtrochanteric area compared to that of the femoral neck for the same group of age and gender is in general slightly higher for all groups. In conclusion, gender in the young age group played a significant role in bone resistance in breaking whereas in the older age group it played a less important role.
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Affiliation(s)
- E Panagiotopoulos
- Orthopaedic Department, University of Patras, 1 Vikela and Sofokleus St., 26442 Patras, Greece.
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Thomas CDL, Feik SA, Clement JG. Regional variation of intracortical porosity in the midshaft of the human femur: age and sex differences. J Anat 2005; 206:115-25. [PMID: 15730477 PMCID: PMC1571459 DOI: 10.1111/j.1469-7580.2005.00384.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2005] [Indexed: 11/27/2022] Open
Abstract
This study investigated age and sex differences in patterns of porosity distribution in the midshaft of the human femur. Cross-sections were obtained from 168 individuals from a modern Australian population. The sample comprised 73 females and 95 males, aged between 20 and 97 years. Microradiographs were made of 100-microm sections and pore and bone areas were determined using image processing software. Initially the sample was divided by age: young (20-44 years), middle (45-64 years) and old (65+ years), but it was found that analysis on the basis of the ratio of medullary area to total subperiosteal area gave clearer results. The cortex was divided into three rings radially and into octants circumferentially and the porosity of each segment was calculated. Results showed that a pattern with raised porosity in the posterior and anterolateral regions, and with greater porosity in the inner parts of the cortex, becomes more pronounced with age. In males this pattern develops steadily; in females there are much greater differences between the middle and older groups than earlier in life. The patterns observed are consistent with progressive bone loss occurring along a neutral axis of the cortex where bending stress is lowest and the mechanical advantage of the bone is least.
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Affiliation(s)
- C David L Thomas
- University of Melbourne, School of Dental Science, Melbourne, Australia.
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Khalil DA, Lucas EA, Smith BJ, Soung DY, Devareddy L, Juma S, Akhter MP, Recker R, Arjmandi BH. Soy isoflavones may protect against orchidectomy-induced bone loss in aged male rats. Calcif Tissue Int 2005; 76:56-62. [PMID: 15549639 DOI: 10.1007/s00223-004-0018-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 07/30/2004] [Indexed: 10/26/2022]
Abstract
Evidence from several studies suggests that soy protein and/or its isoflavones may have beneficial effects on bone in postmenopausal women and animal models who have osteoporosis. The present study examined the dose-dependent effects of soy isoflavones in the context of soy protein or casein on the male skeleton. Thirteen-month-old male Fisher 344 rats were orchidectomized (ORX; 5 groups) or sham-operated (Sham; 1 group) and immediately placed on dietary treatments for 180 days. Diets were semi-purified and the protein source was either casein (Sham and ORX; controls), casein with two added doses of isoflavones (Iso1; 600 mg/kg diet and Iso2; 1200 mg/kg diet), soy protein with normal isoflavones content (Soy; 600 mg/kg diet), or soy protein with added isoflavones (Soy+; 1200 mg/kg diet). A 7% loss of whole body bone mineral density (BMD) was observed due to orchidectomy; however, the ORX induced BMD loss was significantly reduced to 4.3 and 4.7 % with the Soy and Soy+, respectively. Both doses of isoflavones in conjunction with casein also reduced the loss of whole body BMD, albeit not significantly different from ORX control animals. Trabecular bone histomorphometric analysis of the proximal tibia further supported the bone-sparing role of soy isoflavones as indicated by higher percent bone volume and trabecular number, and lower trabecular separation. We conclude that isoflavones exert modest beneficial effects on the male skeleton whether provided with casein or a soy protein.
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Affiliation(s)
- D A Khalil
- Department of Nutritional Sciences, Oklahoma State University, Stillwater, OK, USA,
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Zhang YY, Liu PY, Lu Y, Davies KM, Dvornyk V, Recker RR, Deng HW. Race and sex differences and contribution of height: A study on bone size in healthy Caucasians and Chinese. Am J Hum Biol 2005; 17:568-75. [PMID: 16136538 DOI: 10.1002/ajhb.20427] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Osteoporosis is characterized by a loss of bone strength, of which bone size (BS) is an important determinant. However, studies on the factors determining BS are relatively few. The present study evaluated the independent effects of height, age, weight, sex, and race on areal BS at the hip and spine, measured by dual-energy X-ray absorptiometry, while focusing on the differential contributions of height to BS across sex, race, and skeletal site. The subjects were aged 40 years or older, including 763 Chinese (384 males and 379 females) from Shanghai, People's Republic of China, and 424 Caucasians (188 males and 236 females) from Omaha, Nebraska. Basically, Caucasians had significantly larger BS than Chinese. After adjusting for height, age, and weight, the Chinese had similar spine BS, but significantly larger intertrochanter BS in both sexes and larger total hip BS in females compared with Caucasians. Males had significantly larger BS than females before and after adjustment in both ethnic groups. The effects of age, weight, and race varied, depending on skeletal site. As expected, height had major effects on BS variation in both sexes and races. Height tended to account for larger BS variation at the spine than at the hip (except for Chinese females), and larger BS variation in Caucasians than in Chinese of the same sex (except for the trochanter in females). We conclude that height is a major predictor for BS, and its contributions vary across sex, race, and skeletal site.
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Affiliation(s)
- Yuan-Yuan Zhang
- Osteoporosis Research Center, Creighton University, Omaha, Nebraska 68131, USA
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Abstract
PURPOSE A presentation on osteoporosis, obesity and obesity related disease at the Conference on Innovations and Challenges in Prostate Cancer: Prevention, Detection and Treatment is summarized. MATERIALS AND METHODS A focused literature review was done. RESULTS Gonadotropin-releasing hormone (GnRH) agonists decrease bone mineral density and increase fracture risk. GnRH agonists also increase weight and fat mass, and decrease lean body mass. Treatment related changes in body composition may contribute to fatigue and fracture risk. The phenotype of men with GnRH agonist shares some features with the insulin resistance syndrome, raising the possibility that GnRH may also increase the risk of diabetes mellitus and cardiovascular disease. CONCLUSIONS The routine use of GnRH agonists in men with long life expectancy increases the importance of understanding and preventing the unintended adverse effects of treatment. Some adverse effects have the potential to impact not only quality of life, but also noncancer mortality. Additional research is needed to characterize better the unintended effects of androgen deprivation therapy and develop optimal strategies to prevent osteoporosis, obesity and obesity related disease.
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Affiliation(s)
- Matthew R Smith
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts 02114, USA.
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