Osteoporosis: pathophysiology and non-pharmacological management

Dietary Protein Intake in Relation to the Risk of Osteoporosis in Middle-Aged and Older Individuals: A Cross-Sectional Study

OBJECTIVES

Dietary protein intake is of great significance for the bone health of middle-aged and elderly people. This study is aimed to explore the relationships between dietary protein intake and the risk of osteoporosis in middle-aged and older individuals among US population.

METHODS

Based on the National Health and Nutrition Examination Survey (NHANES), this study includes a total of 20497 participants during 2005-2008, and identify 4707 middle-aged and older people aged 45 years or above. Demographic data and relevant dietary intake information are acquired through in-home management questionnaires. The logistic regression models are established to identify the odds ratio (OR) and 95% confidence interval (CI) of OP in each quartile category of energy-adjusted dietary protein intake. The receiver operating characteristic (ROC) curve is applied to explore the optimal cut-off value of daily dietary protein intake for predicting risk of OP.

RESULTS

442 participants with OP are identified among 4707 middle-aged and older people, and the dietary protein intake of OP group is significantly lower than that of non-OP group (P<0.001). The logistic regression analysis shows that with the increase of daily dietary protein intake, the prevalence of OP in each quartile category decreases gradually (P<0.001). This trend is not altered in univariate model (P<0.001), as well as the adjustments for the covariates of age and BMI (Model 1, P<0.001), the covariates of sex (Model 2, P=0.036), the covariates of smoking, drinking alcohol, education, ratio of family income to poverty, hypertension and diabetes (Model 3, P<0.001), and the covariates of dietary intake (Model 4, P=0.008). Moreover, we also identify that the daily dietary protein intake of 61.2g is the optimal cut-off value for predicting risk of OP.

CONCLUSION

In general, among US population, the lower daily dietary protein intake is positively related to the ascending risk of OP in middle-aged and older individuals.

Diagnostic Validity of Orthopantomogram Compared to Dual Energy X-ray Absorptiometry Scan in Detecting Osteoporosis

Introduction Osteoporosis is one of the most common and rampant metabolic bone disorders among the geriatric, particularly affecting postmenopausal women. Even though resorption tends to occur more rapidly in bones with a higher proportion of trabecular bone (e.g., vertebrae, pelvis, calcaneus), bones with significant cortical bone content also do undergo resorption, for example, mandible. The dental manifestations that may indicate low-bone density include loose teeth, receding gums, and ill-fitting or loose dentures.

Objective To validate the efficacy of orthopantomograms (OPGs) in recognizing bone mineral density (BMD) changes of the mandible using mandibular cortical index (MCI) and substantiate the same with dual energy X-ray absorptiometry (DEXA) scan on femoral neck and spine.

Materials and Methods This cross-sectional study comprised 60 geriatric patients of both genders. All the patients were subjected to panoramic radiographs wherever clinically indicated. The visual analysis was done based on the radiographic appearance of the mandibular cortical border and results were compared with DEXA scan reports, followed by an analysis of three grades of MCI and BMD statistically.

Results In our study, out of 40 patients in C2 and C3 subgroups, 67% and 20% were normal, respectively. The incidence of osteopenia was 33% in the C2 group and 70% in the C3 group, whereas Osteoporosis was present only among 10% of the population in the C3 group. The difference between the groups are statistically significant (p = 0.01). These findings imply that a progressive link exists between BMD and deteriorating cortical morphology.

Conclusion The purpose of this study is that dentists will be able to refer patients to physicians of suspected low BMD, based on incidental findings on panoramic radiographs for further examination. There is a statistically significant correlation present between DEXA and MCI, so the latter can also be used for screening BMD changes.

Unveiling the Pharmacological Mechanisms of Eleutheroside E Against Postmenopausal Osteoporosis Through UPLC-Q/TOF-MS-Based Metabolomics

Postmenopausal osteoporosis (PMOP) is a common metabolic bone disease in postmenopausal women in the Worldwide, and seriously affects the quality of life of middle-aged and elderly women. Therefore, there is an urgent need to discover a highly effective drug for PMOP treatment. In this study, ultra-high performance liquid tandem quadrupole time-of-flight mass spectrometry (UPLC-Q/TOF-MS) was used to analyze the urine metabolic profiling and potential biomarkers, the relevant metabolic network of PMOP rats, and further to evaluate the intervention effect of Eleutheroside E (EE) against PMOP. Using multivariate statistical analysis combined with UPLC-Q/TOF-MS, a total of 27 biomarkers were identified, which related with 16 metabolic pathways, mainly involving steroidogenesis, beta oxidation of very long chain fatty acids, glutathione metabolism, carnitine synthesis, estrone metabolism, oxidation of branched chain fatty acids, etc. After treatment of EE, these biomarkers were markedly regulated, mainly involving steroid hormone biosynthesis, arachidonic acid metabolism, primary bile acid biosynthesis, indicating that EE had the therapeutic effect on PMOP. This study identified the potential urine metabolic markers and related metabolic pathways of the PMOP, explained the metabolic effect and pharmacological mechanisms of EE against PMOP, and provided a basis for the pharmacological study of EE.

Measurements in Mandibular Pantomographic X-rays and Relation to Skeletal Mineral Densitometric Values

The gold standard diagnostic modality for osteoporosis is dual-energy X-ray absorptiometry (DXA). But it is expensive and often unavailable. Studies have demonstrated that decreased bone mineral density (BMD) may affect mandibular bone morphometrically on radiographs. Such studies are rare in the Indian population. This study was conducted to evaluate correlation between radiomorphometric markers on digital orthopantomograms (OPGs) and BMD measurements done by DXA in an Indian population. A total of 344 subjects aged 45 years or above, who visited a dental outpatient department over a period of 6 years were included in the study after obtaining ethical committee approval and informed consent. Digital OPG and DXA BMD measurements were obtained. Subjects' T-scores were obtained, on the basis of which they were divided into osteoporotic, osteopenic, and normal. OPGs were evaluated to obtain the mandibular cortical index (MCI) and the panoramic mandibular index (PMI). Correlations of MCI and PMI with BMD were analyzed statistically with SPSS (version 16.0; SPSS, Chicago, IL). In the osteoporotic group, there was no subject with MCI finding of C1, and 77.42% prevalence of C3 finding was found. C2 finding was in highest proportion in the osteopenic group (p<0.05). Normal BMD group was associated with the C1 finding of 76.47%. Almost 48% of the osteoporotic group had a PMI score of <0.40, whereas 50% of osteopenic subjects had a PMI score of 0.4-0.44. Normal subjects having a PMI score of >0.44 constituted 49.1% of the population. Mean BMD scores decreased significantly with increasing MCI stage and increased significantly with increasing PMI (p<0.05). Significant correlations between PMI and MCI were obtained with DXA BMD. Digital OPGs may provide an economical and reliable diagnostic tool to rule out osteoporosis or osteopenia in undiagnosed patients, where DXA screening may not be available or is financially nonviable.

Pomegranate and its derivatives can improve bone health through decreased inflammation and oxidative stress in an animal model of postmenopausal osteoporosis

PURPOSE

Recently, nutritional and pharmaceutical benefits of pomegranate (PG) have raised a growing scientific interest. Since PG is endowed with anti-inflammatory and antioxidant activities, we hypothesized that it may have beneficial effects on osteoporosis.

METHODS

We used ovariectomized (OVX) mice as a well-described model of postmenopausal osteoporosis to study the influence of PG consumption on bone health. Mice were divided into five groups as following: two control groups sham-operated and ovariectomized (OVX CT) mice fed a standard diet, versus three treated groups OVX mice given a modified diet from the AIN-93G diet, containing 5.7% of PG lyophilized mashed totum (OVX PGt), or 9.6% of PG fresh juice (OVX PGj) or 2.9% of PG lyophilized mashed peel (OVX PGp).

RESULTS

As expected, ovariectomy was associated with a decreased femoral bone mineral density (BMD) and impaired bone micro-architecture parameters. Consumption of PGj, PGp, or PGt induced bone-sparing effects in those OVX mice, both on femoral BMD and bone micro-architecture parameters. In addition, PG (whatever the part) up-regulated osteoblast activity and decreased the expression of osteoclast markers, when compared to what was observed in OVX CT animals. Consistent with the data related to bone parameters, PG consumption elicited a lower expression of pro-inflammatory makers and of enzymes involved in ROS generation, whereas the expression of anti-inflammatory markers and anti-oxidant actors was enhanced.

CONCLUSION

These results indicate that all PG parts are effective in preventing the development of bone loss induced by ovariectomy in mice. Such an effect could be partially explained by an improved inflammatory and oxidative status.

Pomegranate seed oil prevents bone loss in a mice model of osteoporosis, through osteoblastic stimulation, osteoclastic inhibition and decreased inflammatory status

In the current context of longer life expectancy, the prevalence of osteoporosis is increasingly important. This is why development of new strategies of prevention is highly suitable. Pomegranate seed oil (PSO) and its major component, punicic acid (a conjugated linolenic acid), have potent anti-inflammatory and anti-oxidative properties both in vitro and in vivo, two processes strongly involved in osteoporosis establishment. In this study, we demonstrated that PSO consumption (5% of the diet) improved significantly bone mineral density (240.24±11.85 vs. 203.04±34.19 mg/cm(3)) and prevented trabecular microarchitecture impairment in ovariectomized (OVX) mice C57BL/6J, compared to OVX control animals. Those findings are associated with transcriptional changes in bone tissue, suggesting involvement of both osteoclastogenesis inhibition and osteoblastogenesis improvement. In addition, thanks to an ex vivo experiment, we provided evidence that serum from mice fed PSO (5% by gavage) had the ability to significantly down-regulate the expression of specific osteoclast differentiation markers and RANK-RANKL downstream signaling targets in osteoclast-like cells (RAW264.7) (RANK: negative 0.49-fold vs. control conditions). Moreover, in osteoblast-like cells (MC3T3-E1), it elicited significant increase in alkaline phosphatase activity (+159% at day 7), matrix mineralization (+271% on day 21) and transcriptional levels of major osteoblast lineage markers involving the Wnt/β-catenin signaling pathways. Our data also reveal that PSO inhibited pro-inflammatory factors expression while stimulating anti-inflammatory ones. These results demonstrate that PSO is highly relevant regarding osteoporosis. Indeed, it offers promising alternatives in the design of new strategies in nutritional management of age-related bone complications.

An overview of osteoporosis for the practising prosthodontist

Osteoporosis is an insidious and common bone disorder of the modern age, as a result of the rapidly increasing number of older people in the total population. It has long been concluded that this disease has definite deleterious effects on the stomatognathic system and is therefore of major concern to a Prosthodontist. If features on a dental radiograph, which are the most commonly required radiographs, can be detected regularly and consistently, it would place a prosthodontist in a position to refer the patient for timely management and also modify his treatment plan, greatly improving the prognosis. Available literature was therefore reviewed for pathophysiology, dental radiographic screening measures, implications and management of osteoporosis from the perspective of a prosthodontist.