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Monti F, Perazza F, Leoni L, Stefanini B, Ferri S, Tovoli F, Zavatta G, Piscaglia F, Petroni ML, Ravaioli F. RANK-RANKL-OPG Axis in MASLD: Current Evidence Linking Bone and Liver Diseases and Future Perspectives. Int J Mol Sci 2024; 25:9193. [PMID: 39273141 PMCID: PMC11395242 DOI: 10.3390/ijms25179193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 08/22/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD)-and its worse form, metabolic-associated steatohepatitis (MASH), characterised by inflammation and liver damage-corresponds to the liver's involvement in metabolic syndrome, which constitutes an economic burden for healthcare systems. However, the biomolecular pathways that contribute to steatotic liver disease are not completely clear. Abnormalities of bone metabolism are frequent in people affected by metabolic liver disease, with reduced bone density and an increased risk of fracture. Receptor activator of NF-κB (RANK), receptor activator of NF-κB ligand (RANKL), and osteoprotegerin(OPG) are critical regulators of bone metabolism, performing pleiotropic effects, and may have potential involvement in metabolic disorders like MASLD, resulting in a topic of great interest and intrigue. This narrative review aims to investigate this potential role and its implications in MASLD development and progression and in hepatocellular carcinoma, which represents its worst complication.
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Affiliation(s)
- Federico Monti
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federica Perazza
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Laura Leoni
- Department of Dietetics and Clinical Nutrition, Maggiore-Bellaria Hospital, Azienda Unità Sanitaria Locale (AUSL), 40138 Bologna, Italy
| | - Bernardo Stefanini
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Silvia Ferri
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Francesco Tovoli
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Guido Zavatta
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Maria Letizia Petroni
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Unit of Clinical Nutrition and Metabolism, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
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Ishizawa M, Fujihara K, Yachida J, Ikeda I, Sato T, Yamada T, Kobayashi A, Tanaka S, Nakagawa Y, Matsuzaka T, Shimano H, Tashiro M, Kodama S, Kato K, Sone H. Cross-Sectional and Longitudinal Associations between Forearm Bone Mineral Density and Anthropometry in Adult Japanese Men and Women. J Bone Metab 2024; 31:21-30. [PMID: 38485238 PMCID: PMC10940109 DOI: 10.11005/jbm.2024.31.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND No consensus exists regarding which anthropometric measurements are related to bone mineral density (BMD), and this relationship may vary according to sex and age. A large Japanese cohort was analyzed to provide an understanding of the relationship between BMD and anthropometry while adjusting for known confounding factors. METHODS Our cohort included 10,827 participants who underwent multiple medical checkups including distal forearm BMD scans. Participants were stratified into four groups according to age (≥50 years or <50 years) and sex. The BMD values were adjusted for confounding factors, after which single and partial correlation analyses were performed. The prevalence of osteopenia was plotted for each weight index (weight or body mass index [BMI]) class. RESULTS Cross-sectional studies revealed that weight was more favorably correlated than BMI in the older group (R=0.278 and 0.212 in men and R=0.304 and 0.220 in women, respectively), whereas weight and BMI were weakly correlated in the younger age groups. The prevalence of osteopenia exhibited a negative linear relationship with weight among older women ≥50 years of age, and an accelerated increase was observed with decreasing weight in older men weighing <50 kg and younger women weighing <60 kg. When weight was replaced with BMI, the prevalence was low in most subgroups classified by weight. CONCLUSIONS Weight, rather than BMI, was the most important indicator of osteopenia but it might not be predictive of future bone loss.
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Affiliation(s)
- Masahiro Ishizawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata,
Japan
- Clinical and Translational Research Center, Niigata University Medical and Dental Hospital, Niigata,
Japan
| | - Kazuya Fujihara
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata,
Japan
| | - Junko Yachida
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata,
Japan
| | - Izumi Ikeda
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata,
Japan
| | - Takaaki Sato
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata,
Japan
| | - Takaho Yamada
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata,
Japan
| | - Ayako Kobayashi
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata,
Japan
| | - Shiro Tanaka
- Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto,
Japan
| | - Yoshimi Nakagawa
- Division of Complex Biosystem Research, Department of Research and Development, Institute of Natural Medicine, University of Toyama, Toyama,
Japan
| | - Takashi Matsuzaka
- Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Ibaraki,
Japan
| | - Hitoshi Shimano
- Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Ibaraki,
Japan
| | - Minoru Tashiro
- Niigata Association of Occupational Health, Niigata,
Japan
| | - Satoru Kodama
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata,
Japan
| | - Kiminori Kato
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata,
Japan
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata,
Japan
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García-Alfaro P, García S, Rodriguez I, Pascual MA, Pérez-López FR. Association of Endogenous Hormones and Bone Mineral Density in Postmenopausal Women. J Midlife Health 2023; 14:196-204. [PMID: 38312770 PMCID: PMC10836432 DOI: 10.4103/jmh.jmh_115_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 02/06/2024] Open
Abstract
Aim The aim of this study was to examine the association between endogenous hormones and bone mineral density (BMD) in postmenopausal women. Materials and Methods This was a cross-sectional study of 798 postmenopausal women aged 47-85 years. Data were collected on age, age at menopause, years since menopause, smoking status, body mass index, adiposity, BMD, physical activity, and Vitamin D supplementation. Measured hormonal parameters were: follicle-stimulating hormone (FSH), estradiol, testosterone, dehydroepiandrosterone sulfate, ∆4-androstenedione, cortisol, insulin-like growth factor-1, 25-hydroxyvitamin D, and parathormone (PTH) levels. BMD was measured at the lumbar spine, femoral neck, and total hip using dual-energy X-ray absorptiometry. A directed acyclic graph was used to select potential confounding variables. Results Multivariable analysis showed significant associations between cortisol and femoral neck BMD (β: -0.02, 95% confidence interval [CI]: -0.03--0.00), and PTH with femoral neck BMD (β: -0.01, 95% CI: -0.02--0.01) and total hip BMD (β: -0.01, 95% CI: -0.01--0.00). Hormonal factors more likely associated with a higher risk of low BMD (osteopenia or osteoporosis) were FSH (odds ratio [OR]: 1.02, 95% CI: 1.01-1.03) and PTH (OR: 1.02, 95% CI: 1.01-1.04). Conclusions Higher cortisol and PTH levels were inversely associated with BMD. Postmenopausal women with higher FSH or PTH levels were likely to have low BMD.
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Affiliation(s)
- Pascual García-Alfaro
- Department of Obstetrics, Gynecology and Reproduction, University Hospital Dexeus, Barcelona, Spain
| | - Sandra García
- Department of Obstetrics, Gynecology and Reproduction, University Hospital Dexeus, Barcelona, Spain
| | - Ignacio Rodriguez
- Department of Obstetrics, Gynecology and Reproduction, University Hospital Dexeus, Barcelona, Spain
| | - Maria Angela Pascual
- Department of Obstetrics, Gynecology and Reproduction, University Hospital Dexeus, Barcelona, Spain
| | - Faustino R. Pérez-López
- Department of Obstetrics and Gynecology, University of Zaragoza Faculty of Medicine, Zaragoza, Spain
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Wang LT, Chen LR, Chen KH. Hormone-Related and Drug-Induced Osteoporosis: A Cellular and Molecular Overview. Int J Mol Sci 2023; 24:ijms24065814. [PMID: 36982891 PMCID: PMC10054048 DOI: 10.3390/ijms24065814] [Citation(s) in RCA: 36] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
Osteoporosis resulting from an imbalance of bone turnover between resorption and formation is a critical health issue worldwide. Estrogen deficiency following a nature aging process is the leading cause of hormone-related osteoporosis for postmenopausal women, while glucocorticoid-induced osteoporosis remains the most common in drug-induced osteoporosis. Other medications and medical conditions related to secondary osteoporosis include proton pump inhibitors, hypogonadism, selective serotonin receptor inhibitors, chemotherapies, and medroxyprogesterone acetate. This review is a summary of the cellular and molecular mechanisms of bone turnover, the pathophysiology of osteoporosis, and their treatment. Nuclear factor-κβ ligand (RANKL) appears to be the critical uncoupling factor that enhances osteoclastogenesis. In contrast, osteoprotegerin (OPG) is a RANKL antagonist secreted by osteoblast lineage cells. Estrogen promotes apoptosis of osteoclasts and inhibits osteoclastogenesis by stimulating the production of OPG and reducing osteoclast differentiation after suppression of IL-1 and TNF, and subsequent M-CSF, RANKL, and IL-6 release. It can also activate the Wnt signaling pathway to increase osteogenesis, and upregulate BMP signaling to promote mesenchymal stem cell differentiation from pre-osteoblasts to osteoblasts rather than adipocytes. Estrogen deficiency leads to the uncoupling of bone resorption and formation; therefore, resulting in greater bone loss. Excessive glucocorticoids increase PPAR-2 production, upregulate the expression of Dickkopf-1 (DKK1) in osteoblasts, and inhibit the Wnt signaling pathway, thus decreasing osteoblast differentiation. They promote osteoclast survival by enhancing RANKL expression and inhibiting OPG expression. Appropriate estrogen supplement and avoiding excessive glucocorticoid use are deemed the primary treatment for hormone-related and glucocorticoid-induced osteoporosis. Additionally, current pharmacological treatment includes bisphosphonates, teriparatide (PTH), and RANKL inhibitors (such as denosumab). However, many detailed cellular and molecular mechanisms underlying osteoporosis seem complicated and unexplored and warrant further investigation.
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Affiliation(s)
- Li-Ting Wang
- Department of Physical Medicine and Rehabilitation, Mackay Memorial Hospital, Taipei 104, Taiwan
| | - Li-Ru Chen
- Department of Physical Medicine and Rehabilitation, Mackay Memorial Hospital, Taipei 104, Taiwan
- Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
| | - Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan
- School of Medicine, Tzu-Chi University, Hualien 970, Taiwan
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Cheng CH, Chen LR, Chen KH. Osteoporosis Due to Hormone Imbalance: An Overview of the Effects of Estrogen Deficiency and Glucocorticoid Overuse on Bone Turnover. Int J Mol Sci 2022; 23:ijms23031376. [PMID: 35163300 PMCID: PMC8836058 DOI: 10.3390/ijms23031376] [Citation(s) in RCA: 157] [Impact Index Per Article: 78.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 02/07/2023] Open
Abstract
Osteoporosis is a serious health issue among aging postmenopausal women. The majority of postmenopausal women with osteoporosis have bone loss related to estrogen deficiency. The rapid bone loss results from an increase in bone turnover with an imbalance between bone resorption and bone formation. Osteoporosis can also result from excessive glucocorticoid usage, which induces bone demineralization with significant changes of spatial heterogeneities of bone at microscale, indicating potential risk of fracture. This review is a summary of current literature about the molecular mechanisms of actions, the risk factors, and treatment of estrogen deficiency related osteoporosis (EDOP) and glucocorticoid induced osteoporosis (GIOP). Estrogen binds with estrogen receptor to promote the expression of osteoprotegerin (OPG), and to suppress the action of nuclear factor-κβ ligand (RANKL), thus inhibiting osteoclast formation and bone resorptive activity. It can also activate Wnt/β-catenin signaling to increase osteogenesis, and upregulate BMP signaling to promote mesenchymal stem cell differentiation from pre-osteoblasts to osteoblasts, rather than adipocytes. The lack of estrogen will alter the expression of estrogen target genes, increasing the secretion of IL-1, IL-6, and tumor necrosis factor (TNF). On the other hand, excessive glucocorticoids interfere the canonical BMP pathway and inhibit Wnt protein production, causing mesenchymal progenitor cells to differentiate toward adipocytes rather than osteoblasts. It can also increase RANKL/OPG ratio to promote bone resorption by enhancing the maturation and activation of osteoclast. Moreover, excess glucocorticoids are associated with osteoblast and osteocyte apoptosis, resulting in declined bone formation. The main focuses of treatment for EDOP and GIOP are somewhat different. Avoiding excessive glucocorticoid use is mandatory in patients with GIOP. In contrast, appropriate estrogen supplement is deemed the primary treatment for females with EDOP of various causes. Other pharmacological treatments include bisphosphonate, teriparatide, and RANKL inhibitors. Nevertheless, more detailed actions of EDOP and GIOP along with the safety and effectiveness of medications for treating osteoporosis warrant further investigation.
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Affiliation(s)
- Chu-Han Cheng
- Department of Physical Medicine and Rehabilitation, Mackay Memorial Hospital, Taipei 104, Taiwan; (C.-H.C.); (L.-R.C.)
| | - Li-Ru Chen
- Department of Physical Medicine and Rehabilitation, Mackay Memorial Hospital, Taipei 104, Taiwan; (C.-H.C.); (L.-R.C.)
- Department of Mechanical Engineering, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
| | - Kuo-Hu Chen
- Department of Obstetrics and Gynecology, Taipei Tzu-Chi Hospital, The Buddhist Tzu-Chi Medical Foundation, Taipei 231, Taiwan
- School of Medicine, Tzu-Chi University, Hualien 970, Taiwan
- Correspondence: ; Tel.: +886-2-66289779
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Wang X, Jiang J, Guan W, Yu W, Xu T, Li M, Zhang J. The risk factors for developing clustered vertebral compression fractures: a single center study. Endocr Pract 2021; 28:243-249. [PMID: 34952220 DOI: 10.1016/j.eprac.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/14/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Vertebral compression fractures (VCFs) are common among elderly individuals, but clustered VCFs (C-VCFs) are rare and more severe. The risk factors for C-VCFs remain unclear. Thus, we investigated the clinical characteristics of C-VCFs to identify the imminent fracture risk and to improve the treatment for such patients. METHODS We reviewed records of VCF patients at a single medical center between January 2011 and September 2020. Patients who had four or more VCFs within one year were categorized into the C-VCF group, and the remaining patients were paired into the control group at a ratio of 2:1. We collected demographic, clinical, laboratory, and radiological information regarding these patients. Univariate analyses, stratified analyses, and multivariate logistic regression were performed to identify the risk factors for C-VCFs. RESULTS A total of 156 patients were enrolled, of whom 52 were C-VCF patients. C-VCF patients had more severe fractures and pain, with fractures occurring at uncommon sites of the spine. The independent risk factors for C-VCFs included glucocorticoid treatment (P<0.001, HR: 12.7), recent fracture history (P=0.021, HR: 5.5), and lower trabecular bone score (TBS, P=0.044, HR: 1.6). TBS and bone mineral density had greater predictive values in patients without glucocorticoid treatment (P<0.001). Sex, age, and bone turnover biomarkers were not independent risk factors for C-VCFs. CONCLUSION C-VCFs are rare adverse consequences of severe osteoporosis, for which glucocorticoid treatment, recent fracture history, and lower TBS are unique risk factors that are valuable for the early identification and prevention of C-VCFs.
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Affiliation(s)
- Xianze Wang
- Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Jialin Jiang
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Wenmin Guan
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tao Xu
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Mei Li
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Jia Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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7
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Fistarol M, Rezende CR, Figueiredo Campos AL, Kakehasi AM, Geber S. Time since menopause, but not age, is associated with increased risk of osteoporosis. Climacteric 2019; 22:523-526. [PMID: 31280605 DOI: 10.1080/13697137.2019.1634046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives: This study aimed to determine whether estrogen deficiency is a sole risk factor for osteoporosis or is also associated with age, through indicators such as gender, age, and time since menopause. Methods: A cross-sectional study was conducted evaluating 938 postmenopausal women who underwent bone mineral densitometry. We collected the following data: age, ethnic group, body mass index, smoking, and time since menopause. These data were correlated to the presence of osteoporosis, according to the T-score of the femur and lumbar spine. Results: The prevalence of osteoporosis was 37.8%. Ethnic group (p = 0.47) and smoking habits (p = 0.19) were not associated with osteoporosis. In the group of women with osteoporosis, mean age was significantly higher (p < 0.001), mean body mass index was significantly lower (p < 0.001), and time since menopause was significantly higher (p < 0.001) than in the group of women with no osteoporosis. After multivariate analysis was performed, the only variables that remained independently associated with osteoporosis were body mass index and time since menopause. Higher body mass index was a protective factor (odds ratio = 0.80 [95% confidence interval 0.76; 0.84], p < 0.001). Time since menopause represented a risk factor for osteoporosis (odds ratio = 1.04 [1.02; 1.06], p < 0.001). When divided into categories, the risk increased after 20 years of menopause and gradually every 5 years. Conclusion: Time since menopause and body mass index were the most important factors associated with osteoporosis, confirming that estrogen deficiency, and not age, is the major cause of the disease.
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Affiliation(s)
- M Fistarol
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte , Belo Horizonte , Brazil
| | - C R Rezende
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte , Belo Horizonte , Brazil
| | - A L Figueiredo Campos
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte , Belo Horizonte , Brazil
| | - A M Kakehasi
- Department of Locomotor System, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte , Belo Horizonte , Brazil
| | - S Geber
- Department of Obstetrics and Gynecology, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte , Belo Horizonte , Brazil
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Liao EY, Zhang ZL, Xia WB, Lin H, Cheng Q, Wang L, Hao YQ, Chen DC, Tang H, Peng YD, You L, He L, Hu ZH, Song CL, Wei F, Wang J, Zhang L. Clinical characteristics associated with bone mineral density improvement after 1-year alendronate/vitamin d3 or calcitriol treatment: Exploratory results from a phase 3, randomized, controlled trial on postmenopausal osteoporotic women in China. Medicine (Baltimore) 2018; 97:e11694. [PMID: 30075569 PMCID: PMC6081166 DOI: 10.1097/md.0000000000011694] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 07/02/2018] [Indexed: 02/05/2023] Open
Abstract
Baseline and on-treatment characteristics, including age, obesity, calcium intake, and bone turnover markers, may predict the bone mineral density (BMD) response in women with postmenopausal osteoporosis (PMO) to 1 to 2 years of antiresorptive therapy and/or vitamin D supplementation. This study aimed to explore clinical characteristics associated with 12-month BMD improvement in Chinese women with postmenopausal osteoporosis (PMO).In this post hoc analysis of a previous phase 3 multicenter, randomized controlled trial, Chinese PMO women who were treated with once weekly alendronate 70 mg/vitamin D3 5600 IU (ALN/D5600) or once daily calcitriol 0.25 mcg, and had measurements of 1-year lumbar spine BMD (LS-BMD) and on-treatment bone turnover markers (BTMs) were included in the analysis.In Chinese PMO patients on ALN/D5600, 1-year LS-BMD change was negatively correlated with age (β = -0.00084, P < .01), dietary calcium (β = -0.0017, P = .07), and procollagen type 1 N-terminal propeptide (P1NP) change at month 6 (β = -0.000469, P = .0016), but positively with body mass index (BMI) (β = 0.00128, P = .08); baseline P1NP above the median was associated with a significantly greater BMD percentage change at the lumbar spine (P = .02) and the total hip (P = .0001). In the calcitriol group, a significant 1-year LS-BMD increase was associated with BMI (β = 0.0023, P = .02), baseline P1NP (β = 0.00035, P = .0067), history of prior vertebral fracture(s) (β = 0.034, P < .0001) and baseline serum 25(OH)D level (β = -0.00083, P = .02).The presented findings from Chinese postmenopausal osteoporotic women suggested clinically meaningful baseline and on-treatment characteristics predicting BMD improvement after 1 year of ALN/D5600 treatment, which differed from calcitriol treatment with baseline identifiable associations. The study remained exploratory and further accumulation of evidence is needed.
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Affiliation(s)
- Er-Yuan Liao
- The Second Xiangya Hospital, Central South University, Changsha
| | - Zhen-Lin Zhang
- The Sixth People's Hospital, Shanghai Jiaotong University
| | | | - Hua Lin
- Nanjing Drum Tower Hospital, Nanjing
| | - Qun Cheng
- Huadong Hospital Affiliated to Fudan University
| | | | | | - De-Cai Chen
- West China Hospital, West China School of Medicine, Sichuan University, Chengdu
| | - Hai Tang
- Beijing Friendship Hospital, Capital Medical University
| | | | - Li You
- The First People's Hospital
| | | | | | | | - Fang Wei
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
| | - Jue Wang
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
| | - Lei Zhang
- Global Medical Affairs, Merck Sharp & Dohme China, Shanghai, China
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Cui J, Liu H, Shao J, Xu DM, Wang Y, Fei Z, Wei J, Lu W, Wang CR, He R, Tan Y, Fan Y, Ning Y, Cassidy RM, Soares JC, Huang X, Zhang XY. Prevalence, risk factors and clinical characteristics of osteoporosis in Chinese inpatients with schizophrenia. Schizophr Res 2018; 195:488-494. [PMID: 29056492 DOI: 10.1016/j.schres.2017.10.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/12/2017] [Accepted: 10/15/2017] [Indexed: 11/26/2022]
Abstract
Patients with schizophrenia have a high prevalence of developing osteoporosis and osteoporosis-related fractures. We examined the prevalence of osteoporosis and its clinical correlates in Chinese patients with schizophrenia, which is not well-studied. A total of 199 inpatients (males/females=132/67; average age: 54.5±11.1years) and 107 healthy controls (males/females=22/85; average age: 41.7±11.9years) were recruited. Bone mineral density (BMD) was measured by ultrasonography of the calcaneus. The prevalence of osteoporosis and low BMD (osteoporosis and osteopenia) was 23.1% and 65.3% for the patient group, versus 7.5% and 39.3% for the control group (both p<0.001). Further, the average BMD T-score in patients was significantly lower than in controls (p<0.05). There was gender difference in the prevalence of low BMD conditions for the patients (males: 56.1% versus females: 76.1%; p<0.01) as well as the BMD T-score (p<0.001). Several risk factors correlated with the osteoporosis classification in the patient group: older age (58.9±11.2years vs. 53.3±11.0years), lower weight (63.7±12.2kg vs. 70.4±15.2kg) and body mass index (BMI) (22.8±4.1kg/m2 vs. 24.2±4.7kg/m2; all p<0.01) than those without osteoporosis. Stepwise multiple logistic regression analysis indicated that age, weight and BMI remained significantly associated with osteoporosis. In addition, correlation analysis showed significant correlations between BMD T-score and the following parameters: gender, age and drug type (clozapine versus non-clozapine) (Bonferroni corrected p's<0.05). Our results suggest a higher prevalence of osteoporosis and osteopenia in Chinese schizophrenic inpatients, with both the expected risk factors of gender and age, as well as drug type.
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Affiliation(s)
- Jingyi Cui
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Huaqing Liu
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Jing Shao
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Dong-Mei Xu
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Yi Wang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Zheng Fei
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Jiyu Wei
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Wei Lu
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Chun-Rong Wang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Rui He
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Yangya Tan
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Yi Fan
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Yuping Ning
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China
| | - Ryan M Cassidy
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Xingbing Huang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou Huiai Hospital, Guangzhou, China.
| | - Xiang Yang Zhang
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Pedrera-Zamorano JD, Roncero-Martin R, Calderon-Garcia JF, Santos-Vivas M, Vera V, Martínez-Alvárez M, Rey-Sanchez P. Treatment of subclinical hypothyroidism does not affect bone mass as determined by dual-energy X-ray absorptiometry, peripheral quantitative computed tomography and quantitative bone ultrasound in Spanish women. Arch Med Sci 2015; 11:1008-14. [PMID: 26528344 PMCID: PMC4624745 DOI: 10.5114/aoms.2015.54855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/05/2013] [Accepted: 10/07/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The results of studies examining the influence of subclinical hypothyroidism (SCH) and levothyroxine (L-T4) replacement therapy on bone have generated considerable interest but also controversy. The present research aims to evaluate the effects of L-T4 treatment on different skeletal sites in women. MATERIAL AND METHODS A group of 45 premenopausal (mean age: 43.62 ±6.65 years) and 180 postmenopausal (mean age: 59.51 ±7.90 years) women with SCH who were undergoing L-T4 replacement therapy for at least 6 months were compared to 58 pre- and 180 postmenopausal women with SCH (untreated) matched for age. The mean doses of L-T4 were 90.88 ±42.59 µg/day in the premenopausal women and 86.35 ±34.11 µg/day in the postmenopausal women. Bone measurements were obtained using quantitative bone ultrasound (QUS) for the phalanx, dual-energy X-ray absorptiometry (DXA) for the lumbar spine and hip, and peripheral quantitative computed tomography (pQCT) for the non-dominant distal forearm. RESULTS No differences were observed between patients and untreated controls in these bone measurements except in the bone mineral density (BMD) of the spine (p = 0.0214) in postmenopausal women, which was greater in treated women than in untreated controls. CONCLUSIONS Our results indicate that adequate metabolic control through replacement treatment with L-T4 in pre- and postmenopausal women does not affect bone mass.
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Affiliation(s)
- Juan D Pedrera-Zamorano
- Metabolic Bone Diseases Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Caceres, Spain
| | - Raul Roncero-Martin
- Metabolic Bone Diseases Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Caceres, Spain
| | - Julian F Calderon-Garcia
- Metabolic Bone Diseases Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Caceres, Spain
| | - Mercedes Santos-Vivas
- Metabolic Bone Diseases Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Caceres, Spain
| | - Vicente Vera
- Metabolic Bone Diseases Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Caceres, Spain
| | - Mariana Martínez-Alvárez
- Metabolic Bone Diseases Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Caceres, Spain
| | - Purificación Rey-Sanchez
- Metabolic Bone Diseases Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Caceres, Spain
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11
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Nair S, Slaughter JC, Terry JG, Appiah D, Ebong I, Wang E, Siscovick DS, Sternfeld B, Schreiner PJ, Lewis CE, Kabagambe EK, Wellons MF. Anti-mullerian hormone (AMH) is associated with natural menopause in a population-based sample: The CARDIA Women's Study. Maturitas 2015; 81:493-8. [PMID: 26139426 PMCID: PMC4515384 DOI: 10.1016/j.maturitas.2015.06.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/05/2015] [Accepted: 06/05/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE AMH is associated with menopausal timing in several studies. In contrast to prior studies that were restricted to women with regular cycles, our objective was to examine this association in women with either regular or irregular menstrual cycles. METHODS CARDIA is a longitudinal, population-based study that recruited adults ages 18-30 when it began in 1985-1986. AMH was measured in serum stored in 2002-2003. Natural menopause was assessed by survey in 2005-2006 and 2010-2011. RESULTS Among 716 premenopausal women, median [25th, 75th] AMH was 0.77 [0.22-2.02]ng/dL at a median age of 42 [39-45] years. Twenty-nine percent of the women (n=207) reported natural menopause during 9 years of follow up. In fully adjusted discrete-time hazard models, a 0.5 ng/dL AMH decrement was associated with higher risk of menopause (p<0.001). Hazard ratios varied with time since AMH measurement. The HR (95% CI) for menopause was 8.1 (2.5-26.1) within 0-3 years and 2.3 (1.7-3.3) and 1.6 (1.3-2.1) for 3-6 and 6-9 years, respectively. When restricted to women with regular menses, results were similar (e.g., HR=6.1; 95% CI: 1.9-20.0 for 0-3 years). CONCLUSION AMH is independently associated with natural menopause. AMH appears most useful in identifying women at risk of menopause in the near future (within 3 years of AMH measurement).
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Affiliation(s)
- Sangeeta Nair
- Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, 2525 West End Avenue, Suite 600, Nashville, TN 37203, United States
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 1100, Nashville, TN 37203, United States
| | - James G Terry
- Department of Radiology and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, 2525 West End Avenue, Suite 600, Nashville, TN 37203, United States
| | - Duke Appiah
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St., Suite 300, Minneapolis, MN 55454, United States
| | - Imo Ebong
- Loma Linda University Medical Center Transplantation Institute, 25865 Barton Road, Suite 101, Loma Linda, CA 92354, United States
| | - Erica Wang
- Department of Obstetrics and Gynecology, Cedars Sinai Medical Center, San Diego, CA 90048, United States
| | | | - Barbara Sternfeld
- Kaiser Permanente, Division of Research, Epidemiology and Prevention, 2000 Broadway, Oakland, CA 94612, United States
| | - Pamela J Schreiner
- Division of Epidemiology and Community Health, University of Minnesota, 1300 S 2nd St., Suite 300, Minneapolis, MN 55454, United States
| | - Cora E Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama Birmingham, 1717 11th Avenue South, Room 614, Birmingham, AL 35205, United States
| | - Edmond K Kabagambe
- Department of Medicine and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, 2525 West End Avenue, Suite 600, Nashville, TN 37203, United States
| | - Melissa F Wellons
- Department of Medicine and Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC), Vanderbilt University, 2525 West End Avenue, Suite 600, Nashville, TN 37203, United States.
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12
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Chung W, Lee J, Ryu OH. Is the negative relationship between obesity and bone mineral content greater for older women? J Bone Miner Metab 2014; 32:505-13. [PMID: 24114196 DOI: 10.1007/s00774-013-0519-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 08/26/2013] [Indexed: 11/24/2022]
Abstract
Obesity and osteoporosis are two important body composition problems with increasing prevalences in aged populations. Traditionally, obesity has been regarded as being beneficial to bone health. However, the protective effect of obesity on osteoporosis has been questioned. In some recent studies, obesity, as defined by percentage body fat, was regarded as a risk factor for osteoporosis. The purpose of this study was to (1) evaluate the effect of waist circumference, a surrogate measure for abdominal obesity, on bone mineral content (BMC) and (2) examine whether the effect of waist circumference increases with advancing age. The study population is made up of women aged over 45 years who completed the body composition and bone mineral density examinations in the fifth Korea National Health and Nutrition Examination Survey in 2010. Subjects who take estrogen or are under medical treatment for osteoporosis were excluded. Stroke patients are also excluded. Femoral neck, total-hip, and whole-body BMC were measured by dual-energy X-ray absorptiometry. A total of 1,434 subjects were included in the analysis. Waist circumference was negatively associated with BMC in all tested regions after correction for weight, menopausal status, smoking, drinking, and exercise. In addition, the negative association between waist circumference and BMC in the femoral neck and total hip increases with age, after correction for confounding factors, showing an interaction effect between waist circumference and age on BMC. In conclusion, this study shows that the negative relationship between waist circumference and BMC in the femoral neck and total hip is greater for older women.
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Affiliation(s)
- Wankyo Chung
- College of Business, Hallym University, Chuncheon-si, South Korea
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13
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Wellons MF, Bates GW, Schreiner PJ, Siscovick DS, Sternfeld B, Lewis CE. Antral follicle count predicts natural menopause in a population-based sample: the Coronary Artery Risk Development in Young Adults Women's Study. Menopause 2013; 20:825-30. [PMID: 23422869 PMCID: PMC3675173 DOI: 10.1097/gme.0b013e31827f06c2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The timing of menopause is associated with multiple chronic diseases. Tools that predict this milestone have relevance for clinical and research purposes. Among infertile women, a positive relationship exists between antral follicle count (AFC) and response to controlled ovarian hyperstimulation, a marker of ovarian reserve. However, an age-independent relationship between AFC and menopause has not been demonstrated. Thus, our objective was to evaluate the relationship between AFC measured in women aged 34 to 49 years and incident natural menopause during 7 years of follow-up. METHODS The Coronary Artery Risk Development in Young Adults Study is a longitudinal community-based study (Chicago, IL; Birmingham, AL; Minneapolis, MN; and Oakland, CA) begun in 1985-1986. In 2002-2003, the Coronary Artery Risk Development in Young Adults Women's Study measured follicle-stimulating hormone (FSH) levels and performed a transvaginal ultrasound protocol that included AFC (2-10 mm follicles on both ovaries). Incident natural menopause was assessed by surveys in 2005-2006 and 2009-2010. RESULTS In our sample (n = 456), the median (interquartile range) AFC and FSH level were 5 (2-9) and 7.8 (5.6-11.0) mIU/mL, respectively, at a mean (range) age of 42 (34-49) years in 2002-2003. One hundred one women reported natural menopause by 2009-2010. In Cox models, current smoking, stable menses, FSH level higher than 13 mIU/mL, and AFC of 4 or less were independently associated with incident natural menopause. Compared with AFC higher than 4, those with an AFC of 4 or less were nearly twice as likely to have undergone menopause during 7 years of follow-up (hazard ratio, 1.89; 95% CI, 1.19-3.02) after adjustment for covariates. CONCLUSIONS AFC has been found to be independently associated with natural menopause during 7 years of follow-up after controlling for other markers of ovarian aging.
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14
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Dangas GD, Maehara A, Evrard SM, Sartori S, Li JR, Chirumamilla AP, Nomura-Kitabayashi A, Gukathasan N, Hassanin A, Baber U, Fahy M, Fuster V, Mintz GS, Kovacic JC. Coronary artery calcification is inversely related to body morphology in patients with significant coronary artery disease: a three-dimensional intravascular ultrasound study. Eur Heart J Cardiovasc Imaging 2013; 15:201-9. [PMID: 23904334 DOI: 10.1093/ehjci/jet139] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS Emerging data have indicated unexpected complexity in the regulation of vascular and bone calcification. In particular, several recent studies have challenged the concept of a universally positive relationship between body morphology [weight, height, body mass index (BMI), body surface area (BSA)] and the extent of vascular calcification. We sought to clarify these discrepancies and investigated the relationship between index lesion coronary artery calcification (CAC) and body morphology in patients undergoing percutaneous coronary intervention (PCI) using three-dimensional intravascular ultrasound (IVUS). METHODS AND RESULTS We analysed CAC in patients who underwent PCI with pre-intervention IVUS imaging. The main outcome measure was the calcium index (CalcIndex); a three-dimensional IVUS-derived measure of total calcification per obstructive coronary lesion. A total of 346 patients (65.3 ± 10.6 years; 29.5% females) underwent PCI with IVUS-based CAC assessment. CalcIndex was categorized as zero-low (0-0.1399; n = 152) or intermediate-high (0.1400-1.2541; n = 194). All measures of body morphology were lower in patients with intermediate-high CalcIndex (height, P = 0.024; weight, P = 0.008; BMI, P = 0.064; BSA, P = 0.005). In adjusted multivariable models, weight and BSA were independent inverse predictors of intermediate-high CalcIndex [weight: odds ratio (OR) 0.986, P = 0.017; BSA: OR 0.323, P = 0.012] while CalcIndex also trended towards an inverse association with both height (P = 0.068) and BMI (P = 0.064). These independent inverse associations were consistent across multiple clinical subgroups, including stratification by age, race, gender, diabetes, and renal impairment. CONCLUSION Using three-dimensional IVUS to assess vascular calcification, these data confirm an independent, inverse relationship between body size and index lesion CAC in patients with obstructive coronary artery disease.
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15
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Li Y, Qin Y, Xie Y, Tian F. Grouped penalization estimation of the osteoporosis data in the traditional Chinese medicine. J Appl Stat 2013. [DOI: 10.1080/02664763.2012.724660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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16
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Kim SJ, Yang WG, Cho E, Park EC. Relationship between Weight, Body Mass Index and Bone Mineral Density of Lumbar Spine in Women. J Bone Metab 2012; 19:95-102. [PMID: 24524039 PMCID: PMC3780918 DOI: 10.11005/jbm.2012.19.2.95] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 08/23/2012] [Accepted: 09/03/2012] [Indexed: 11/25/2022] Open
Abstract
Objectives This study aims to identify a relationship between bone mineral density (BMD) of lumbar spine, and the weight and body mass index (BMI) in women. Methods The subjects were 1,143 females who visited the public health center. BMD (T-score), height and weight were measured and age, menopause, diabetes and hypertension, exercising status and smoking status were inquired by interview. Results Among the subjects, 362 (31.7%) were in the normal group and 781 (68.3%) were in the abnormal group. As the result of the logistic regression analysis with BMI (Model I), the odds ratio of getting into the abnormal BMD group as age increases by 1 year marked 1.044 (95% CI = 1.009-1.080). The odds ratio of getting into the abnormal BMD group due to menopause was 2.663 (1.516-4.679) and the odds ratio according to lack of walking exercise was 2.597 (1.878-3.591). The odds ratio with 1 kg/m2 of BMI increase was 0.909 (0.862-0.959). In the logistic regression analysis with weight (Model II), the odds ratio of getting into the abnormal BMD group as age increases by 1 year marked 1.044 (1.009-1.080). The odds ratio of getting into the abnormal bone density group due to menopause was 2.575 (1.472-4.507) and the odds ratio according to lack of walking exercise was 2.598 (1.881-3.587). The odds ratio with 1 kg of weight increase was 0.963 (0.942-0.984). The Akaike's information criterion (AIC) values of Model I and Model II were 1196.18 and 1197.14 respectively, indicating Model I has the better compatibility of regression analysis model. Conclusion Weight, BMI and BMD had a positive correlation. However, the coefficient of correlation between weight and BMD was higher than the coefficient between BMI and BMD, which means low weight is much more likely to be related to osteoporosis with no other factor considered. On the other hand, under the condition considering age, height, menopause and walking exercise smoking status, low BMI is much more compatible as a risk factor for osteoporosis.
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Affiliation(s)
- Sang Jun Kim
- Graduate School of Public Health, Yonsei University, Seoul, Korea
| | | | - Eun Cho
- Graduate School of Public Health, Yonsei University, Seoul, Korea. ; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Institute of Health Services Research, Yonsei University, Seoul, Korea
| | - Eun-Cheol Park
- Graduate School of Public Health, Yonsei University, Seoul, Korea. ; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Institute of Health Services Research, Yonsei University, Seoul, Korea
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17
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Calderon-Garcia JF, Lavado-Garcia JM, Martin RR, Moran JM, Canal-Macias ML, Pedrera-Zamorano JD. Bone ultrasound and physical activity in postmenopausal Spanish women. Biol Res Nurs 2012; 15:416-21. [PMID: 22997347 DOI: 10.1177/1099800412459800] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We studied the effects of moderate physical activity on bone mass in healthy postmenopausal women as assessed by quantitative bone ultrasound. We enrolled a total of 326 postmenopausal women (60.95 ± 8.51 years old and 13.02 ± 9.52 years since menopause) and categorized them by weekly physical activity in their leisure time (sedentary, moderate, and active). We administered a questionnaire on general health and diet and measured bone density by ultrasound on phalanges II-V in the nondominant hand. We found no significant difference in the amplitude-dependent speed of sound (Ad-SoS; p > .05) between sedentary and active women. We concluded that the changes induced by moderate physical activity on bone mass are minimal in healthy postmenopausal women.
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Affiliation(s)
- Julian F Calderon-Garcia
- 1Metabolic Bone Diseases Research Group, School of Nursing and Occupational Therapy, University of Extremadura, Caceres, Spain
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18
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Abstract
Decreased bone mineral density (BMD) is common in patients with schizophrenia; however, the pathogenesis is unclear. Different classes of antipsychotic agents may affect BMD. This study systemically examined the effects of clozapine vs. other antipsychotics, and several hormonal and metabolic factors that may contribute to BMD in female patients with schizophrenia, who are more vulnerable than males. Forty-eight women with schizophrenia, treated with long-term antipsychotics of the prototype prolactin-sparing (PS) antipsychotic agent clozapine vs. prolactin-raising (PR) antipsychotics were enrolled. They were matched for demographic and clinical characteristics. Various factors, including blood levels of prolactin and sex hormones, psychopathological symptoms, global assessment of functioning, physical activity, and menopausal status, were determined to explore their contribution to low BMD (LBMD), defined as a dual-energy X-ray absorptiometer (DEXA) T score <-1. Overall, women receiving clozapine have better bone density than women receiving PR antipsychotics. Compared to PR antipsychotics, PS clozapine therapy is a protective factor (odds ratio 28.2, 95% confidence interval 2.37-336.10, p=0.008) for LBMD. Predictors for higher bone density in the clozapine group included higher clozapine dose (p<0.001), younger age (p<0.001), and higher thyroid-stimulating hormone level (p<0.001); in the PR group, higher body mass index (p=0.003) and lower alkaline phosphatase level (p=0.007) were associated with LBMD. This study suggests that clozapine treatment is beneficial for BMD compared to PR antipsychotic treatment in women with chronic schizophrenia, and clozapine's bone-density protecting effect is dose-related.
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19
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Kovacic JC, Lee P, Baber U, Karajgikar R, Evrard SM, Moreno P, Mehran R, Fuster V, Dangas G, Sharma SK, Kini AS. Inverse relationship between body mass index and coronary artery calcification in patients with clinically significant coronary lesions. Atherosclerosis 2011; 221:176-82. [PMID: 22204865 DOI: 10.1016/j.atherosclerosis.2011.11.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 10/12/2011] [Accepted: 11/07/2011] [Indexed: 01/07/2023]
Abstract
AIMS Mounting data support a 'calcification paradox', whereby reduced bone mineral density is associated with increased vascular calcification. Furthermore, reduced bone mineral density is prevalent in older persons with lower body mass index (BMI). Therefore, although BMI and coronary artery calcification (CAC) exhibit a positive relationship in younger persons, it is predicted that in older persons and/or those at risk for osteoporosis, an inverse relationship between BMI and CAC may apply. We sought to explore this hypothesis in a large group of patients with coronary artery disease undergoing percutaneous coronary intervention (PCI). METHODS AND RESULTS We accessed our single-center registry for 07/01/1999 to 06/30/2009, extracting data on all patients that underwent PCI. To minimize bias we excluded those at the extremes of age or BMI and non-Black/Hispanic/Caucasians, leaving 9993 study subjects (age 66.6±9.9 years). Index lesion calcification (ILC) was analyzed with respect to BMI. Comparing index lesions with no angiographic calcification to those with the most severe, mean BMI decreased by 1.11 kgm(-2); a reduction of 3.9% (P<0.0001). By multivariable modeling, BMI was an independent inverse predictor of moderate-severe ILC (m-sILC; odds ratio [OR] 0.967, 95% CI 0.953-0.980, P<0.0001). Additional fully adjusted models identified that, compared to those with normal BMI, obese patients had an OR of 0.702 for m-sILC (95% CI 0.596-0.827, P<0.0001). CONCLUSIONS In a large group of PCI patients, we identified an inverse correlation between BMI and index lesion calcification. These associations are consistent with established paradigms and suggest a complex interrelationship between BMI, body size and vascular calcification.
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Affiliation(s)
- Jason C Kovacic
- The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, United States.
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Kadam N, Chiplonkar S, Khadilkar A, Divate U, Khadilkar V. Low bone mass in urban Indian women above 40 years of age: prevalence and risk factors. Gynecol Endocrinol 2010; 26:909-17. [PMID: 20849208 DOI: 10.3109/09513590.2010.487604] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the prevalence and the relative importance of risk factors for low bone mass in Indian pre- and post-menopausal women. METHODS Data were collected on anthropometry and lifestyle factors in apparently healthy 80 pre- and 92 post-menopausal (40-75 years) women. Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry. Fasting blood samples were analysed for Parathyroid hormone, vitamin D, calcium and zinc. RESULTS BMD at all three sites was significantly lower in post-menopausal than the pre-menopausal women (p < 0.001). Prevalence of osteoporosis was highest at the lumbar spine (25.8%) in post-menopausal women, while prevalence of osteopenia was high in pre-menopausal women (44.3%). Vitamin D deficiency was seen in 54.5% pre and 41.8% post-menopausal women and significant correlation of serum 25(OH)D levels (r = 0.16) was obtained only for total hip Z-score (p < 0.05). Correlation between sun index and lumbar spine BMD was marginally significant (r = 0.14, p = 0.07). Generalised linear models revealed that after adjusting for age, weight and height, percent decrease of 2.1-4.5% in BMD may be attributed to menopause. CONCLUSION Age, weight, height, menopause, low intakes of calcium and low 25(OH)D along with poor sunlight exposure are the major factors contributing to bone loss in Indian women above 40 years of age.
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Bolanowski M, Zadrozna-Sliwka B, Jawiarczyk A, Syrycka J. The influence of other than prolactin hormones on bone mineral density in women with hyperprolactinaemia of various origins. Gynecol Endocrinol 2010; 26:623-7. [PMID: 20218822 DOI: 10.3109/09513591003686320] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Hyperprolactinaemia may lead to bone loss, both due to hypogonadism and other hormonal disturbances. Aim of the case-control study was the analysis of influences of hormonal profiles associated with hyperprolactinaemia on the bone mineral density (BMD) in women with hyperprolactinaemia of various origin. MATERIAL AND METHODS The subjects were 32 patients with prolactinoma, 43 ones with functional hyperprolactinaemia and 29 healthy controls. All of them were studied for BMD (lumbar spine, proximal femur, forearm, total body) by dual-energy X-ray absorptiometry and their correlations with hormones levels (prolactin, oestradiol, luteinising hormone, follicle stimulating hormone, sex hormone binding globulin (SHBG), testosterone, dehydroepiandrosterone sulphate (DHEA-S), insulin-like growth factor-1 and intact parathyroid hormone) using Spearman correlation analysis and multiple regression analysis model. RESULTS Correlation analysis revealed the anabolic influence of PTH on lumbar spine in women with prolactinoma, and on ultradistal radius in functional hyperprolactinaemia. In multiple regression analysis, oestradiol had greatest influence on lumbar spine and total body BMD. Moreover, positive influence of testosterone, SHBG on spine BMD, and of oestradiol, testosterone, SHBG and DHEA-S on total body BMD were observed in patients with prolactinoma. CONCLUSION Hormonal disturbances associated with hyperprolactinaemia influence BMD more in patients with prolactinoma than in ones with functional hyperprolactinaemia.
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Affiliation(s)
- Marek Bolanowski
- Department of Endocrinology, Diabetology and Isotope Therapy, Medical University, Wroclaw, Poland.
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