Ethnic Variation in Risk for Osteoporosis among Women: A Review of Biological and Behavioral Factors

Recipient race modifies the association between obesity and long-term graft outcomes after kidney transplantation

Donor and recipient obesity (defined using body mass index [BMI]) are associated with worse outcomes after kidney transplant (KT). In adult KT recipients identified using the Scientific Registry of Transplant Recipients (2000-2017), we examined the modifying effect of recipient race on recipient obesity (BMI > 30 kg/m2) and combined donor and recipient (DR) obesity pairing, with death-censored graft loss (DCGL), all-cause graft loss (ACGL), and short-term graft outcomes using multivariable Cox proportional hazards models and logistic regression. Obesity was associated with a higher risk of DCGL in White (adjusted hazard ratio [aHR], 1.29; 95% CI, 1.25-1.35) than Black (aHR, 1.13; 95% CI, 1.08-1.19) recipients. White, but not Black, recipients with obesity were at higher risk for ACGL (aHR, 1.08; 95% CI, 1.05-1.11, for White recipients; aHR, 0.99; 95% CI, 0.95-1.02, for Black recipients). Relative to nonobese DR, White recipients with combined DR obesity experienced more DCGL (aHR, 1.38; 95% CI, 1.29-1.47 for White; aHR, 1.19; 95% CI, 1.10-1.29 for Black) and ACGL (aHR, 1.12; 95% CI, 1.07-1.17 for White; aHR, 1.00; 95% CI, 0.94-1.07 for Black) than Black recipients. Short-term obesity risk was similar irrespective of race. An elevated BMI differentially affects long-term outcomes in Black and White KT recipients; uniform BMI thresholds to define transplant eligibility are likely inappropriate.

Whole-Body Vibration Therapy as a Modality for Treatment of Senile and Postmenopausal Osteoporosis: A Review Article

Whole-body vibration therapy is an intentional biomechanical stimulation of the body using various frequencies of vibrations with the motive of health improvement. Ever since its discovery, this therapy has been extensively used in physiotherapeutic measures and the sports industry. For its property of increasing bone mass and density, space agencies use this therapy on astronauts who return to Earth after long-term space missions to regain lost bone and muscle mass. The potential of this therapy to restore bone mass encouraged researchers to look for its scope in the treatment of age-related bone degenerative diseases such as osteoporosis and sarcopenia, as well as in the correction of posture control and gait in geriatrics and post-menopausal women. Osteoporosis and osteopenia account for roughly half of all fractures worldwide. These degenerative diseases also cause gait and posture changes. Bisphosphonates, monoclonal antibodies, parathyroid hormone fragments, hormone replacement therapies, and calcium and vitamin D supplementation are among the medical treatments available. Lifestyle changes and physical exercise are advised. However, vibration therapy's scope as a treatment option is yet to be explored. The safe range of frequency, amplitude, duration, and intensity of the therapy is still to be determined. This article is a review of the results of various clinical trials done in the last 10 years that target the effect of vibration therapy in both osteoporotic women and the elderly for the treatment of such ailments and deformities. We collected data from PubMed using advanced search and applied the exclusion criteria. In total, we analyzed nine clinical trials.

Epidemiology of Fragility Pubic Ramus Fractures in the United States

Introduction

Previous studies illustrate significant increases in pelvic fracture incidence; however, there is a paucity of information on the incidence of osteoporotic pelvic ring injuries based on large-scale examinations of geographically and ethnically diverse populations. This study addresses the epidemiology of osteoporotic pubic ramus fractures in the United States and details differences in incidence rates with respect to age, gender, and race.

Materials and Methods

National Electronic Injury Surveillance System (NEISS) data between 2002 and 2019 was gathered for individuals aged 60 and above presenting to U.S. emergency departments with ramus fractures. Incidence rates for ramus injuries were calculated using adjusted U.S. Census Bureau estimates of population. Fracture incidences were calculated for age, gender, and race strata.

Results

The overall incidence rate of pubic ramus fractures in the United States between 2002 and 2019 was 13.47 per 1,000,000 people 60 years and older (95% confidence limit: 9.92-17.01). The incidence of pubic ramus fractures for females in the US was 21.71 (16.08-27.34). Rates of ramus fracture increased overall (P < .001) and for both genders between the ages of 60 and 100, though the rate increase was significantly greater in females than in males (P < .001). In terms of race, incidence was highest Asian females and lowest in Native American and Pacific Islander men.

Discussion/Conclusion

: As the first national study addressing the epidemiology of ramus injuries in the United States, this work reveals these injuries comprise a significant fracture risk in the elderly. In addition, it highlights gender and ethnic strata that are more susceptible to these injuries.

Higher latitude and lower solar radiation influence on hip fracture admissions in Chilean older population

Data linking solar radiation with fractures are lacking. We found that lower solar radiation was associated with higher hip fracture admission rates in men from Chile. This supports the idea that solar radiation, a surrogate of vitamin D, may be involved in the development of fractures in older population. INTRODUCTION : To explore the associations between solar radiation and latitude with hip fracture admission rates in people aged 65 years or older in Chile, the country with the greatest variation in solar radiation in the world.

METHODS

In this ecological study, we investigated the associations between regional solar radiation and latitude with hospitalizations due to hip fracture in population aged 65 years or older, by reviewing national records between 2013 and 2018. We also evaluated the role of sociodemographic factors such as poverty, education, indigenous ethnicity, and rurality rates.

RESULTS

Between 2013 and 2018, there were 44,328 admissions due to hip fracture in people aged 65 years or older; 77.5% were women and 65.1% were aged 80 years or older. The national admission rate was 389.3 per 100,000 inhabitants (95% CI: 382.4-396.2). The highest admission rate was registered in the Region IX (445.3 per 100,000, 95% CI: 398.3-492.4), which has the highest poverty rates, indigenous ethnicity rates, and rurality rates. We found a north-south increasing gradient of admission rates in men (β=1.5 [95% CI: 0 to 3], p=0.044) and a significant association between solar radiation and admission rates in men (β=-4.4 [95% CI: -8 to 0.8], p=0.02). Admission rates in men were also associated with sociodemographic variables such as poverty (β=2.4 [95% CI: 0 to 4.8], p=0.048) and rurality rates (β=1.2 [95% CI: 0.1 to 2.4], p=0.039).

CONCLUSION

Regional solar radiation and latitude were associated with hip fracture admission rates in men aged 65 years or older in Chile, with highest admission rates at higher latitudes and lower solar radiation.

The importance of the UGT1A1 variants in the development of osteopenia and osteoporosis in postmenopausal women

The UDP-glucuronosyltransferase 1A1 (UGT1A1) is involved in the process of estrogen conjugation and elimination. The aim of the study was to analyze whether the UGT1A1 genetic variants are associated with the development of osteopenia and osteoporosis in postmenopausal women. The analysis of the rs4148323 (UGT1A1*6) and rs3064744 (UGT1A1*28) variants in the UGT1A1 gene was conducted using real-time PCR. A significant correlation was observed between the genotypes of the rs3064744 (UGT1A1*28) sequence variant and body mass in women with osteoporosis. The analysis of the Z-score values revealed that women with osteoporosis and carrying the 6/6 variant had the lowest Z-score values as compared to women with the 6/7 and the 7/7 variants (− 1.966 ± 0.242 vs. − 1.577 ± 0.125 and − 1.839 ± 0.233). In addition, the odds ratio for the investigated genotypes (6/6, 6/7, 7/7) indicated an increased risk for osteopenia and osteoporosis in women with the 7/7 homozygous genotype. The analysis of the frequencies of the GG, GA and AA genotypes of the rs4148323 UGT1A1 gene showed no statistically significant differences between the groups. Our analysis revealed that the UGT1A1 rs3064744 variant may affect the risk of developing osteoporosis in postmenopausal Polish women. The UGT1A1 rs4148323 variant is not directly associated with the development of osteopenia and osteoporosis.

Factors Associated with Bone Mineral Density and Bone Resorption Markers in Postmenopausal HIV-Infected Women on Antiretroviral Therapy: A Prospective Cohort Study

The study aimed to determine factors associated with changes in bone mineral density (BMD) and bone resorption markers over two years in black postmenopausal women living with human immunodeficiency virus (HIV) on antiretroviral therapy (ART). Women (n = 120) aged > 45 years were recruited from Potchefstroom, South Africa. Total lumbar spine and left femoral neck (LFN) BMD were measured with dual energy X-ray absorptiometry. Fasting serum C-Telopeptide of Type I collagen (CTx), vitamin D and parathyroid hormone were measured. Vitamin D insufficiency levels increased from 23% at baseline to 39% at follow up. In mixed linear models serum CTx showed no change from baseline to end (p = 0.363, effect size = 0.09). Total and LFN BMD increased significantly over two years, but effect sizes were small. No significant change in spine BMD over time was detected (p = 0.19, effect size = 0.02). Age was significantly positively associated with CTx over time, and negatively with total and LFN BMD. Physical activity (PA) was positively associated with LFN BMD (p = 0.008). Despite a decrease in serum vitamin D, BMD and CTx showed small or no changes over 2 years. Future studies should investigate PA interventions to maintain BMD in women living with HIV.

Low Bone Mineral Density in Young Patients Newly Diagnosed with Inflammatory Bowel Disease

BACKGROUND

The prevalence and risk factors of low bone mineral density (BMD) in Asian patients newly diagnosed with inflammatory bowel disease (IBD) have not been fully suggested.

AIMS

We aimed to examine the prevalence and risk factors of low BMD in young Korean patients newly diagnosed with IBD.

METHODS

We prospectively enrolled 132 patients aged less than 50 years and newly diagnosed with IBD from six tertiary referral centers in Korea between November 2014 and April 2017. BMD was measured by dual-energy X-ray absorptiometry, and then the Z-score was determined. We defined low BMD as a Z-score ≤ - 1.0.

RESULTS

Of 68 patients with ulcerative colitis (UC), 22 (32.4%) had low BMD. Also, of 64 patients with Crohn's disease (CD), 24 (37.5%) showed low BMD. Results from multivariate regression analysis identified the risk factors for low BMD as a high level of alkaline phosphatase (ALP) (≥ 140 U/L) (P = 0.010) in UC patients, and being underweight (body mass index ≤ 18.5 kg/m²) (P = 0.017) in CD patients.

CONCLUSIONS

Our study showed that about one-third of newly diagnosed IBD Asian patients had low BMD. The clinical factors associated with low BMD were a high level of ALP in UC patients, and being underweight, in CD patients. Therefore, measurements of BMD in young patients should be considered at the diagnosis of IBD.

Ethnic differences in risk of hip fracture in Norway: a NOREPOS study

Hip fracture is a major public health problem, and the incidence rates vary considerably between countries. Ethnic differences in bone mineral density have been identified as a factor to explain some of the geographical differences in rates of hip fracture. In this Norwegian register-based study, we found that all immigrant groups experienced lower risk of hip fracture than individuals born in Norway.

INTRODUCTION

Norway is among the countries with the highest incidence rates. The aim of this study was to investigate differences in risk of hip fracture between ethnic groups living in Norway.

METHODS

We linked individuals in the Norwegian Population and Housing Census conducted in 2001 and a database consisting of all hip fractures in Norway in the period 2001-2013. Residents (n = 1,392,949) between 50 and 89 years and born in nine different geographical regions of the world were examined, and we computed age-standardized incidence rates for the different geographic regions-denoted ethnic groups in the paper. Gender-stratified Cox regression analysis, adjusted for age, was used to model risk of hip fracture as a function of region of birth.

RESULTS

Age-standardized incidence rates of hip fracture varied considerably between regions of birth living in Norway, in both genders. All immigrant groups had lower risk of hip fracture compared to the Norwegian-born population. Immigrants from Central and Southeast Asia had the lowest risk of hip fracture when compared to individuals born in Norway (HR = 0.2, 95% CI 0.1-0.3 and HR =0.2, 95% CI 0.2-0.4 in men and women, respectively).

CONCLUSION

Lower risk of hip fracture was found in all immigrant groups compared to the Norwegian-born majority population.

Muscle-Bone Interactions in Chinese Men and Women Aged 18-35 Years

To characterize bone mineral density (BMD), bone strength, muscle and fat mass, and muscle strength and power in Chinese women (n = 25) and men (n = 28) classified as in the bone accrual phase (18-25 years) or in the peak bone mass phase (26-35 years). Calcium intakes, physical activity levels, and serum vitamin D were measured. Dual-energy X-ray absorptiometry (DXA) assessed body composition, lumbar spine, and hip areal BMD (aBMD) variables and peripheral quantitative computed tomography (pQCT) assessed cortical and trabecular volumetric BMD (vBMD) and bone strength. Muscle strength and power were assessed by grip strength, leg press, and vertical jump tests. Calcium, serum vitamin D, and physical activity levels were similar across age and sex groups. Significant sex differences (p < 0.05) were found for most body composition variables, hip aBMD, tibia variables, and muscle strength and power. Adjusting for height and weight eliminated most of the significant sex differences. Women showed stronger positive correlations between body composition and bone variables (r = 0.44 to 0.78) than men. Also, correlations between muscle strength/power were stronger in women vs. men (r = 0.43 to 0.82). Bone traits were better related to body composition and muscle function in Chinese women compared to Chinese men aged 18 to 35 years, and peak bone mass seems to be achieved by 25 years of age in both Chinese men and women since there were no differences between the two age groups.

Lannea acida A. Rich. (Anacardiaceae) Ethanol Extract Exhibits Estrogenic Effects and Prevents Bone Loss in an Ovariectomized Rat Model of Osteoporosis

Phytoestrogens have been shown to prevent postmenopausal osteoporosis. Lannea acida is a medicinal plant traditionally used in Cameroon to treat infertility, gynaecological complaints, and rheumatism. These uses prompted us to evaluate estrogenic activity of Lannea acida bark ethanolic extract and its antiosteoporotic potential in ovariectomized Wistar rats. In vitro, the E-screen assay was used to assess the ability of L. acida extract to induce MCF-7 cells proliferation. In vivo, a 3-day uterotrophic assay and a 12-week oral treatment in ovariectomized adult rats were carried out to evaluate the ability of L. acida extract to prevent bone mass loss. L. acida extract induced MCF-7 cell proliferation. In vivo, it significantly increased the uterine wet weight, uterine and vaginal epithelial heights, and mammary glands differentiation. At 200 mg/kg, a long-term treatment with the extract prevented body weight gain (p < 0.05) and loss of bone mass and/or density (p < 0.05) induced by ovariectomy. Also, a significant (p < 0.001) decrease of alkaline phosphatase activity was observed with 50 mg/kg. L. acida extract improved bone microarchitecture and could restore normal bone mineralization by increasing the inorganic phosphorus and calcium level in bone. These findings provide evidence that Lannea acida is a potential alternative for the prevention of postmenopausal osteoporosis.

The effects of pentoxifylline adminstration on fracture healing in a postmenopausal osteoporotic rat model

Previous studies report positive effects of pentoxifylline (PTX) alone or in combination with other drugs on some pathologic bone diseases as well as an ability to accelerate osteogensis and fracture healing in both animal models and human patients. The aim of this present study was to evaluate the effects of PTX administration on Hounsfield unit and bone strength at catabolic response (bone resorbing) of a fracture in an experimental rat model of ovariectomy induced osteoporosis (OVX-D). Thirty adult female rats were divided into groups as follows: 1 (OVX, control, no treatment); 2 (OVX, sham: daily distilled water); 3 (OVX, daily alendronate: 3 mg/kg); 4 (OVX, twice daily 100 mg/kg PTX) and 5 (OVX, PTX+alenderonate). OVX was induced by bilateral ovariectomy in all rats. A complete standardized osteotomy of the right femur was made after 3.5 months. PTX and alendronate treatments were performed for eight weeks. Then, rats were euthanized and had its right femur subjected to computerized tomography scanning for measuring Hounsfield unit; eventually, the samples were sent for a three point bending test for evaluation of the bone strength. Administration of PTX with 200 mg/kg and alendronate alone and in combination showed no significant alteration in Hounsfield unit and biomechanical properties of repairing callus of the complete osteotomy compared with the control group. Results showed increased bending stiffness and stress high load mean values of repairing complete osteotomy in PTX-treated rats compared to the control OVX-D.

Aging and bone health in Singaporean Chinese pre-menopausal and postmenopausal women

OBJECTIVE

The study evaluated relationships between menopausal statuses, hormone replacement therapy (HRT), body mass index (BMI), percent body fat (PBF), and exercise with osteoporosis and bone mineral density (BMD) in Singaporean women.

STUDY DESIGN

This is a cross-sectional study.

MAIN OUTCOME MEASURES

The spine BMD, and femoral neck BMD as well as the prevalence of osteoporosis are the main outcome measures studied.

RESULTS

Age, BMI, PBF and exercise intensity were independently associated with spine and femoral neck BMD. Women with higher BMI and lower PBF had higher BMD and lower prevalence of osteoporosis. Postmenopausal women without HRT had lower BMD and higher prevalence of osteoporosis while those on HRT had similar BMD and prevalence of osteoporosis as premenopausal women.

CONCLUSION

This study shows that BMI and PBF are powerful predictors of BMD. Osteoporosis is site-specific in the Singapore population, being higher in the femoral neck than in the lumbar spine. The bone status after menopause may not be worse than that dictated by age alone and both ERT and E/PRT could sustain the BMD to levels corresponding to those of women a decade younger. A strategy to improve bone health should include dieting and physical exercise program that focuses on selectively reducing fat mass and increasing lean mass.

Epidemiology and treatment of osteoporosis in women: an Indian perspective

The number of women with osteoporosis, ie, with reduced bone mass and the disruption of bone architecture, is increasing in India. While data on prevalence of osteoporosis among women in India come from studies conducted in small groups spread across the country, estimates suggest that of the 230 million Indians expected to be over the age of 50 years in 2015, 20%, ie, ~46 million, are women with osteoporosis. Thus, osteoporosis is a major public health problem in Indian women. Low calcium intakes with extensive prevalence of vitamin D deficiency, increasing longevity, sex inequality, early menopause, genetic predisposition, lack of diagnostic facilities, and poor knowledge of bone health have contributed toward the high prevalence of osteoporosis. Bone health may be optimized by creating an environment to achieve peak bone mass during adolescence, maintenance of healthy bone throughout the life cycle, and prevention of bone loss postmenopausal. In Indian women, calcium, vitamin D, and bisphosphonates are the commonest first-line therapies used. The use of other drugs such as hormone replacement therapy, estrogen agonists, calcitonin, parathyroid hormone, and denosumab is decided as per the affordability and availability of treatment options. Major gaps still remain in the diagnosis and management of osteoporosis, thus highlighting the need for more structured research in this area. This review focuses on the epidemiology of osteoporosis in Indian women and available treatments.

Characteristics of distal radius speed of sound data in Chinese mainland men and women

Quantitative ultrasound (QUS) assessment of bone health status, as a reliable method, is rapidly gaining popularity. Speed of sound (SOS) is one parameter of skeletal status provided by QUS assessment. The objective of the present study was first to determine the normative distal radius SOS data on healthy Chinese mainland men and women and second to investigate the effects of sex, age, and body size on this parameter. A study cohort consisting of 19,980 healthy Chinese women and 8722 men aged 20-89 yr participated in this investigation. They answered a detailed questionnaire on their healthy condition, and their anthropometric measurements were taken. Their distal radius SOS values were evaluated using the Sunlight ultrasound systems. The distal radius SOS values exhibited a characteristic rise-then-fall pattern with increasing age in both sexes. The peak SOS value occurred at the age of 40-49 both in males and females. Age-related differences were both pronounced among males and females. Pearson correlation and regression analysis showed that age was a major determinant of SOS in both sexes. In females, SOS values had a much stronger correlation with age than male subjects. Body weight was also correlated with SOS but not as well as age. The SOS values of distal radius at present study may be used as normal reference data for Chinese mainland population and will be useful for comparing the results of individual studies and determining diagnostic criteria of osteoporosis by QUS.

Tooth loss early in life accelerates age-related bone deterioration in mice

Both osteoporosis and tooth loss are health concerns that affect many older people. Osteoporosis is a common skeletal disease of the elderly, characterized by low bone mass and microstructural deterioration of bone tissue. Chronic mild stress is a risk factor for osteoporosis. Many studies showed that tooth loss induced neurological alterations through activation of a stress hormone, corticosterone, in mice. In this study, we tested the hypothesis that tooth loss early in life may accelerate age-related bone deterioration using a mouse model. Male senescence-accelerated mouse strain P8 (SAMP8) mice were randomly divided into control and toothless groups. Removal of the upper molar teeth was performed at one month of age. Bone response was evaluated at 2, 5 and 9 months of age. Tooth loss early in life caused a significant increase in circulating corticosterone level with age. Osteoblast bone formation was suppressed and osteoclast bone resorption was activated in the toothless mice. Trabecular bone volume fraction of the vertebra and femur was decreased in the toothless mice with age. The bone quality was reduced in the toothless mice at 5 and 9 months of age, compared with the age-matched control mice. These findings indicate that tooth loss early in life impairs the dynamic homeostasis of the bone formation and bone resorption, leading to reduced bone strength with age. Long-term tooth loss may have a cumulative detrimental effect on bone health. It is important to take appropriate measures to treat tooth loss in older people for preventing and/or treating senile osteoporosis.

Effects of Active Mastication on Chronic Stress-Induced Bone Loss in Mice

Chronic psychologic stress increases corticosterone levels, which decreases bone density. Active mastication or chewing attenuates stress-induced increases in corticosterone. We evaluated whether active mastication attenuates chronic stress-induced bone loss in mice. Male C57BL/6 (B6) mice were randomly divided into control, stress, and stress/chewing groups. Stress was induced by placing mice in a ventilated restraint tube (60 min, 2x/day, 4 weeks). The stress/chewing group was given a wooden stick to chew during the experimental period. Quantitative micro-computed tomography, histologic analysis, and biochemical markers were used to evaluate the bone response. The stress/chewing group exhibited significantly attenuated stress-induced increases in serum corticosterone levels, suppressed bone formation, enhanced bone resorption, and decreased trabecular bone mass in the vertebrae and distal femurs, compared with mice in the stress group. Active mastication during exposure to chronic stress alleviated chronic stress-induced bone density loss in B6 mice. Active mastication during chronic psychologic stress may thus be an effective strategy to prevent and/or treat chronic stress-related osteopenia.

Prevalence of fracture and osteoporosis risk factors in American Indian and Alaska Native people

OBJECTIVE

Little is known about prevalence of osteoporosis risk factors among American Indians and Alaska Natives (AIAN).

METHODS

We included AIAN people (n=8,039) enrolled in the Education and Research Towards Health (EARTH) Study. Prevalence ratios were used to determine cross-sectional associations of risk factors with self-reported bone fractures.

RESULTS

There is a high prevalence of multiple risk factors for osteoporosis in AIAN, although the factors that are associated with past fracture vary by gender and geographical area. In general, women who reported a fracture reported more risk behaviors, more than two medical conditions, and low physical activity. Men with higher BMI were less likely to report a fracture. Smoking history was associated with fracture for both genders, though not significantly in all sub-groups.

CONCLUSION

We prevent a high prevalence of risk factors for osteoporosis for AIAN. Future research for osteoporosis risk reduction and prevention in AIAN people is indicated.

Effects of health insurance on racial disparity in osteoporosis medication adherence

OBJECTIVE

To explore whether racial disparity in osteoporosis drug therapy maintenance varies by health insurance coverage status.

DESIGN

Longitudinal observation study.

SETTING

Cleveland Clinic Health System (Cleveland, OH) from January 2006 to December 2009.

PATIENTS

3,901 black and white female Medicare beneficiaries starting osteoporosis drug therapy.

INTERVENTION

Analysis of the health system's integrated electronic medical records.

MAIN OUTCOME MEASURES

Drug therapy adherence (medication possession ratio ≥80%) for more than 12 of 15 surveillance units and occurrence of extended nonadherence gaps for at least two surveillance units in a row.

RESULTS

Among patients with supplementary health insurance (n = 2,278), no difference was observed for drug therapy adherence ( P = 0.17) and extended nonadherence gaps ( P = 0.53) between black and white participants. When patients did not have supplementary health insurance (n = 1,623), blacks (36% [95% CI 28-47]) were less likely to adhere to drug therapy than whites (47% [38-57]; odds ratio [OR] 0.34 [95% CI 0.09-0.92], P = 0.004). Blacks (25% [19-32]) also were more likely to have an extended nonadherence gap episode than whites (18% [11-26]; OR 2.42 [1.13-3.50], P = 0.03).

CONCLUSION

Similar to previous research on racial disparity in health services, racial disparity in osteoporosis drug therapy maintenance between black and white female older patients existed when supplementary health insurance was not affordable.

The problem of osteoporosis in epileptic patients taking antiepileptic drugs

INTRODUCTION

Epilepsy is a common neurological disorder associated with recurrent seizures. Therapy with antiepileptic drugs (AEDs) helps achieve seizure remission in approximately 70% of epileptic patients. Treatment with AEDs is frequently lifelong and there are reports suggesting its negative influence on bone health. This is especially important in terms of general occurrence of osteoporosis, affecting over 50 million people worldwide.

AREAS COVERED

This study refers to two main groups of AEDs: hepatic enzyme inducers (carbamazepine, oxcarbazepine, phenobarbital, phenytoin, primidone and topiramate) and non-inducers (clobazam, clonazepam, ethosuximide, gabapentin, lacosamide, lamotrigine, levetiracetam, pregabalin, tiagabine, valproate, vigabatrin and zonisamide). Some reports indicate that enzyme inducers may exert a more negative influence on bone mineral density (BMD) compared to non-inducers. Bone problems may appear in both sexes during AED therapy, although women are additionally burdened with postmenopausal osteoporosis. Supplementation of vitamin D and calcium in patients on AEDs is recommended.

EXPERT OPINION

Apart from enzyme inducers, valproate (an even enzyme inhibitor) may also negatively affect BMD. However, the untoward effects of AEDs may depend upon their doses and duration of treatment. Although the problem of supplementation of vitamin D and calcium in epileptic patients on AEDs is controversial, there are recommendations to do so.

Chewing ameliorates chronic mild stress-induced bone loss in senescence-accelerated mouse (SAMP8), a murine model of senile osteoporosis

Chronic mild stress is a risk factor for osteoporosis and chewing inhibits the stress response. We examined the effect of chewing on chronic stress-induced bone loss and bone microstructural deterioration in mice. The senescence-accelerated mouse strain P8 (SAMP8) was randomly divided into control, stress, and stress with chewing groups of fifteen animals each. Mice in the stress and stress with chewing groups were placed in a ventilated restraint tube for 60minutes, twice a day for 4weeks. The restrained mice were simultaneously subjected daily to one of the following stressors: water immersion, physical shaking and flashing lights. Mice in the stress with chewing group were allowed to chew a wooden stick during the experimental period. After the experiment, the bone response was evaluated using quantitative micro computed tomography, bone histomorphometry, and biochemical markers. Exposure of SAMP8 mice to chronic stress resulted in significant increase of the blood corticosterone and noradrenaline levels, and adrenal weight. The bone resorption was activated and the bone formation was suppressed. Trabecular bone volume and trabecular number were decreased in both the vertebra and distal femur of the stress group. Chewing under chronic stress prevented the increase in the blood corticosterone and noradrenaline levels, attenuated the reduced bone formation and increased bone resorption, improved the trabecular bone loss and bone microstructural deterioration induced by chronic mild stress. These findings indicate that chewing can ameliorate chronic stress-induced bone loss in SAMP8 mice. Thus, chewing may represent a useful method preventing and/or treating chronic stress-related osteoporosis.

Supplementing a low-protein diet with dibasic amino acids increases urinary calcium excretion in young women

Increasing dietary protein within a physiologic range stimulates intestinal calcium absorption, but it is not known if specific amino acids or dietary protein as a whole are responsible for this effect. Therefore, we selectively supplemented a low-protein (0.7 g/kg) diet with either the calcium-sensing receptor-activating amino acids (CaSR-AAAs) L-tryptophan, L-phenylalanine, and L-histidine, or the dibasic amino acids (DAAs) L-arginine and L-lysine, to achieve intakes comparable to the content of a high-protein diet (2.1 g/kg) and measured intestinal calcium absorption. Fourteen young women took part in a placebo-controlled, double-blind, crossover feeding trial in which each participant ingested a 6-d low-protein diet supplemented with CaSR-AAAs, DAAs, or methylcellulose capsules (control) after an 11-d adjustment period. All participants ingested all 3 diets in random order. Intestinal calcium absorption was measured between days 5 and 6 using dual-stable calcium isotopes ((42)Ca, (43)Ca, and (44)Ca). There was no difference in calcium absorption between the diet supplemented with CaSR-AAAs (22.9 ± 2.0%) and the control diet (22.3 ± 1.4%) (P = 0.64). However, calcium absorption tended to be greater during the DAA supplementation period (25.2 ± 1.4%) compared with the control diet period (22.3 ± 1.4%) (P < 0.10). Larger and longer clinical trials are needed to clarify the possible benefit of arginine and lysine on calcium absorption.

[Ethnicity and vitamin D]

Cohort studies, mainly US, show that vitamin D deficiency is more common in African-American population. Social and environmental factors play a role but the difference in skin color is essential. Despite low 25-hydroxyvitamin D concentrations, a lower risk of fragility or fracture exists in these populations. Vitamin D deficiency is a contributing factor in many chronic diseases. There is a relationship between vitamin D deficiencies, progression of chronic kidney disease and increased relative risk of mortality. If the ethnicity of patients is now taken into account to estimate renal function, probably specific recommendations for vitamin D deficiency are needed.

Treatment and Management of Postmenopausal Osteoporosis within an Ambulatory Care Network

Background:

Postmenopausal osteoporosis (PMO) is associated with substantial morbidity and mortality. Despite established guidelines for the care of PMO, the treatment and management of this disease remain suboptimal.

Objective:

To examine the treatment and management of PMO in a community-based ambulatory care setting.

Methods:

Women with a new diagnosis of PMO (International Classification of Diseases, 9th Revision, code 733.01) were identified through the electronic health records (EHR) of a community-based ambulatory care network in northern California between January 1, 2007, and December 31, 2008. Patients were included if they were 65 years of age or older and had EHR activity 26 months or more after diagnosis. They were excluded if they had a diagnosis of osteoporosis (ICD-9:733.xx) prior to the study period. A retrospective review of the EHR and medical charts was performed to identify patients who were prescribed FDA-approved pharmacotherapy, who received bone mineral density (BMD) testing via dual-energy X-ray absorptiometry (DXA), and who experienced a fracture.

Results:

One hundred thirty-one PMO patients were identified who met study eligibility criteria. Fifty-nine patients (45%) were prescribed FDA-approved pharmacotherapy at diagnosis. Ninety patients (69%) were prescribed pharmacotherapy at any point during follow-up. Sixty-four patients (49%) had a baseline DXA scan and 95 patients (73%) had 1 or more DXA scans during follow-up. Seventeen of 90 patients (19%) who received pharmacotherapy had 2 DXA scans within 2 years of follow-up. Nineteen fractures were reported among 16 patients during the study period.

Conclusions:

The proportion of patients with PMO who received pharmacologic treatment at diagnosis and had a baseline DXA scan was relatively low; however, the majority of these patients received treatment and had 1 or more DXA scans at some point during the 26-month follow-up period. Future studies should be conducted to assess the role of early BMD testing and pharmacologic intervention in optimizing outcomes among women with PMO.

Relationship between self-reported high-heeled shoe use and bone mineral density using quantitative ultrasound at a community health fair

This is the first known study to examine the relationship between high-heel use and bone mineral density (BMD). Because women are disproportionately affected by osteoporosis, it is important to identify possible modifiable behaviors of women that may adversely affect bone health. Many studies have shown changes in body mechanics when wearing high-heeled shoes in comparison to normal gait. Because the composition of bone changes according to mechanical load and muscle activity, this study investigates whether wearing high heels may alter BMD. Two hundred and twenty-one participants at a community health fair in Lansing, Michigan, were surveyed on high-heel use and bone health risk (gender, thin/small frame, fair skin, family history of fracture, smoking history, walking, dairy consumption, and early menopause or oopherectomy at <45 years old). Quantitative ultrasound (QUS) of the heel by Hologic's Sahara Sonometer was used to measure BMD. The mean age was 45.2 (SD 13.7) years, and the majority of participants were female (208, 94 %). A significant difference between mean BMD and high-heel use was not found. Independent correlations existed between fair skinned/sunburn easily and BMD, r(212) = -0.14, p = 0.038, as well as history of smoking and BMD, r(212) = -0.14, p = 0.042. Bone health risk score was strongly correlated with heel use binary variable "yes/no," r(210) = 0.21, p = 0.003. Our study suggests that wearing high-heeled shoes does not lead to appreciable differences in BMD among community health fair participants as assessed by QUS.

The association between fat and lean mass and bone mineral density: the Healthy Twin Study

The potential beneficial effects of increased body weight on bone mineral density (BMD) conflict with the adverse effects of obesity on various health outcomes, necessitating more specific evaluations of the association between each body component and BMD. In the present study, we evaluated associations of lean mass (LM) and fat mass (FM) with BMD in a Korean sample consisting of a total of 1782 men and women whose mean (standard deviation) age was 43.2 (12.6) years. They were selected from the Healthy Twin Study, a nationwide Korean twin and family study. BMD, FM and LM were measured using dual-energy X-ray absorptiometry. Quantitative genetic analysis and linear mixed analysis were performed with respect to familial relationships and a wide range of probable covariates. Linear mixed analysis revealed that BMD was positively associated with both FM and LM at each region of BMD measurement (whole body, spine, arms, and legs) in men, premenopausal women, and postmenopausal women. However, the association with BMD was stronger for LM than FM. Both LM and FM had positive genetic correlations with BMD at each region, although the correlation with BMD tended to be stronger for LM than FM. Together, these findings suggest that increased LM, rather than FM, is more beneficial for BMD in the Korean population and warrants further study of the common genetic determinants of BMD and body composition.

Bone health in adults with epilepsy

Patients with epilepsy have a 2-6 times greater risk of bone fractures compared with the general population. There are several potential explanations. Some fractures are caused by seizure-related injuries, or they may be associated with the osteopenic effect of reduced physical activity in patients with epilepsy. Antiepileptic drugs (AEDs), especially those that affect the liver enzymes, e.g., phenytoin, carbamazepine, phenobarbital, as well as valproate, are also associated with increased fracture rate and low bone mineral density. Many patients with epilepsy and general practitioners seem unaware of this problem. Measurements of bone density should be taken regularly in patients at risk of developing osteoporosis. Non-pharmaceutical initiatives, such as partaking in regular physical activity and eating a well-balanced diet, should be recommended. The risk of developing osteoporosis should be taken into consideration in the selection of an AED for treating a newly diagnosed patient with epilepsy.

Trabecular bone deficits among Vietnamese immigrants

SUMMARY

Compared to white women, lower areal bone mineral density (aBMD) in middle-aged Vietnamese immigrants is due to reduced trabecular volumetric bone mineral density (vBMD), which in turn is associated with greater trabecular separation along with lower estrogen levels.

INTRODUCTION

The epidemiology of osteoporosis in Asian populations is still poorly known, but we previously found a deficit in lumbar spine aBMD among postmenopausal Southeast Asian women, compared to white women, that persisted after correction for bone size. This issue was revisited using more sophisticated imaging techniques.

METHODS

Twenty Vietnamese immigrants (age, 44-79 years) were compared to 162 same-aged white women with respect to aBMD at the hip, spine and wrist, vBMD at the hip and spine by quantitative computed tomography and vBMD and bone microstructure at the ultradistal radius by high-resolution pQCT. Bone turnover and sex steroid levels were assessed in a subset (20 Vietnamese and 40 white women).

RESULTS

The aBMD was lower at all sites among the Vietnamese women, but femoral neck vBMD did not differ from middle-aged white women. Significant differences in lumbar spine and ultradistal radius vBMD in the Vietnamese immigrants were due to lower trabecular vBMD, which was associated with increased trabecular separation. Bone resorption was elevated and bone formation depressed among the Vietnamese immigrants, although trends were not statistically significant. Serum estradiol was positively associated with trabecular vBMD in the Vietnamese women, but their estrogen levels were dramatically lower compared to white women.

CONCLUSIONS

Although reported discrepancies in aBMD among Asian women are mainly an artifact of smaller bone size, we identified a specific deficit in the trabecular bone among a sample of Vietnamese immigrants that may be related to low estrogen levels and which needs further study.

Clinical and demographic factors associated with fractures among older Americans

Medicare claims data were used to investigate associations between history of previous fractures, chronic conditions, and demographic characteristics and occurrence of fractures at six anatomic sites. The study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.

INTRODUCTION

This study investigates the associations of a history of fracture, comorbid chronic conditions, and demographic characteristics with incident fractures among Medicare beneficiaries. The majority of fracture incidence studies have focused on the hip and on white females. This study examines a greater variety of fracture sites and more population subgroups than prior studies.

METHODS

We used Medicare claims data to examine the incidence of fracture at six anatomic sites in a random 5% sample of Medicare beneficiaries during the time period 2000 through 2005.

RESULTS

For each type of incident fracture, women had a higher rate than men, and there was a positive association with age and an inverse association with income. Whites had a higher rate than nonwhites. Rates were lowest among African-Americans for all sites except ankle and tibia/fibula, which were lowest among Asian-Americans. Rates of hip and spine fracture were highest in the South, and fractures of other sites were highest in the Northeast. Fall-related conditions and depressive illnesses were associated with each type of incident fracture, conditions treated with glucocorticoids with hip and spine fractures and diabetes with ankle and humerus fractures. Histories of hip and spine fractures were associated positively with each site of incident fracture except ankle; histories of nonhip, nonspine fractures were associated with most types of incident fracture.

CONCLUSIONS

This study confirmed previously established associations for hip and spine fractures and identified several new associations of interest for nonhip, nonspine fractures.

The impact of substance abuse on osteoporosis screening and risk of osteoporosis in women with psychotic disorders

Review of the 1-year prevalence of screening for osteoporosis and of osteoporosis or idiopathic fracture in Maryland Medicaid administrative records found that screening rates did not differ among women in the control population, women with psychosis, and women with major mood disorders, but were reduced compared to controls in women with substance use disorder, with or without psychosis. Prevalence of osteoporosis was increased compared to controls in women with major mood disorders or women over 55 dually diagnosed with psychosis and substance use disorder.

INTRODUCTION

Osteoporosis is a major public health concern. Substance abuse and psychosis may be risk factors, however, frequency of screening and disease risk in women with psychotic disorders and substance use disorder (SUD) remains unknown.

METHODS

This study examined rates (FY 2005) of osteoporosis screening and disease risk in Medicaid enrolled women aged 50 to 64 (N = 18,953). Four diagnostic groups were characterized: (1) psychosis, (2) SUD, (3) major mood disorder, and (4) controls. The interaction of psychosis and SUD on screening and disease prevalence of osteoporosis was tested.

RESULTS

The prevalence of osteoporosis across the entire population was 6.7%. Four percent of those without an osteoporosis diagnosis received osteoporosis screening with no notable differences between psychosis and controls. Those with SUD, however, had a significant reduction in screening compared to controls (OR = 0.61, 95% CI = 0.40-0.91, p = 0.016). Women with a major mood disorder were more likely to have osteoporosis in their administrative record (OR = 1.32, 95% CI = 1.03-1.70, p = 0.028) compared to controls. Those who were dually diagnosed (SUD and psychosis) in the oldest ages (55-64 years) had a markedly higher prevalence of osteoporosis compared to controls (OR = 6.4 CI = 1.51-27.6, p = 0.012), whereas this interaction (SUD and psychosis) was not significant in the entire population over age 49.

CONCLUSIONS

Osteoporosis screening in the Medicaid population is significantly lower for women with SUD, after adjusting for age, race, and Medicaid enrollment category. The prevalence of osteoporosis appears markedly elevated in those with major mood disorders and those over age 55 dually diagnosed with schizophrenia and SUD.

Bone health and type 2 diabetes mellitus: a systematic review

PURPOSE

To systematically review the literature related to bone health in older adults with type 2 diabetes mellitus (T2DM).

METHODS

We conducted a systematic review of the literature from January 2005 until February 2010, using keywords related to T2DM and bone-health imaging technology in older adults (aged ≥60 years) to search PubMed, OVID MEDLINE, Ageline, CINAHL, Embase, and PsycINFO.

RESULTS

We found a total of 13 studies that met the inclusion criteria for this review. The majority of the studies used dual X-ray absorptiometry (DXA) and showed either higher or similar areal bone mineral density (aBMD) for older adults with T2DM relative to healthy controls. Studies using more advanced imaging suggested that there may be differences in bone geometry between older adults with and without T2DM.

CONCLUSIONS

Older adults with T2DM have similar or higher aBMD at the hip relative to older adults without T2DM, despite previous literature reporting an increased risk of low-trauma fractures. Recent studies with advanced imaging have suggested that there may be differences in bone geometry between older adults with T2DM and those without. Health professionals, especially physiotherapists, should be aware of the increased risk and include assessment of fall risk factors and exercise prescription for fall prevention for older adults with T2DM.

Soda intake and osteoporosis risk in postmenopausal American-Indian women

OBJECTIVE

Low bone mass often leads to osteoporosis and increased risk of bone fractures. Soda consumption may contribute to imbalances that lead to decreased bone mineral density (BMD) and general bone health. We examined the relationship between soda consumption and osteoporosis risk in postmenopausal American-Indian women, an at-risk population because of nutritional and other lifestyle-related factors.

DESIGN

Cross-sectional analysis using logistic regression to examine associations between soda consumption and osteoporosis, and linear regression to examine the association between soda consumption and BMD, with and without adjustment for demographic and lifestyle factors. Quantitative ultrasound of the heel was performed to estimate BMD (g/cm2).

SETTING

American-Indian communities in the Northern Plains and Southwestern USA.

SUBJECTS

A total of 438 postmenopausal American-Indian women.

RESULTS

Women with osteoporosis were significantly older and had lower BMI, average daily soda intakes, BMD levels and use of hormones than women without osteoporosis (P < 0·05). Soda consumption was not associated with increased odds of osteoporosis in either unadjusted or adjusted models (P > 0·05), although age (increased), BMI (decreased) and past hormone use (decreased) were all significantly associated with osteoporosis risk (P < 0·05).

CONCLUSIONS

Although the present study did not find associations between soda consumption and osteoporosis risk in postmenopausal American-Indian women, analyses did confirm confounding between soda consumption and age and BMI. This suggests that any potential effects of soda consumption on bone health are largely mediated through these factors.

Age curves of bone mineral density at the distal radius and calcaneus in Koreans

This study evaluated age-related changes in bone mineral density (BMD) and identified the peak bone mineral density (PBMD) in Koreans. We recruited 2929 subjects, ranging in age from 5 to 86 years, from three regions: Seoul, Siwha, and Gwangyang. The BMD at the distal radius and calcaneus were measured with dual-energy X-ray absorptiometry, and anthropometric measures were also obtained. PBMD was calculated from the highest mean in each age group. The PBMD at the distal radius was 0.514 +/- 0.06 g/cm(2) in females and 0.598 +/- 0.07 g/cm(2) in males. Peak ages for both sexes were the thirties. For the calcaneus, PBMD was 0.509 +/- 0.09 g/cm(2) in females and 0.629 +/- 0.09 g/cm(2) in males. Peak ages were the thirties for females and the twenties for males. These results could facilitate international or interracial comparisons and be used as reference data to screen for osteoporosis in Koreans.

Greater osteoporosis educational outreach is desirable among Chinese immigrants in Chinatown, Chicago

Osteoporosis beliefs were assessed in immigrant Chinese women in Chinatown, Chicago. Results from a survey utilizing the Osteoporosis Health Belief Scale showed that women expressed concern about osteoporosis but lacked both knowledge of preventive care and health motivation.

INTRODUCTION

The objective of this study was to assess osteoporosis beliefs in immigrant Chinese women in Chinatown, Chicago.

METHODS

In a community-based health fair, osteoporosis knowledge and self-efficacy among postmenopausal Chinese immigrants were assessed using the translated Osteoporosis Health Belief Scale. Bone mineral density (BMD) was assessed with calcaneal ultrasound.

RESULTS

The study population included 94 women with mean age of 51 +/- 9 years, mean length of residence in the United States of 9 +/- 7 years, and 73% (n = 76) of whom were recent immigrants. Women expressed concern about the seriousness of osteoporosis and their relative susceptibility to osteoporosis. In particular, women with a prior fracture reported higher seriousness to osteoporosis. Nonetheless, women exhibited low health motivation and low awareness of the benefits of calcium and exercise. Bone densitometry results corresponded to a T score of -1.2 +/- 1.5. Multiple regression analysis revealed that a younger age and longer length of residence in the USA were associated with higher BMD.

CONCLUSION

Chinese immigrant women in Chicago exhibit concern regarding osteoporosis, but are unaware of the benefits of calcium and exercise, and exhibit low health motivation. Chinese women in Chinatown lack necessary knowledge about osteoporosis to develop adequate self-efficacy. Public health initiatives should be undertaken among recent immigrant Chinese women.

Loss of bone mineral density after antiretroviral therapy initiation, independent of antiretroviral regimen

BACKGROUND

Decreased bone mineral density (BMD) has been described in HIV-infected patients initiating antiretroviral therapy (ART), but the contributions of ART and immunologic and/or virologic factors remain unclear.

METHODS

We compared total BMD changes over 96 weeks in 106 ART-naive HIV-infected subjects who were randomized to receive efavirenz (EFV) + zidovudine/lamivudine (n = 32) or lopinavir/ritonavir (LPV/r) + zidovudine/lamivudine induction (n = 74) for 24-48 weeks followed by LPV/r monotherapy. We also sought to identify factors associated with BMD loss, including markers of systemic inflammation [soluble tumor necrosis factor-alpha receptors (sTNFR I and II)].

RESULTS

After 96 weeks, the mean percent change from baseline in total BMD was -2.5% (LPV/r) and -2.3% (EFV) (P < 0.01 for within-group changes in either arm; P = 0.86 for between-group differences). No alteration in the rate of BMD change was observed upon simplification to LPV/r monotherapy. Although soluble tumor necrosis factor-alpha receptor II concentrations at baseline and 24 weeks were at least marginally associated with subsequent changes in BMD (P = 0.06 and P = 0.028, respectively), these associations were no longer significant after adjustment for CD4 T cell count. Subjects with lower baseline CD4 T cell count, non-black race, and higher baseline glucose demonstrated a higher risk for >5% decrease in BMD.

CONCLUSIONS

Similar decreases in BMD over 96 weeks occurred in ART-naive subjects receiving either EFV-based regimen or LPV/r-based regimen, which was not altered by simplification to LPV/r monotherapy and was unrelated to markers of tumor necrosis factor-alpha activity.

Demographical aspects of Schmorl nodes: a skeletal study

STUDY DESIGN

A descriptive study of the association between Schmorl nodes (SNs) and gender, ethnic origin, and age in a normal skeletal population.

OBJECTIVES

To gain reliable data on behavioral patterns of SNs in various human groups shedding light on its etiology.

SUMMARY OF BACKGROUND DATA

Opinions regarding SNs prevalence in human populations vary greatly (from 5% to 70%). This caveat greatly reduced our ability to recognize the etiology of the phenomenon and understand its clinical significance.

METHODS

Two hundred forty human skeleton vertebrae (T4-L5) from a normal adult population (divided by gender, ethnicity, and age) were examined for SNs. SNs were defined as depressions with sclerotic margins appearing on the vertebral body surface.

RESULTS

One hundred sixteen individuals (48.3%) of the 240 studied manifested SNs along their thoracolumbar spine. SNs are age independent and gender and ethnicity dependent, are significantly more common in males (54.2%) versus females (43%) and more common in European-Americans (60.3%) versus African-Americans (36.7%).

CONCLUSION

SNs are a common phenomenon in the normal adult populations with almost half of the individuals in our sample manifesting at least 1 vertebra with SN. Its demographic characteristics suggest that the phenomenon is not of occupational origin, promoting the notion of genetic background.

Effect of osteoporosis on morphology and mobility of the lumbar spine

STUDY DESIGN

Cross-sectional study.

OBJECTIVE

The purpose of this study was to examine disc morphology and spinal mobility in subjects with varying degrees of osteoporosis.

SUMMARY OF BACKGROUND DATA

There was limited information on the effect of osteoporosis on lumbar morphology and spinal mobility. It was also unclear how osteoporosis affects the nonosseous tissues such as the intervertebral disc.

METHODS

Ninety elderly subjects with varying bone mineral densities (22 normal, 28 osteopenia, 40 osteoporosis) were recruited from an osteoporosis clinic. Lateral radiographs and magnetic resonance images of their lumbar spines were obtained. An electromagnetic tracking device was employed to measure the ranges of motion of the whole lumbar spine.

RESULTS

Although the thoracic spine had been shown to have decreased anterior vertebral body height in subjects with osteoporosis, this study revealed that the anterior height was increased in the lumbar region. Osteoporosis was associated with expansion of the middle of the disc with corresponding collapse of vertebral bodies, but osteoporosis was found not to be related to either disc preservation or degeneration. No significant change in spinal mobility was observed in patients with osteoporosis.

CONCLUSION

Osteoporosis does not only affect the bone but also the nonosseous tissues. It was found to be associated with expansion of the intervertebral disc, which was likely to be secondary to changes in the vertebral endplate.

Fracture rates in urban South African children of different ethnic origins: the Birth to Twenty cohort

Fracture rates were compared in children of different ethnic backgrounds from Johannesburg, South Africa. More white children fracture than black and mixed ancestry children. Reasons for this may be due to greater sports participation by whites and genetic protective factors in blacks. This has to be further investigated.

INTRODUCTION

Fracture rates in childhood are as high as those in the elderly. Recent research has been undertaken to understand the reasons for this, but there is little information available on ethnic differences in childhood fracture rates.

METHODS

Using the birth to twenty longitudinal cohort of children, we retrospectively obtained information on fractures and their sites from birth to 14.9 years of age on 2031 participants. The ethnic breakdown of the children was black (B) 78%, white (W) 9%, mixed ancestry (MA) 10.5% and Indian (I) 1.5%.

RESULTS

Four hundred and forty-one (22%) children had sustained a fracture one or more times during their lifetime (males 27.5% and females 16.3%; p < 0.001). The percentage of children fracturing differed between the ethnic groups (W 41.5%, B 19%, MA 21%, I 30%; p < 0.001). Of the 441 children reporting fractures, 89(20%) sustained multiple fractures. The most common site of fracture was the upper limb (57%).

CONCLUSION

More white children fracture than black and mixed ancestry children. This is the first study to show ethnic differences in fracture rates among children. The reasons for these differences have to be further elucidated. Greater sports participation by whites and genetic protective factors in blacks may be contributing factors.

Active comparator trial of teriparatide vs alendronate for treating glucocorticoid-induced osteoporosis: results from the Hispanic and non-Hispanic cohorts

Glucocorticoid use is a leading cause of secondary osteoporosis. This post hoc analysis compared teriparatide vs alendronate on bone mineral density (BMD) in Hispanic and non-Hispanic patients with glucocorticoid-induced osteoporosis. The 18-mo results from all patients (N=428) in a double-blind trial of teriparatide (20 microg/d) and alendronate (10 mg/d) who had taken glucocorticoids for >or=3 mo were reported (Saag et al. N Engl J Med 2007). The present study analyzed results from the Hispanic (n=61) and non-Hispanic (n=367) cohorts. The BMD was measured by dual-energy X-ray absorptiometry (DXA). In the Hispanic cohort at 18 mo, there were significantly greater increases from baseline in the teriparatide vs alendronate group in lumbar spine BMD (9.8%+/-1.7% vs 4.2%+/-1.4%; p<0.001; mean+/-SE) and total hip BMD (5.9%+/-1.6% vs 1.3%+/-1.3%, p<0.001), with no significant difference between groups at the femoral neck (4.3%+/-2.2% vs 2.0%+/-1.8%, p=0.228). Within each treatment group, the BMD responses were not significantly different in the Hispanic vs non-Hispanic cohort. The number of patients reporting >or=1 adverse event was not significantly different between treatments in either cohort, with more patients reporting nausea in the teriparatide group. In summary, teriparatide was more efficacious than alendronate in increasing BMD in Hispanic and non-Hispanic patients with glucocorticoid-induced osteoporosis. Both treatments were generally well tolerated.

Molecular genetics and racial disparities of uterine leiomyomas

Uterine leiomyomas (ULMs) are benign oestrogen-dependent tumours of the myometrium. They are the most common tumours of the female genital tract, affecting around 77% of the female population. ULMs are more common in Black women than White women. These tumours tend to develop earlier and be more numerous, larger in size and more symptomatic in Black women than other ethnic groups. The molecular mechanism underlying this ethnic disparity is not fully understood. Polymorphism of genes involved in oestrogen synthesis and/or metabolism (COMT, CYP17), variation in the expression levels or function of oestrogen and progesterone receptors or retinoic acid nuclear receptors (retinoid acid receptor-alpha, retinoid X receptor-alpha), or aberrant expression of micro-RNAs are some of the molecular mechanisms that may be involved.

Epidemiology of distal forearm fractures in Oslo, Norway

The population of Oslo has the highest incidence of hip fracture reported. The present study shows that the overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979.

INTRODUCTION

The population of Oslo has the highest incidence of hip fracture reported. The present study reports the incidence of distal forearm fracture in Oslo and the fracture rates of immigrants.

METHODS

Patients aged > or = 20 years resident in Oslo sustaining a distal forearm fracture in a one-year period in 1998/99 were identified using electronic diagnosis registers, patient protocols, and/or X-ray registers of the clinics in Oslo. Medical records were obtained and the diagnosis verified. The age- and sex-specific incidence rates were calculated and compared with those for 1979. Data on immigrant category and country of origin of the patients were obtained.

RESULTS

The age-adjusted fracture rates per 10,000 for the age group > or = 50 years were 109.8 and 25.4 in 1998/99 compared with 108.3 and 23.5 in 1979 for women and men, respectively (n.s.). The relative risk of fracture in Asians was 0.72 (95% CI 0.53-1.00) compared with ethnic Norwegians.

CONCLUSIONS

The overall incidence of distal forearm fractures in Oslo is higher than in other countries and has not changed significantly when comparing the incidence of 1998/99 with 1979. Furthermore, the present data suggest that Asian immigrants in Oslo have a slightly lower fracture risk than ethnic Norwegians.

Effects of weight, body composition, and testosterone on bone mineral density in HIV-infected women

Recent studies suggest that bone loss occurs among HIV-infected women. This study examined the effects of reduced androgen levels, changes in weight, body composition, and menstrual dysfunction on bone mineral density (BMD) among 152 HIV-infected women characterized by normal weight (>90% ideal body weight [IBW], n = 124) and low weight (<or=90% IBW, n = 28) compared with 100 non-HIV-infected control subjects. BMD was assessed by dual x-ray absorptiometry, and free testosterone was assessed by equilibrium dialysis. Abdominal subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) were determined by computed tomography scan. A significant difference was seen in BMD between groups at the lumbar spine (0.92 +/- 0.02 g/cm vs. 1.01 +/- 0.01 g/cm vs. 1.07 +/- 0.01 g/cm; P < 0.0001), total hip (0.84 +/- 0.03 g/cm vs. 0.94 +/- 0.01 g/cm vs. 0.98 +/- 0.01 g/cm; P < 0.0001), and femoral neck (0.73 +/- 0.03 g/cm vs. 0.83 +/- 0.01 g/cm vs. 0.87 +/- 0.01 g/cm; P < 0.0001) (HIV-infected low-weight group, HIV-infected normal-weight group, and non-HIV-infected control subjects, respectively, for each comparison; mean +/- SEM). Among the HIV-infected subjects, lumbar BMD correlated with percent IBW (r = 0.37, P < 0.0001), total body lean mass (r = 0.43, P < 0.0001), total body fat mass (r = 0.35, P < 0.0001), and SAT (r = 0.41, P < 0.0001), but not VAT (r = 0.07, P = 0.417). Clinical risk factors for osteopenia and osteoporosis in the HIV population identified in univariate analysis included low free testosterone (<1.1 pg/mL [lower limit of the normal range of free testosterone for women] or 3.8 pmol/L; P = 0.0007), low weight (P = 0.014), and oligomenorrhea (P = 0.0006). In multivariate regression analysis, lean body mass was most significantly associated with BMD among those with HIV. These data demonstrate that BMD is reduced among HIV-infected women in association with low weight, reduced lean mass, reduced androgen levels, and abnormal menstrual function.

A 6-month longitudinal study of bone mineral density with antiepileptic drug monotherapy

Antiepileptic drugs (AEDs) can affect bone metabolism, but the exact mechanisms or differences in individual drugs are still unknown. The purpose of this study was to prospectively investigate the alterations in bone mineral density (BMD) and markers of bone metabolism induced by different AEDs in Koreans with epilepsy. Subjects included 33 drug-naïve, newly diagnosed patients with epilepsy aged between 18 and 50. BMD at right calcaneus and various markers for bone metabolism were measured before and after 6months of AED monotherapy including carbamazepine, valproic acid, and lamotrigine. Carbamazepine caused a significant decrease in BMD, which was accompanied by a decrease in the level of vitamin D (25-OHD(3)). BMD and vitamin D were not affected by 6months of valproic acid or lamotrigine therapy. Interestingly, valproic acid and lamotrigine, but not carbamazepine, significantly increased osteocalcin, a marker of bone formation. All AEDs almost doubled the parathyroid hormone level, whereas urinary Pyrilinks, a marker of bone resorption, was not affected by those AEDs. These findings suggest that carbamazepine, a hepatic enzyme-inducing drug, decreases BMD.