Determining the prevalence of osteoporosis and related factors using quantitative ultrasound in Vietnamese adult women

Excessive salt intake reduces bone density in the general female population

BACKGROUND

Osteoporosis is a multifactorial disorder in which nutrition is associated with its onset and progression. Excessive salt intake is closely associated with the onset and progression of various diseases, such as osteoporosis and hypertension. We investigated the effects of dietary salt intake on bone density in the general female population.

METHODS

In 884 female participants (60.1 ± 10.1 years old) who visited our hospital for an annual physical checkup, salt intake (g/day) was assessed using a spot urine sample, and bone density was evaluated as a speed of sound (m/s) of ultrasonic pulses in a calcaneus by quantitative ultrasound. We investigated the relationship between bone density and salt intake and the differences in bone density or salt intake between the presence and absence of lifestyle-related diseases such as hypertension, diabetes mellitus and dyslipidaemia.

RESULTS

The average bone density and salt intake were 1497 ± 26 m/s and 8.5 ± 1.8 g/day, respectively. Univariate and multivariate regression analyses revealed that bone density was significantly negatively associated with salt intake. Bone density was lower, and salt intake was higher in participants with hypertension, diabetes mellitus and dyslipidaemia than in those without. After adjusting for age, hypertension, diabetes mellitus and dyslipidaemia, bone density was negatively correlated with salt intake.

CONCLUSIONS

We confirmed that excessive salt intake reduces bone density independently of age and lifestyle-related diseases in the general female population. Since dietary salt intake is a modifiable factor, osteoporosis can be prevented by dietary intervention, including salt reduction.

The Diagnostic Value of the Osteoporosis Self-assessment Tool for Asians in Vietnamese Postmenopausal Women

Introduction: Osteoporosis is a common disease that affects many women in the postmenopausal period. Dual-energy X-ray absorptiometry (DXA) is a simple and noninvasive method used to diagnose osteoporosis. The Osteoporosis Self-Assessment Tool for Asians (OSTA) is an osteoporosis risk assessment toolkit, used for menopausal women in Asia. This study aimed to evaluate the diagnostic values of the OSTA index in determining the risk of osteoporosis in postmenopausal women. Material and Methods:  This cross-sectional study was conducted on 919 postmenopausal women to determine the value of OSTA in osteoporosis risk assessment. The bone density was measured using the DXA method in the lumbar spine and femoral neck. Results: Based on the ROC curve, the sensitivity and specitivity of OSTA were 70.3% and 63.6% at the cut-off of ≤ -1.4 at the femoral neck or lumber spine or both (p = 0.005) . At a cut-off point of ≤-1 at one of two position or both, the OSTA index showed a specificity of 87.23%, sensitivity of 66.08%, positive predictive value of 46.90%, and negative predictive value of 93.78% in predicting the osteoporosis risk. Conclusions: The OSTA index is a simple tool that is highly sensitive and specific in predicting the risk of osteoporosis in postmenopausal women.

Evaluation of community-based screening tools for the early screening of osteoporosis in postmenopausal Vietnamese women

Background

Osteoporosis affects people worldwide. However, there are few validated tools for the early screening of osteoporosis in Vietnam. We set out to evaluate the performance of the osteoporosis self-assessment tool for Asians (OSTA) and the osteoporosis screening tool for Chinese (OSTC) for the early screening of osteoporosis in postmenopausal Vietnamese women.

Methods

We analyzed retrospective data from 797 postmenopausal Vietnamese women. The bone mineral density (BMD) in the lumbar vertebrae (L1–L4) and the left and right femoral necks of all participants were measured using dual-energy X-ray absorptiometry (DXA). Osteoporosis was defined as the BMD (T-score) < -2.5. The OSTA and OSTC scores were calculated from the age and weight of participants. Receiver operating characteristic analysis was conducted to compare the performance of the two tools with the BMD measurements by DXA at different anatomical sites.

Results

The rates of osteoporosis determined by BMD varied between anatomical sites, and ranged from 43.4% to 54.7% in the lumbar vertebrae and 29.2% and 8.9% in the left and right femoral necks, respectively. For the vertebrae, the area under the curve (AUC) for OSTA ranged from 70.9% to 73.9% and for OSTC ranged from 68.7% to 71.6%. The predictive value of both tools was higher for femoral necks, with the AUC of OSTA for the left and right femoral necks being 80.0% and 85.8%, respectively. The corresponding figures for OSTC were 80.5% and 86.4%, respectively. The highest sensitivity and specificity of OSTA were 74.6% and 81.4%, while these figures for OSTC were 73.9% and 82.6%, respectively.

Conclusion

OSTA and OSTC were shown to be useful self-assessment tools for osteoporosis detection in Vietnam postmenopausal women. Further research is encouraged to determine the applicability of tools for other populations and settings.

The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis

BACKGROUND

Osteoporosis affects all sections of society, including families with people affected by osteoporosis, government agencies and medical institutes in various fields. For example, it involves the patient and his/her family members, and government agencies in terms of the cost of treatment and medical care. Providing a comprehensive picture of the prevalence of osteoporosis globally is important for health policymakers to make appropriate decisions. Therefore, this study was conducted to investigate the prevalence of osteoporosis worldwide.

METHODS

A systematic review and meta-analysis were conducted in accordance with the PRISMA criteria. The PubMed, Science Direct, Web of Science, Scopus, Magiran, and Google Scholar databases were searched with no lower time limit up till 26 August 2020. The heterogeneity of the studies was measured using the I2 test, and the publication bias was assessed by the Begg and Mazumdar's test at the significance level of 0.1.

RESULTS

After following the systematic review processes, 86 studies were selected for meta-analysis. The sample size of the study was 103,334,579 people in the age range of 15-105 years. Using meta-analysis, the prevalence of osteoporosis in the world was reported to be 18.3 (95% CI 16.2-20.7). Based on 70 studies and sample size of 800,457 women, and heterogenicity I2: 99.8, the prevalence of osteoporosis in women of the world was reported to be 23.1 (95% CI 19.8-26.9), while the prevalence of osteoporosis among men of the world was found to be 11.7 (95% CI 9.6-14.1 which was based on 40 studies and sample size of 453,964 men.). The highest prevalence of osteoporosis was reported in Africa with 39.5% (95% CI 22.3-59.7) and a sample size of 2989 people with the age range 18-95 years.

CONCLUSION

According to the medical, economic, and social burden of osteoporosis, providing a robust and comprehensive estimate of the prevalence of osteoporosis in the world can facilitate decisions in health system planning and policymaking, including an overview of the current and outlook for the future; provide the necessary facilities for the treatment of people with osteoporosis; reduce the severe risks that lead to death by preventing fractures; and, finally, monitor the overall state of osteoporosis in the world. This study is the first to report a structured review and meta-analysis of the prevalence of osteoporosis worldwide.

Prevalence and risk factors associated with osteoporosis among residents aged above 20 years old in Chongqing, China

Standardized prevalence of osteoporosis was 19.90% in the whole subjects aged between 50 and 87, 5.87% in men and 30.23% in women respectively. Risk factors associated with osteoporosis were analyzed. It is the first time to estimate the prevalence and characterize the epidemiology of osteoporosis in Chongqing, China.

PURPOSE

To investigate bone mineral density (BMD) profiles, osteoporosis prevalence, and its risk factors among residents aged above 20 years old in Chongqing Municipality, China.

METHODS

The study population consisted of 770 men and 1085 women aged 20 years and older with BMD measurements using central dual-energy X-ray absorptiometry (DXA). Information on sociodemographic characteristics and the potential risk factors associated with osteoporosis were collected by a standardized interviewer-administered questionnaire.

RESULTS

Crude prevalence of osteoporosis was 12.99% in the whole subjects, 4.42% for men, and 19.08% for women by WHO criteria at various skeletal regions (among lumbar spine, femoral neck, and total hip). Standardized prevalence of osteoporosis was 19.90% in the whole subjects aged between 50 and 87, 5.87% in men and 30.23% in women respectively. Prevalence of osteoporosis increased with age, and the prevalence of osteoporosis in women was 6.10 times higher than it in men. The prevalence of osteoporosis was significantly associated with the past medical history of fracture (OR = 1.794, P = 0.007); overweight and obesity were considered to be protective factors for osteoporosis with OR of 0.514 and 0.300, respectively; high school graduate (OR = 0.399, P = 0.000 ) and milk intake (OR = 0.648, P = 0.008) were also protective factors for osteoporosis in men and women considered together; menopause was an independent risk factor of osteoporosis in females (OR = 1.782, P = 0.029); current smoking was an independent risk factor of osteoporosis in males (OR = 2.437, P = 0.046).

CONCLUSION

The prevalence of osteoporosis and osteopenia was high among residents in Chongqing, China. Health education and behavior intervention should be focused on the elderly or female residents to promote the formulation of healthy lifestyle. Necessary steps are needed for more public education and a wider dissemination of information about osteoporosis and its prevention.

Type 2 deiodinase Thr92Ala polymorphism is associated with a reduction in bone mineral density: A community-based korean genome and epidemiology study

OBJECTIVE

Type 2 deiodinase (DIO2)-mediated thyroid hormone synthesis stimulates osteoblast activity and increases the expression of osteoblast differentiation markers, but there are no large cohort studies to identify the role of the DIO2 polymorphism in bone mineral density in humans.

METHODS

To investigate the hypothesis that individuals with the DIO2 gene polymorphism are susceptible to osteoporosis, we assessed the polymorphism of the DIO2 gene in 7,524 Koreans drawn from the large-scale Ansan-Anseong cohort of the Korean Genome and Epidemiology Study. All of the participants underwent genotyping of the DIO2 Thr92Ala polymorphism (rs225014).

RESULTS

A total of 6,022 participants were recruited; 1991 (33.0%) were homozygous for the Thr allele, 2,967 (49.3%) were heterozygous (Thr/Ala), and 1064 (17.7%) were homozygous for the Ala allele. The effects of the DIO2 Thr92Ala polymorphism on axial speed of sound (SOS) and the T-score in the tibia and radius were assessed, with age, gender, oestrogen status, body mass index (BMI), serum calcium, 25-hydroxyvitamin D, and parathyroid hormone (PTH) included as covariables. Female subjects carrying the DIO2 Thr92Ala polymorphism had significantly lower SOS and T-scores than control participants. Cox regression analysis revealed a significant relationship between the DIO2 polymorphism and diagnosis of osteoporosis in female participants.

CONCLUSION

DIO2 Thr92Ala polymorphism is associated with decreased SOS and T-scores in the tibia of female subjects independent of other clinical parameters, where this indicates a potential functional role of DIO2 in the maintenance of bone mineral density.

The Evaluation of Bone Mineral Density based on Age and Anthropometric Parameters in Southeast Chinese Adults: A Cross-Sectional Study

BACKGROUND Osteoporosis is a chronic skeletal disease characterized by a reduction in bone density, resulting in high death rates and high costs among patients worldwide. This study investigated the associations among age, anthropometric parameters and bone mineral density (BMD) in southeast Chinese adults and evaluated the characteristics of southeast Chinese adults at high risk of osteoporosis. MATERIAL AND METHODS This study enrolled 424 female and 265 male volunteers. Height, weight and BMD were measured, and body mass index (BMI) was calculated. Based on their BMD T-scores, female and male participants were divided into groups with osteoporosis (OG1) and osteopenia (OG2) and a normal group (NG). RESULTS The findings revealed no significant correlations between BMD and anthropometric parameters in either gender. However, a significant negative correlation was noted between BMD and age in the female participants, and a significant positive correlation was observed between BMD and age in the male participants. Multiple comparisons between groups revealed that women in the OG1 and OG2 groups were significantly older than those in the NG group. CONCLUSIONS Age, anthropometric parameters and BMD correlate differently between groups and genders in southeast Chinese adults.

Sarcopenia-related features and factors associated with low muscle mass, weak muscle strength, and reduced function in Chinese rural residents: a cross-sectional study

Muscle strength and function declined more than the concomitant loss of muscle mass. Measures of muscle strength and function are an effective way to assess functional ability and physical health in older people. A healthy lifestyle such as physical exercise, good nutrition, and higher BMI can benefit older people.

INTRODUCTION

The study investigated the characteristics of aging-related differences in appendicular lean mass (ALM/Ht²), handgrip strength (HGS), usual gait speed (UGS), repeated chair stands (RCS), Timed Up and Go (TUG) test, and their associated factors in 6703 rural residents.

METHODS

We assessed their anthropometry, body composition, muscle strength and function, bone mineral density, blood pressure, and blood biochemical indices via clinical examination or laboratory tests and investigated demographic characteristics, lifestyle, medical history, physical activity, and dietary intake via questionnaire. Stepwise logistic regression was used to determine the associated factors of low muscle mass, weak muscle strength, reduced physical performance, and sarcopenia.

RESULTS

The mean values of muscle strength and function decreased more rapidly with age than the mean values of muscle mass, especially in females. The prevalence of low ALM/Ht², weak HGS, slow UGS, long RCS, long TUG, and sarcopenia increased (P < 0.01). Higher body mass index (BMI) and daytime sleep were associated with high ALM/Ht². Comorbidity factors such as hypertension, bone mineral density loss, central adiposity, metabolic syndrome, and tumors were associated with the risk of weak muscle strength and reduced physical performance, while physical activity and better nutrition were associated with better muscle strength and physical performance.

CONCLUSIONS

At the higher decades of life, the decline of muscle strength and function is greater than the loss in muscle mass. Measures of muscle strength and function are an effective way to assess functional ability and physical health in older people. Maintaining a healthy lifestyle by means such as physical exercise, good nutrition, and higher BMI throughout the course of life may be benefit older people by improving their muscle mass, strength, and function.

The Prevalence of Osteopenia and Osteoporosis Among Malaysian Type 2 Diabetic Patients Using Quantitative Ultrasound Densitometer

Background:

Type 2 Diabetes Mellitus (T2DM) and osteoporosis are both chronic conditions and the relationship between them is complex.

Objective:

The aims of this study were to assess the prevalence of Low Bone Mineral density (LBMD, i.e., osteopenia and osteoporosis), as well as, the difference and associations between Quantitative Ultrasound Scan (QUS) parameters with socio-demographic data and clinical related data among T2DM in Penang, Malaysia.

Method:

An observational, cross-sectional study with a convenient sample of 450 T2DM patients were recruited from the outpatient diabetes clinic at Hospital Pulau Pinang (HPP) to measure Bone Mineral Density (BMD) at the heel bone using QUS. In addition, a self-reported structured questionnaire about the socio-demographic data and osteoporosis risk factors were collected. Moreover, the study included the retrospective collection of clinical data from patients’ medical records.

Results:

The mean value of T-score for normal BMD, osteopenic and osteoporotic patients’ were (-0.41±0.44), (-1.65±0.39) and (-2.76±0.27), respectively. According to QUS measurements, more than three quarters of T2DM patients (82%) were at high risk of abnormal BMD. The results showed that QUS scores were significantly associated with age, gender, menopausal duration, educational level and diabetic related data. Moreover, the QUS parameters and T-scores demonstrated significant negative correlation with age, menopausal duration, diabetic duration and glycaemic control, as well as, a positive correlation with body mass index and waist to hip ratio. The current study revealed that none of the cardiovascular disease risk factors appear to influence the prevalence of low BMD among T2DM Malaysian patients.

Conclusion:

The study findings revealed that the assessment of T2DM patients’ bone health and related factor are essential and future educational programs are crucial to improve osteoporosis management.

Toe Gap Force is Related to Ultrasonic Parameter of Calcaneus Bone Status in General Population

Background:

Elucidating the relation between bone health condition and muscle strength can provide useful knowledge for Japan’s super-aged society. This study ascertained the Speed Of Sound (SOS) of the calcaneus and upper and lower limb muscle strength in a general population.

Methods:

Medical examinations were conducted of 277 adult residents (100 men, 177 women; average age 67.1 years) of a mountain village. Bilateral hand grip and hand key pinch strength were measured. Hip abductor muscle strength was measured using a hand-held dynamometer. The pressure between the hallux and second toe (toe-gap force) was measured using a toe pressure measuring instrument. The Speed Of Sound (SOS) of the calcaneus was assessed using an ultrasound bone densitometer. Stepwise linear regression was used to identify the predictor of SOS using several factors as explanatory variables: gender, age, height, weight BMI, grip and key pinch power strength, hip abductor muscle strength, and toe-gap force in bilateral side. P values of < .05 were inferred as statistically significant.

Results:

Significant positive correlation was found between the SOS and each of bilateral hand grip and hand key pinch strength, hip abductor muscle strength, and toe-gap force in all participants. Stepwise logistic regression revealed gender (β coefficient= -0.32, p= .0001), age (β coefficient=-0.53, p= .000), height (β coefficient= -0.19, p= .03), and right toe-gap force (β coefficient= 0.11, p= .027) as predictors of calcaneal SOS for all participants.

Conclusion:

Toe-gap force assessment might be more useful to predict calcaneal SOS than grip assessment in the general population.

Relations between quantitative ultrasound assessment of calcaneus and grip and key pinch power in Japanese mountain village residents

PURPOSE

It seems to be important to recognize bone health condition using a simple method in Japanese super-aged society. The aim of our study was to investigate whether grip and key pinch strength were associated with bone quality.

METHODS

Medical examinations were conducted of 337 adult residents (123 men, 214 women; average age of 64.7 years) of a mountain village. Bilateral grip and key pinch strength were measured. The sound of speed (SOS) of calcaneus was assessed using an ultrasound bone densitometer. Study participants were divided into non-osteoporotic and osteoporotic groups according to the relevant WHO classification to evaluate statistical significance by age-adjusted analysis. Stepwise linear regression was used to identify the predictor of SOS using the following factors as explanatory variables: age, height, weight BMI, grip and key pinch power strength in bilateral side. A P value of < .05 was regarded as statistically significant.

RESULTS

In age-adjusted analysis, significant associations were found between osteoporosis and BMI (OR 0.87, 95%CI 0.80-0.95), gender (OR 3.21, 95%CI 1.83-5.62), grip strength (right side:, OR 0.95, 95%CI 0.92-0.98; left side: OR 0.95, 95% CI 0.92-0.98) and key pinch strength (right side: OR 0.76, 95%CI 0.65-0.88; left side: OR 0.79, 95%CI 0.68-0.91). In stepwise linear regression, age and left key pinch strength were predictors of calcaneal SOS (age β coefficient = -0.46, P = .00; left key pinch strength β coefficient = 0.17, P = .0049).

CONCLUSIONS

Key pinch strength assessment might be useful to predict calcaneal SOS in general population.

Aging, lifestyle factors, hormones and bone health in Singaporean men

Purpose

The present study examined how age, bodyweight, body fat, regular exercise and some endocrine factors are associated with osteoporosis, spine bone mineral density (Sbmd) and femoral neck bone mineral density (Fnbmd) in Singaporean men.

Methods

Body composition and bone scans of lumbar spine at L2-L4 and hip were carried out with duel-energy X-ray absorptiometry (DXA). Anthropometric parameters were measured and demographic data, medical history and exercise schedule were collected via a questionnaire.

Results

Osteoporosis prevalence was higher and Sbmd and Fnbmd were lower in men with high percent body fat (PBF) and conversely osteoporosis prevalence was lower and Sbmd and Fnbmd were higher in men with higher body mass index (BMI). Age was negatively associated with Fnbmd but not Sbmd. On the other hand, PBF and insulin levels were negatively associated with both Sbmd and Fnbmd. Body mass index and exercise intensity were positively associated with both Sbmd and Fnbmd. Sex hormones were significantly associated with only Sbmd but not Fnbmd. Both estradiol and DHEAS were positively, while testosterone was negatively associated with Sbmd.

Conclusion

The study shows that the prevalence of osteoporosis and some of the determinants of bone mineral density (BMD) in Singaporean men was site-specific. Further, BMI and PBF are opposing predictors of BMD. Therefore, any strategy for improving bone health should include modalities that increase lean and bone mass and decrease fat mass. The bone health of Singaporean men is comparable to non-Hispanic whites and better than some other Asian men.

•

Determinants of the prevalence of osteoporosis and BMD in Singaporean men are site-specific.

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Further, BMI and PBF are opposing predictors of BMD.

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Strategy for improving bone health should include modalities that increase lean and bone mass and decrease fat mass.

Preventable risk factors for osteoporosis in postmenopausal women: Systematic review and meta-analysis

Background and Objective:

The osteoporosis is becoming public health problem in India and neighboring Asian countries. As the environmental risk factors for osteoporosis in women are similar in these countries, the study was planned to compare risk factors for osteoporosis in postmenopausal women in Asian countries.

Materials and Methods:

A systematic literature search was done in August 2015. The period included for this search was from January 2005 to December 2014. The search was done for India and neighboring countries. The final analysis was done on the studies from India, China, Korea, and Japan. The literature search was done in PubMed and Google Scholar using key words, “Osteoporosis” and “Menopause” and “Risk factor.”

Results:

The pooled prevalence for the osteoporosis in postmenopausal women is 41%, but in India alone, it is 53%. Various risk factors are studied in China as compared to other countries. Adequate calcium intake and various exercises were found to be useful modifiable factors. Other factors like age, height, and postmenopausal status cannot be modified.

Conclusion:

Adequate calcium and Vitamin D intake and combinations of various exercises can be considered as preventive measures for osteoporosis in postmenopausal women.

Serum amyloid a gene polymorphism and its association with lipid profile in Saudi females with osteoporosis

Background and Objective:

Osteoporosis can be defined as a systemic skeletal disease characterized by low bone mass and micro architectural decline of bone tissue. Serum amyloid A (SAA) is a family of protein that increases up to 1,000-fold in blood during inflammation. In this study, we aimed to study the relationship between SAA1 gene polymorphism (rs12218) and lipid profile and osteoporosis.

Methods:

The study was performed on the female students of Taibah University in Al Medina, KSA during June 2014 to April 2015. According to BMD; osteoporosis group (138 students) and control group (128 students). All groups were subjected to; BMI, BMD, calcium, phosphorus, creatinine, lipid profile and SAA. Polymerase chain reaction and Real Time were done to determine the distribution of allele and genotype frequency of SAA (rs12218) C/T polymorphism.

Results:

This study shows that the TT genotype of rs12218 was more frequent in osteoporosis group than control group (P<0.001). Also, TT genotype and T allel was found to be associated with plasma total cholesterol, TG, LDLc, HDLc, Tscore, Zscore and SAA1 level in osteoporosis group (P=0.000, P=0.05, and P=0.000, P=0.000, P=0.01, P=0.02, P=0.000 respectively). The logistic regression analysis with and without lipid disorders in the osteoporosis group also show that the TT genotype of rs12218 still differed significantly between these two groups (P=0.001, OR=1.814, 95% CI: 0.719-4.577).

Conclusion:

The results of this study shows a significant association between TT genotype of rs12218 and both lipid level and osteoporosis in Saudi female population.

Lifestyle and Genetic Predictors of Stiffness Index in Community-dwelling Elderly Korean Men and Women

PURPOSE

Differing lifestyle, nutritional, and genetic factors may lead to a differing stiffness index (SI) determined by quantitative ultrasound in elderly men and women. The purpose of this study was to determine SI and the gender-specific factors associated with low SI in a Korean elderly cohort.

METHODS

This was a cross-sectional descriptive study identifying the gender-specific factors related to SI in 252 men and women aged 65 years and greater from local senior centers in Seoul, Korea between January and February 2009.

RESULTS

The mean SI of elderly men was significantly higher than that of the women's. A multiple regression analysis reveals that age, nutritional status, and physical activity were predictive factors of lower SI in men, whereas age, alcohol consumption, educational level, and genetic polymorphism were predictive factors for elderly women.

CONCLUSIONS

Low SI was common in both elderly men and women. We found gender differences in factors linked to low SI. In multiple regression analysis, nutritional status and physical activity were more important factors in men, whereas alcohol consumption, educational level, and genetic polymorphism were significant factors predicting low SI in women. Gender-specific modifiable risk factors associated with low SI should be considered when developing osteoporosis prevention programs for the elderly.

Quantitative ultrasound measurements of bone quality in female adolescents with idiopathic scoliosis compared to normal controls

OBJECTIVE

The aims of this study were to compare the speed-of-sound (SOS) between adolescent idiopathic scoliosis (AIS) patients and controls using quantitative ultrasound examination and to further analyze the relationship between the SOS and curve type, curve magnitude, maturation status and Risser's sign in AIS patients compared to controls.

METHODS

Seventy-eight female AIS patients and 58 healthy female controls 10 to 16 years of age were recruited to participate. Quantitative ultrasound measurements were performed at the non-dominant distal end of the radius. The standard method for estimating the SOS and z-score was used. Comparisons were made between the SOS values and z-score in AIS patients and age-matched Asian adolescents.

RESULTS

The SOS values of the patients were significantly lower than the controls (P < .01). The percentage of cases with low bone quality was 25% in the entire AIS sample. The prevalence of low bone quality in AIS patients was 20.5%. However, there were no correlations between the SOS and types of scoliosis (P > .05). The SOS values among different severity groups were significant, particularly between the 10° to 19° and 20° to 39° groups as well as between 10° to 19° and ≥40° groups. However, there was no significant correlation between the SOS and Cobb angles. Significant correlations were also found between the pre- and post-menarchy status in patients. There was a significant difference in the SOS values for different Rissers' signs (P < .05).

CONCLUSIONS

Compared to nonscoliotic controls, subjects with AIS had a generally lower SOS, indicating lower bone quality. The age, Risser's sign, or maturation status, may have an effect on the bone quality; however, the curve type and magnitude do not affect the bone quality. The results of this study indicate that slower bone maturation may affect the bone quality in adolescents with AIS.

Impact of Dietary Habits and Physical Activity on Bone Health among 40 to 60 Year Old Females at Risk of Osteoporosis in India

Osteoporosis is a disorder of bones with increasing risk among women. However, a number of modifiable factors can help in combating this disorder. Present study examined the relationship of diet and physical activity and risk of osteoporosis through biochemical tests, bone mass density (BMD) scores, and standard questionnaires. Genetic risk for osteoporosis, presence of osteoarthritis, and thyroid problems were found among 8%, 7%, and 3% of participants, respectively; and 78% had onset of menopause between 47 to 55 years of age. Results revealed that less intake of proteins, minerals, and diverse fruit and vegetable consumption was significantly (p≤0.05; 0.01) correlated with decreased BMD score and serum calcium. It was concluded that adequate intake of varied fruits and vegetables, good protein, habit of daily physical activity, adequate sun exposure, and dietary calcium, may play a promising role in decreasing the risk of osteoporosis among women of this age group.

Lifelong bound feet in China: a quantitative ultrasound and lifestyle questionnaire study in postmenopausal women

OBJECTIVE

The phenomenon of foot binding, also known as 'lotus feet', has an enduring and influential history in China. To achieve a man-made smaller foot size, lifelong foot binding may have had adverse effects on the skeleton. We investigated bone properties in postmenopausal women with bound feet, which may provide new information for developing countermeasures for prevention of fragility fractures.

DESIGN

Population-based cohort study.

PARTICIPANTS

This study involved 254 postmenopausal women aged 65-80, including 172 with bound feet and 82 age- and gender-matched control subjects, living in a remote region of China.

OUTCOMES

Anthropometric, SF-36 Lifestyle Questionnaire and heel quantitative ultrasound (QUS) data were collected for the whole study population. A small subset of two cases was also invited for assessment of bone mineral density and microarchitecture at the distal tibia using high-resolution peripheral quantitative CT (HR-pQCT) and gait and balance tests.

RESULTS

Women with bound feet had significantly lower QUS values than age-matched women with normal feet; this was supported by HR-pQCT data. However, SF-36 Questionnaire results did not reveal any statistically significant differences in any categorical responses, including physical functioning, general health vitality and physical component summary score, and number of previous fractures. No impairment of body balance was found in the small subset.

CONCLUSIONS

The man-made changes caused by foot binding led to reduced physical activity, making the subjects prone to osteoporosis. Women with bound feet and osteoporosis did not have a higher incidence of fragility fractures than controls. This might be explained by compensation in physical activity to improve body balance, implying the importance of improving or maintaining body balance in overall prevention strategies against fragility fractures.

Preliminary investigation on prevalence of osteoporosis and osteopenia: Should we tune our focus on healthy adults?

AIM

Osteoporosis and osteopenia are global health problems with increasing trend, particularly in developed regions. Apart from traditional well-recognized high-risk groups (i.e. postmenopausal women and elders), prevalence of such problems among adults should not be ignored because of the advantages of early detection and health promotion. Therefore, this preliminary study aims to investigate the prevalence of osteoporosis and osteopenia among adult office workers, which represented a relatively large proportion of the population in urbanized cities.

METHODS

An GE-Lunar Achilles ultrasonometer was used to screen the bone mineral density (BMD) of 80 participants.

RESULTS

The BMD T-score ranged from -3 to 3.5. The majority of the participants had normal BMD result (T-score, ≥ -1), whereas 35% was classified as abnormal (T-score, < -1) including 31.3% osteopenia and 3.8% osteoporosis.

CONCLUSION

High prevalence rate of abnormal BMD among healthy adults should be further studied in this population. The findings also suggest that the current ignorance in adulthood may increase the prevalence of osteoporotic fractures in the future.

Somatic outcome among patients hospitalised for anorexia nervosa in adolescence: disorders reported and links with global outcome

AIMS

(1) To describe the frequency of somatic pathologies and depression among former anorexia nervosa (AN) patients; (2) to study links with subjects' clinical history and global outcomes.

METHODS

97 women hospitalised for AN during adolescence, 9.00 ± 1.92 years previously, were interviewed using structured questionnaires concerning somatic and psychiatric disorders that they had experienced.

RESULTS

Iron deficiency, migraine, cystitis, upper digestive system disorders, fractures, osteoporosis, and dental problems were reported with a frequency >20 %. Depression was reported by 2/3 of the sample. Osteoporosis was 14 times more frequent in case of vitamin D deficiency. Fractures were three times more frequent in presence of osteoporosis and less frequent when the overall outcome was better.

CONCLUSION

Among women who had AN in adolescence, somatic comorbidities are frequent in adulthood. They are linked to the severity and the duration of AN, and to the overall outcome of the subject.

Discrepancy between the quantitative ultrasound value of Malaysian men and the manufacturer's reference and the impact on classification of bone health status

The local normative value in quantitative ultrasound (QUS) equipment needs to be established for wider application and accurate classification of patients into respective fracture risk groups. The present study aimed to establish the calcaneal speed of sound (SOS) value for Chinese and Malay men in Malaysia and determine the difference between calcaneal SOS of the local population and the reference values provided by the manufacturer for each age group. This study will also determine the effect of using the manufacturer's young adult (20-29yr) reference or the local young adult reference to classify the subjects into the respective risk groups. Eight hundred forty Malay and Chinese men residing in central peninsular Malaysia were recruited and their calcaneal QUS value was determined using the CM-200 machine (Furuno Electric, Nishinomiya City, Japan). The results showed that the differences in SOS values between Chinese and Malay men were not significant across all the age groups studied (p>0.05). The age-dependent reduction of SOS value assumed a biphasic form, which was evident at 30-39yr and older than 60yr. The calcaneal SOS of the subject under study was significantly higher as compared with the manufacturer's reference (based on Japanese population) in all groups aged 40yr and older (p<0.05). A significant proportion of the subjects in the osteoporosis group was misclassified using the manufacturer's young adult reference as compared with using the local young adult reference (p<0.05). In conclusion, the overall normative value of SOS obtained was suitable for Chinese and Malay men in Malaysia, and a local reference value should be applied to avoid misclassification of subjects into the respective risk groups.

Bone health comparison in seven Asian countries using calcaneal ultrasound

BACKGROUND

Bone density measurements by DXA are not feasible for large population studies, whereas portable ultrasound heel scanners can provide a practical way of assessing bone health status. The purpose of this study was to assess bone health in seven Asian countries using heel ultrasound.

METHODS

Stiffness index (SI) was measured and T-scores generated against an Asian database were recorded for 598,757 women and 173,326 men aged over 21 years old using Lunar Achilles (GE Healthcare) heel scanners. The scanners were made available in public centres in Singapore, Vietnam, Malaysia, Taiwan, Thailand, Indonesia and the Philippines.

RESULTS

The mean SI was higher for men than women. In women SI as well as T-scores declined slowly until approximately 45 years of age, then declined rapidly to reach a mean T-score of < -2.5 at about 71-75 years of age. For men, SI as well as the T-score showed a slow steady decline to reach a mean of -2.0 to -2.5 at about 81-85 years. The results for females indicate that there are differences in the rate of decline between countries (significant differences between the slopes at P < 0.05). Vietnam had the fastest decrease for both T-Score and SI, resulting in this population having the poorest bone health of all countries at older ages. The results for males aged 46-85 years indicate that there are no significant differences in the rate of decline between countries for SI and T-Score. In both men and women aged 46-85 years, Vietnam and Indonesia have the lowest SI as well as T-Score for all age groups. For Vietnam and Indonesia, more than 50% of the women could be at risk of having osteoporosis and related fractures after the age of 70, while in Thailand and the Philippines this was >80 years.

CONCLUSIONS

The heel scan data shows a high degree of poor bone health in both men and women in Asian countries, raising concern about the possible increase in fractures with ageing and the expected burden on the public health system.

The effects of age, physical activity level, and body anthropometry on calcaneal speed of sound value in men

The influences of age, physical activity, and body anthropometry on calcaneal speed of sound are different among young adults, middle-aged, and elderly men.

INTRODUCTION

Quantitative ultrasound assessment of bone health status is much needed for developing countries in the screening of osteoporosis, but further studies on the factors that influence the quantitative ultrasound indices are required.

OBJECTIVES

The present study examined the influence of age, lifestyle factors, and body anthropometry on calcaneal speed of sound (SOS) in a group of Malaysian men of diverse age range.

SUBJECTS AND METHODS

A cross-sectional study was conducted, and data from 687 eligible males were used for analysis. They answered a detailed questionnaire on their physical activity status, and their anthropometric measurements were taken. Their calcaneal SOS values were evaluated using the CM-200 sonometer (Furuno, Nishinomiya City, Japan).

RESULTS

Subjects with higher body mass index (BMI) had higher calcaneal SOS values albeit significant difference was only found in the elderly subjects (p < 0.05). Sedentary subjects had lower calcaneal SOS values than physically active subjects, but significant difference was only found in the middle-aged subjects (p < 0.05). Calcaneal SOS was significantly (p < 0.05) correlated with age in young men; height, BMI, and physical activity score in middle-aged men; height and physical activity score in elderly men; and age and physical activity score for overall subjects. In a multivariate regression model, significant (p < 0.05) predictors for calcaneal SOS included age for young men; physical activity, BMI, body fat percentage, and height for middle-aged men; height for elderly men; and age, height, physical activity, weight, and body fat percentage for overall subjects.

CONCLUSION

Age, body anthropometry, and physical activity level have significant effects on the calcaneal SOS value in men.

The effect of physical loading on calcaneus quantitative ultrasound measurement: a cross-section study

Background

Physical loading leads to a deformation of bone microstructure and may influence quantitative ultrasound (QUS) parameters. This study aims at evaluating the effect of physical loading on bone QUS measurement, and further, on the potential of diagnosing osteoporosis using QUS method under physical loading condition.

Methods

16 healthy young females (control group) and 45 postmenopausal women (divided into 3 groups according to the years since menopause (YSM)) were studied. QUS parameters were measured at calcaneus under self-weight loading (standing) and no loading (sitting) conditions. Weight-normalized QUS parameter (QUS parameter measured under loading condition divided by the weight of the subject) was proposed to evaluate the influence of loading. T-test, One-Way analysis of variance (one way ANOVA) and receiver operating characteristic (ROC) analysis were applied for analysis.

Results

In QUS parameters, mainly normalized broadband ultrasound attenuation (nBUA), measured with loading significantly differed from those measured without loading (p < 0.05). The relative changes of weight-normalized QUS parameters on postmenopausal women with respect to premenopausal women under loading condition were larger than those on traditional QUS parameters measured without loading. In ROC analysis, weight-normalized QUS parameters showed their stronger discriminatory ability for menopause.

Conclusions

Physical loading substantially influenced bone QUS measurement (mainly nBUA). Weight-normalized QUS parameters can discriminate menopause more effectively. By considering the high relationship between menopause and osteoporosis, an inference was drawn that adding physical loading during measurement may be a probable way to improve the QUS based osteoporosis diagnosis.

Calcaneal quantitative ultrasound value for middle-aged and elderly Malaysian Chinese men and its association with age and body anthropometry

Quantitative ultrasound (QUS) is a relatively easy, reliable, and safe method for bone status assessment, but reference data for Asian males remain scarce. Our study aimed to determine the values for one QUS parameter, the speed of sound (SOS) at the calcaneus, in Malaysian Chinese men and to determine the association between the SOS and several demographic characteristics, such as age, weight, height, and body mass index. Three hundred forty-eight Malaysian Chinese men aged 40 yr and older were recruited, and their calcaneal QUS value was determined using the CM-200 densitometer (Furuno Electric, Nishinomiya City, Japan). The results indicated a significant correlation between SOS and age, and multiple stepwise regression analysis indicated that age and height were important predictors of SOS. A significant reduction in SOS value was observed when men 60 yr and older were compared with men aged 40-49 yr. Compared with the reference data for Japanese males, Chinese men in Malaysia showed higher SOS values across all the age groups studied. In conclusion, there is an age-related decrease in SOS values in Malaysian Chinese men, and the SOS values established in this study can be used as a reference for future studies.

Awareness and knowledge of osteoporosis in Vietnamese women

PURPOSE

Vietnamese women are at particular risk of osteoporosis and its complications. This study examined osteoporosis knowledge and awareness among Vietnamese women who have accessed health care.

METHODS

A sample of 217 women, 13 to 76 years of age, who were attending 1 of 2 health care facilities in Da Nang, Vietnam, between November and December 2009 completed a questionnaire assessing their awareness of osteoporosis and measuring their knowledge using a 30-item instrument reflecting 9 knowledge domains (eg, risk factors, diagnosis, prognosis).

RESULTS

A majority (81.6%) of the women had heard of osteoporosis. Awareness was associated with education, working in health care, and having a family member with osteoporosis. On average, Vietnamese women answered 49% of the knowledge questions correctly; scores ranged from 0 to 26 questions correct out of 30 (mean = 14.71 ± 5.2, median = 15). Mean knowledge scores were higher among those reporting a family member with osteoporosis, nurses (vs other vocations), and women with a high school education or greater (relative to those who had not completed high school). More than 90% of the women expressed interest in a prevention and treatment program.

CONCLUSIONS

Vietnamese women may have heard of osteoporosis, yet they would benefit from education targeting prevention and treatment of the disease.

Quantitative ultrasound and vertebral fractures in patients with type 2 diabetes

Patients with type 2 diabetes (T2DM) are known to have increased risks of femoral neck and vertebral fractures, although their bone mineral density (BMD) is normal or even slightly increased compared to non-DM controls. This observation suggests that bone fragility not reflected by BMD, possibly deterioration of bone quality, may participate in their fracture risks. Quantitative ultrasound (QUS), unlike BMD, could possibly evaluate bone quality, especially the microarchitecture, and therefore may be useful for assessing fracture risk in T2DM. To test this hypothesis, we measured calcaneal QUS as well as BMD at the lumbar spine, femoral neck, and 1/3 radius in 96 women (mean age 66.6 years old) and 99 men (64.7 years old) with T2DM, and examined their associations with prevalent vertebral fractures (VFs). Calcaneal QUS was performed by CM-200 (Elk Corp., Osaka, Japan), and speed of sound (SOS) values were obtained. BMD was measured by QDR4500 (Hologic, Waltham, MA). In T2DM patients, VFs were found in 33 and 45 subjects in women and men, respectively. When compared between subjects with and without VFs, there were no significant differences in values of SOS or BMD at any site between the groups in either gender. The distribution of SOS as a function of age showed that those with VFs were scattered widely, and there were no SOS thresholds for VFs in either gender. Logistic regression analysis adjusted for age and BMI showed that either SOS or BMD was not significantly associated with the presence of VFs in either gender. These results show that QUS as well as BMD are unable to discriminate T2DM patients with prevalent VFs from those without VFs. It seems necessary to seek other imaging modalities or biochemical markers evaluating bone fragility and fracture risk in T2DM.

Epidemiology of osteoporosis in an isolated Sardinian population by using quantitative ultrasound

This study aimed at estimating the prevalence of osteoporosis and osteopenia in a Sardinian isolated population using hand quantitative ultrasound and at investigating the associated factors. The authors utilized a subset of data from a large population-based epidemiologic survey carried out in the Ogliastra region of Sardinia between 2003 and 2008. The sample consists of 6,326 men and women aged ≥30 years, who underwent quantitative ultrasound at the phalanges, bioelectrical impedance, anthropometric measurements, blood tests, and a standardized epidemiologic questionnaire collecting sociodemographic, lifestyle, medical, physiologic, and pharmacologic data. The T-score thresholds for amplitude-dependent speed of sound of -3.2 standard deviations and between -3.2 and -1 standard deviations were used to diagnose osteoporosis and osteopenia, respectively. Prevalence of osteoporosis was 17.0% in women and 5.2% in men. Logistic regression analysis revealed that factors associated with osteoporosis were age, anthropometric and bioimpedance measures, alkaline phosphatase levels, and menopause in women. High education, exercise, and beer consumption seem to be protective factors, whereas a family history of osteoporosis is a risk factor. Results show that osteoporosis in this population is comparable with that found in different countries, suggesting that quantitative ultrasound could be used more widely to detect high-risk individuals for preventing osteoporotic fractures.

The treatment of osteopenia in Asian women: a new approach

PURPOSE

Compare dual energy x-ray absorptiometry (DEXA) scan results to the World Health Organization FRAX™ tool 10-year projected hip fracture risk of immigrant Vietnamese women at antiresorptive medication therapy initiation and to identify whether the current and/or future treatment of patients with osteopenia would change based on the FRAX tool results.

DATA SOURCE

Retrospective study involving a convenience sample of 57 postmenopausal,Vietnamese women concerning the variables age, height, weight, smoking, alcohol use, glucocorticoid use, personal and family fracture history, presence of secondary osteoporosis, and recent DEXA-scan T score. The data were then entered into FRAX and 10-year fracture risk for hip calculated.

CONCLUSIONS

Of the 18 subjects deemed osteopenic by DEXA scan and previously started on an antiresorptive agent, nine would not have been initiated had the FRAX tool been available at the time.

IMPLICATIONS FOR PRACTICE

The FRAX tool was easy to use and applicable in day-to-day care of patients and significantly increases the clinician's ability to make evidence-based decisions.

Prevalence and related risk factors of osteoporosis in peri- and postmenopausal Indian women

AIM

We undertook this study involving 200 peri- and postmenopausal women to determine the prevalence of osteoporosis, and in turn increase the awareness, education, prevention, and treatment of osteoporosis.

SETTING AND DESIGN

Postgraduate Institute of Medical Education and Research, UT Chandigarh, India, and a clinical study.

MATERIALS AND METHODS

A detailed medical, obstetrical, menstrual, and drug history was recorded in a proforma designated for the study. Height and weight was measured, weight-bearing exercise was assessed, and sunlight exposure per day for each woman was recorded. Food intake was estimated by using the 24-hour dietary recall method, and calcium and vitamin D consumption pattern was assessed. Bone mineral density (BMD) at postero-anterior lumbar spine and dual femurs was assessed by densitometer. Women were classified according to the WHO criteria.

STATISTICAL ANALYSIS USED

Student's t-test, multiple logistic regression analysis.

RESULTS

The prevalence of low BMD was found in more than half of this population (53%). The mean age in group I (normal BMD) was found to be 50.56 ± 5.74 years as compared to 52.50 ± 5.94 in group II with low BMD (P=0.02). The two groups were similar with respect to parity, education, socioeconomic status, family history of osteoporosis, hormone replacement therapy, and thyroid disorders. 46.8% of the women in group I and 33% of the women in group II had low physical activity and there was no statistically significant difference in sunlight exposure between the groups. Parity or the number of children and type of menopause was not seen to have much association with low BMD in our study. Lack of exercise and low calcium diet were significantly associated with low BMD. Multiple logistic regression analysis showed that age, exercise, menopause, and low calcium diet acted as significant predictors of low bone density.

CONCLUSION

The findings from the study suggest the need for large community-based studies so that high-risk population can be picked up and early interventions and other life style changes can be instituted if there is delay in implementing national or international health strategies to tackle this increasing global health problem. Strategies to identify and manage low BMD in the primary care setting need to be established and implemented.

Prevalence and risk factors of osteoporosis in Korea: a community-based cohort study with lumbar spine and hip bone mineral density

PURPOSE

To investigate bone mineral density (BMD) profiles, osteoporosis prevalence and risk factors in a community-based cohort in Korea.

METHODS

The present study is a cross-sectional study. The study population consisted of 1,547 men and 1991 women aged 40 years and older with BMD measurements using central dual energy X-ray absorptiometry from a prospective community-based cohort. The data were compared with other ethnic groups. Risk factors related to osteoporosis were analyzed.

RESULTS

Crude prevalence of osteoporosis in the whole subjects (40-79 years old) was 13.1% for men and 24.3% for women by WHO criteria, at any site among lumbar spine, femoral neck or total hip. Standardized prevalence of osteoporosis between age of 50 and 79 at lumbar spine, femoral neck and total hip was 12.9%, 1.3% and 0.7% in men and 24.0%, 5.7% and 5.6% in women, respectively. The mean BMD of studied female subjects after age of 50 was not significantly different from that of Chinese but significantly lower than that of Japanese, non-Hispanic whites, non-Hispanic blacks and Mexican Americans. Risk of osteoporosis was significantly associated with the presence of past fracture history (OR, 1.45; 95% CI, 1.08-1.94), smoking> or =1 pack/day (OR, 1.63; 95% CI, 1.01-2.62), menarche after age of 16 (OR, 1.46; 95% CI, 1.14-1.87), last delivery after age of 30 (OR, 1.58; 95% CI, 1.20-2.09), more than three offspring (OR, 1.42; 95% CI, 1.07-1.89), post-menopause status (OR, 7.32; 95% CI, 3.05-17.6), more than 17 years since menopause (OR, 1.53; 95% CI, 1.10-2.14), regular exercise of two to three times per week (OR, 0.40; 95% CI, 0.18-0.89), monthly income above 500,000 won per household (OR, 0.64; 95% CI, 0.45-0.92), college graduate (OR, 0.29; 95% CI, 0.13-0.63) and calcium intake> or =627.5 mg/day (OR, 0.65; 95% CI, 0.43-0.98) after adjusting for age and BMI.

CONCLUSION

The BMD and osteoporosis prevalence of Koreans are presented. Risk of osteoporosis was significantly associated with fracture history, smoking, reproductive history, regular exercise, income level, education background and calcium intake.

Associations between short one-leg standing time and speed of sound of calcaneal bone in a general population: the Shimanami Health Promoting Program (J-SHIPP) study

AIM

Loss of bone mass is a major cause of fracture in the elderly. One-leg standing (OLS) time has been postulated to be predictive of reduced bone mass. Here, we conducted a cross-sectional study to clarify whether OLS time measurements are associated with the speed of sound (SOS) of calcaneal bone independent of muscle mass in the lower extremity, a major confounding factor for the association, in a community-dwelling population of middle-aged to elderly subjects.

METHODS

The study subjects consisted of 770 apparently healthy middle-aged to elderly community-residents. Quantitative assessment of calcaneal bone was done using a quantitative ultrasound technique. OLS time with eyes open was measured with a maximum time of 60 s. Femoral muscle cross-sectional area (CSA) was measured from a computed tomography image.

RESULTS

Subjects who could not stand 60 s on one leg (n = 192) showed significantly lower SOS (1487 +/- 20, 1501 +/- 24 m/s, P < 0.001). In addition, femoral muscle CSA was positively associated with SOS (male, r = 0.148, P < 0.01; female, r = 0.204, P < 0.001). However, multiple regression analysis adjusted for age, sex and muscle CSA identified short OLS time less than 60 s as an independent determinant of SOS in both male (P < 0.001) and female (P < 0.05) subjects. OLS time was significantly associated with posturograph-measured mobility of the center of gravity. However, multiple regression analysis showed no significant correlation between balance impairment and SOS (P > 0.1).

CONCLUSION

OLS time less than 60 s was significantly associated with reduced SOS independent of age, sex and muscle mass in the lower extremity.

Sociodemographic variation in knowledge of osteoporosis and locally available calcium-rich foods among urban women living on low incomes in Davao, Philippines

We explored knowledge of osteoporosis and locally available calcium-rich foods among 1,151 urban women in the Philippines and analyzed the cross-sectional associations of their responses to questions about knowledge with their age, educational background, and family income status. In total, 80.3% of the women had heard about osteoporosis; a higher educational background independently predicted this awareness. For knowledge about locally available calcium-rich foods, older age was a positive predictor, whereas higher educational background was a negative predictor. We believe that more emphasis should be placed on locally available foods as part of nutritional education for young urban Filipinos.

Bone mineral density in women of a low socioeconomic level using DMPA for contraception in rural Upper Egypt

OBJECTIVE

To evaluate the effect of long-term use of depot medroxyprogesterone acetate (DMPA) on bone mineral density (BMD).

METHODS

A cross-sectional study was performed with 150 women using DMPA and 136 women using nonhormonal methods of contraception in rural Sohag Governorate, Upper Egypt. Socioeconomic scores were measured using the 1983 Fahmy and El Sherbeny system, model II. The mineral density of the left calcaneus was measured by ultrasonographically.

RESULTS

If the overall mean T score was significantly lower for the DMPA than for the control group, osteopenia and osteoporosis were more prevalent among DMPA users only for participants of the lowest socioeconomic level. There was a mild negative correlation between duration of DMPA use and T score, and when contraception duration was considered the differences in T scores between the DMPA and control groups were significant.

CONCLUSION

Prescribing DMPA only for the short term to women of a low socioeconomic level and counseling them about its effect on bone density may be a practical approach.

Application of Osteorisk to postmenopausal patients with osteoporosis

CONTEXT AND OBJECTIVE

Identification of women at risk of bone fracture is becoming less dependent on evaluating bone mineral density through placing greater value on clinical risk factors. The aim of this study was to evaluate the sensitivity of the Osteorisk clinical tool for identifying Brazilian postmenopausal women with osteoporosis, compared with bone densitometry.

DESIGN AND SETTING

Cross-sectional observational study at Faculdade de Medicina do ABC.

METHOD

Information on 812 postmenopausal osteoporotic women was retrospectively evaluated from medical records. The women were divided into the age groups 50-59, 60-69, 70-79 and over 80 years. The results from the Osteorisk clinical tool, which uses only age and weight, were compared with bone densitometry T-scores.

RESULTS

There were significant correlations between the results from the Osteorisk clinical tool and from bone densitometry, in relation to the lumbar spine (P = 0.027) and hip (P < 0.001), thus showing a non-arbitrary relationship. The overall sensitivity of Osteorisk for identifying women with "high risk of osteoporosis" was 86.5%, and it was higher for hip osteoporosis alone (97.2%) than for lumbar spine osteoporosis (85.8%). The sensitivity was better among older women.

CONCLUSION

Osteorisk seems to present good sensitivity for identifying postmenopausal women at risk of osteoporosis. It should be used when bone densitometry is not easily available or as a means of selecting individuals for referral for bone densitometry.

Quantitative ultrasound of the calcaneus in greek women: normative data are different from the manufacturer's normal range

Quantitative ultrasound (QUS) is considered a useful method in evaluating bone status. The aim of the present study was to establish the reference data for the QUS measurements of the calcaneus in a Greek population. We measured a QUS parameter, stiffness index (SI), at the right calcaneus in 1500 women using the Achilles express Ultrasonometer (GE Lunar, Madison, WI). Participants were divided into 7 groups according to their age with a 10-yr span in each group. A progressive decline was found in the SI values after the age of 39 yr in the current study. When the SI values were compared between the age groups, high statistically significant differences were obvious, especially between 20-29 and 50- to 59-yr age groups and 60-69 and 70- to 79-yr age groups (p < 0.0005). Additionally, in the Greek normal range (GNR), the SI values of those aged 60-69 and 70-79 yr were significantly higher (81.84+/-16.14 and 77.45+/-17.65, respectively) than those in the manufacturer's normal range (MNR; 75.84+/-16.14 and 69.10+/-17.65, p < 0.005, respectively). Using the manufacturer's values, significantly fewer women were classified as normal (48% vs 67.3%), although those with T-score < or =-2.5 were more (15.7%) compared with our Greek value (1.5%), and classification of subjects into risk-of-fracture categories was significantly different (kappa: 0.459, 66.2%, p < 0.0005). Multiple regression analysis showed that weight was the most significant predictor for SI in the age groups 30-39 (beta = 0.280, p < 0.05), 40-49, 60-69, and 70-79 yr (beta = 0.185, p < 0.005; beta = 0.329, p < 0.0005; beta = 0.494, p<0.0005, respectively). Using conventional categories of risk, we report a different classification of our subjects from those proposed by the manufacturer, supporting the concept that data specific to the Greek population are necessary.

Effect of community-based nutrition education intervention on calcium intake and bone mass in postmenopausal Vietnamese women

Objective

To examine the effect of community-based nutrition education intervention on calcium intake and bone mass in Vietnamese postmenopausal women.

Design

A controlled trial was conducted in two groups as intervention and control. The intervention group was given nutrition education during 18 months to improve calcium intake, while the control subjects had the usual diet. Calcium intake and bone mass were evaluated every 6 months. Bone mass was assessed by speed of sound (SOS) at calcaneus, referred to as quantitative ultrasound measurement. Anthropometric indices and serum parathyroid hormone (PTH) were determined at baseline and at the end of intervention.

Setting

Two rural communes of Hai Duong province located in the Red River Delta in Vietnam.

Subjects

A total of 140 women aged 55–65 years, who were more than 5 years postmenopausal and with low calcium intake (<400 mg/d), were recruited. After 18 months of intervention, 108 women completed the study.

Results

Calcium intake in the intervention group had increased significantly (P < 0·01) while it had no significant changes in controls. SOS values were not changed significantly in the intervention subjects while it decreased significantly by 0·5 % in the controls (P < 0·01). The intervention led to a decrease in serum PTH by 12 % (P < 0·01). In the controls, there was an increase in serum PTH by 32 % (P < 0·001).

Conclusion

Nutrition education intervention was effective in improving calcium intake and retarding bone loss in the studied subjects.

Osteoporosis in developing countries

Osteoporosis poses a huge challenge in developing countries due to demographic transition and aging of the population coupled with limited availability of resources. The exact disease burden is difficult to quantify because of the paucity of data. Ethnicity affects bone density as well as fracture risk. Population-specific normative data for bone density are lacking in large parts of the world. Vitamin D deficiency is common even in sunny countries. The WHO has developed an algorithm for estimation of 10-year fracture risk which may be used even in the absence of bone mineral density.

Prática de atividade física na adolescência e prevalência de osteoporose na idade adulta

O objetivo deste trabalho foi avaliar a associação entre prática de atividade física na adolescência e osteoporose na vida adulta. Realizou-se um estudo de base populacional incluindo uma amostra aleatória de 1.016 indivíduos de 50 anos ou mais. Atividade física no lazer foi avaliada utilizando o Questionário Internacional de Atividade Física - IPAQ. Os indivíduos foram definidos como ativos se estiveram engajados em atividade física durante a sua adolescência (10-19 anos) pelo menos por seis meses consecutivos. Os indivíduos ativos na adolescência demonstraram probabilidade 67% menor do que os inativos de apresentar osteoporose na vida adulta (p < 0,001). Esse resultado se manteve significativo após ajuste para os fatores de confusão (p = 0,005) e para o efeito mediador do nível de atividade física na idade adulta (p = 0,007). Conclui-se que a prática de atividade física na adolescência reduz o risco de osteoporose, independentemente do nível de atividade física na vida adulta. Desse modo, a adolescência é um importante período no desenvolvimento da saúde óssea.

Quantitative ultrasound in relation to risk factors for low bone mineral density in South African pre-menopausal women

SUMMARY: The study describes the association between risk factors and quantitative ultrasound bone measures in black and mixed-race pre-menopausal South African women. Despite some differences between the two study groups, the findings generally lend support to the use of ultrasound for epidemiological studies of bone mass in resource-limited settings. INTRODUCTION: Quantitative ultrasound at the calcaneus is a convenient and inexpensive method of estimating bone strength well suited to community-based research in countries with limited resources. This study determines, in a large sample of pre-menopausal South African women, whether characteristics associated with quantitative ultrasound measures are similar to those shown to be associated with bone mineral density as measured by dual X-ray absorptiometry. METHODS: This cross-sectional study included 3,493 women (1,598 black and 1,895 mixed race), aged 18-44 living in Cape Town. Study nurses administered structured interviews on reproductive history, lifestyle factors, and measured height and weight. Calcaneus quantitative ultrasound measurements were obtained using the Sahara device. Adjusted means of ultrasound measures according to categories of risk factors were obtained using multivariable regression analysis. RESULTS: Associations between quantitative ultrasound measures and age, body mass index, age at menarche, parity, and primary school physical activity were similar to those known for bone mineral density as measured by dual X-ray absorptiometry. There were no clear associations between quantitative ultrasound measures and educational level, alcohol use, cigarette smoking, and current calcium intake. CONCLUSION: The data give qualified support to the use of quantitative ultrasound as an epidemiological tool in large studies of bone strength in pre-menopausal women.

Prevalence of osteoporosis in middle Anatolian population using calcaneal ultrasonography method

BACKGROUND

There are a few studies on the prevalence of osteoporosis in Turkey. Most of such studies have been performed using classical diagnostic methods. Quantitative calcaneal ultrasonography is a contemporary procedure used in the diagnosis of osteoporosis.

OBJECTIVE

The aim of this study is to determine the prevalence of the osteoporosis and risk factors in middle Anatolian population aged more than 40, using quantitative calcaneal ultrasonography.

SUBJECTS AND METHODS

The present study was carried out in rural and urban areas of primary health care units. Evaluation of skeletal status was based on calcaneal quantitative ultrasound measurement, carried out by the Sahara Clinical Bone Sonometer (Hologic Waltham, MA, USA).

RESULTS

There were 1437 individuals, 866 were females (60.3%) and 571 were males (39.7%), aged in between 40 and 89 years. Standardized prevalence rates using Segi's population were found to be 14.0% in total, 17.1% in female and 9.2% in male. Osteoporosis prevalence increased with increasing ages. The highest prevalence value was determined in the individuals older than 70 years of age. Osteoporosis was more common among women compared to men. Osteoporosis prevalence increased in consistent with a decrease in the amount of milk, yoghurt and cheese consumption.

CONCLUSION

Based on current study, it is concluded that osteoporosis is an important health problem. Requiring health education about life styles (activity and nutrition) to avoid and even control osteoporosis.

Accuracy study on "Osteorisk": a new osteoporosis screening clinical tool for women over 50 years old

CONTEXT AND OBJECTIVE

Osteoporosis is the greatest cause of quality-of-life reductions, morbidity and mortality among postmenopausal women, with growing incidence as populations age. Clinical tools like Osteorisk provide an easy-access and low-cost alternative method that helps physicians to reduce the need for dual-energy X-ray absorptiometry (DXA), the expensive gold standard examination for diagnosing osteoporosis. The aim here was to study the accuracy of Osteorisk using heel ultrasonography for bone mineral density (BMD).

DESIGN AND SETTING

Cross-sectional study, at Faculdade de Medicina do ABC.

METHODS

A structured questionnaire was applied to 615 postmenopausal women, with anthropometric measurements, Osteorisk calculations and quantitative ultrasound on the heel using Sonost 2000 equipment.

RESULTS

461 women were included, with mean age 60 +/- 9 years, weight 67.6 +/- 12.9 kg and body mass index (BMI) 28.8 +/- 5.0 kg/m(2). Their Osteorisk classifications were: 61.0% low-risk, 28.4% medium-risk and 10.6% high-risk. Quantitative ultrasound showed 81.3% low-risk, 10.0% medium-risk and 8.7% high-risk regarding osteoporosis. Statistically significant results were observed (p < 0.001) when Osteorisk was correlated with age, years since menopause and BMI. Correlating these same variables with quantitative ultrasound, statistically significant results were observed for age (p < 0.001), years since menopause (p < 0.001) and BMI (p < 0.006). The sensitivity, specificity, negative predictive value and positive predictive value for Osteorisk were 64%, 6.7%, 89% and 30.6%, respectively.

CONCLUSION

Osteorisk is a valid tool for screening for women at low risk of osteoporosis, making it possible for these women not to have to undergo densitometry.

Osteoporosis in urban post-menopausal women of the Philippines: prevalence and risk factors

Summary

The prevalence of osteoporosis was assessed among post-menopausal women dwelling in an urban community of Davao, Philippines using quantitative ultrasonic bone densitometry and its predictors were investigated. The prevalence of osteoporosis was 19.8%. Advancing age, lower body weight, and higher educational attainment were identified as the independent predictors of osteoporosis.

Introduction

This cross-sectional study assessed the prevalence of osteoporosis among post-menopausal women dwelling in an urban community of the Philippines and investigated the risk factors for osteoporosis using a quantitative ultrasonic bone densitometer.

Methods

The study site was an area with high population density in Davao, the Philippines. Data collection was based on a structured questionnaire interview, and measurements of body size and speed of sound (SOS) at the calcaneus. The SOS T-score was calculated using the young adult mean (YAM) SOS based on data from 905 women aged 20 years and over residing in the community. The data for 339 post-menopausal women were analyzed to identify the prevalence of osteoporosis and its predictors in this study. The predictors of osteoporosis were determined by logistic regression analysis.

Results

The majority of the women lived on low-incomes. The prevalence of osteoporosis was 19.8% in post-menopausal women. Age in 1 year increments (odds ratio [OR] 1.168), body weight (OR 0.954), and duration of education in years (OR 1.132) were predictors of osteoporosis.

Conclusions

This study identified body weight as a modifiable risk factor of osteoporosis for post-menopausal women. Longitudinal observation of the same participants will be necessary to confirm these findings.

Association of estrogen receptor alpha gene polymorphisms and lifestyle factors with calcaneal quantitative ultrasound and osteoporosis in postmenopausal Vietnamese women

Genetic and lifestyle factors are important in the pathogenesis of osteoporosis. We investigated the relationships of PvuII and XbaI polymorphisms of the estrogen receptor alpha (ER-alpha) gene, lifestyle factors with speed of sound at the calcaneus (calcaneal SOS) and osteoporosis in a population-based study of 140 healthy postmenopausal women. By an analysis of covariates, women with higher copies of P or X alleles had higher calcaneal SOS compared with others (P=0.012, PP vs. pp; P=0.045, Xx vs. xx). Women with lower copies of px or higher copies of PX haplotypes had higher calcaneal SOS compared with others (P=0.021, 0 px vs. 2 px; P=0.011, 1 PX vs. 0 PX). The px and PX haplotypes, age and years since menopause were found to be independent predictors of calcaneal SOS in multiple linear regression models. Using logistic regression, we found an increased osteoporosis risk with evidence for a px haplotype dose effect (OR=2.82, 95% CI=1.50-5.31, P=0.001) and for a PX haplotype dose effect (OR=0.42, 95% CI=0.19-0.93, P=0.033). An increased educational level was associated with a reduced risk of osteoporosis (P=0.035 in the model with px, P=0.044 in the model with PX). In conclusion, the present study suggests that PvuII and XbaI polymorphims of the ER-alpha gene, age, years since menopause and educational level are associated with bone density, as assessed by calcaneal SOS, and osteoporosis in postmenopausal Vietnamese women.

Body composition: gender-specific risk factor of reduced quantitative ultrasound measures in older people

INTRODUCTION

Body composition has been reported as a significant determinant of bone mineral density. However, data regarding the relationship between the body composition and quantitative ultrasound (QUS) are scarce.

METHODS

This cross-sectional study examined risk factors of reduced QUS measures in older men and women. A total of 699 subjects aged 60 years old and over-458 women and 241 men-who lived in rural communities of Thailand were randomly recruited.

RESULTS

By using broadband ultrasound attenuation at the cutoff point of mean -1.0 SD based on young Thai people, the independent factors associated with reduced QUS measures in men were: poor activity of daily living, older age, and low fat mass. As for older women, the independent factors were the number of years since menopause, lack of regular exercise, lower height, and low fat mass. When using the stiffness index at the cutoff point of mean -1.6 SD based on young Thai people, the independent factors associated with reduced QUS measures in men were older age and low fat mass. Meanwhile, the number of years since menopause and low lean body mass were independent risk factors in women.

CONCLUSIONS

Poor activity of daily living in men or lack of regular exercise in women was found to be a modifiable risk factor of reduced QUS measures. Years since menopause and low lean body mass were significant factors determining reduced QUS measures in women. Fat mass was an independent factor associated with reduced QUS measures both in men and women.