1
|
Fang XY, Xu HW, Chen H, Zhang SB, Yi YY, Ge XY, Wang SJ. The efficacy of nutritional screening indexes in predicting the incidence of osteosarcopenia and major osteoporotic fracture in the elderly. J Bone Miner Metab 2024; 42:372-381. [PMID: 38795128 DOI: 10.1007/s00774-024-01514-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 04/22/2024] [Indexed: 05/27/2024]
Abstract
INTRODUCTION The effect of nutritional status on osteosarcopenia (OS) and major osteoporotic fracture (MOF) among the elderly is still unclear. So we aimed to compare the efficacy of the Mini-Nutrition Assessment-Short Form (MNA-sf), the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status (CONUT) for predicting OS and MOF among the elderly. MATERIALS AND METHODS A total of 409 participants were enrolled in this prospective study. Blood biochemical indexes, nutritional status, and bone- and muscle-related examinations were assessed at initial visit to the outpatient. Participants were divided into 4 groups: (1) control; (2) osteopenia/osteoporosis; (3) sarcopenia; (4) osteosarcopenia, and then followed for 5 years, recording the occurrence time of MOF. RESULTS The frequency values of osteopenia/osteoporosis, sarcopenia, and OS, at baseline, were respectively 13.4, 16.1, and 12% among the study samples. Correlation analysis showed that nutritional status scores were associated with body mass index, handgrip strength, albumin, bone mineral density, and physical functions. According to multivariate models, poor nutritional status was significantly associated with a higher risk of OS and MOF (P < 0.05). Survival analysis showed that the MOF rate in malnutrition group was significantly higher than normal nutrition group (P < 0.05). The receiver operator characteristic curve shows that the value of MNA-sf to diagnose OS and MOF is greater (P < 0.05). CONCLUSION The poor nutritional status was associated with a higher risk of both OS and MOF. MNA-sf showed a superior diagnostic power for OS and MOF among the elderly. Early nutrition assessments and interventions may be key strategies to prevent OS and fractures.
Collapse
Affiliation(s)
- Xin-Yue Fang
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Hao-Wei Xu
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Hao Chen
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Shu-Bao Zhang
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Yu-Yang Yi
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xiao-Yong Ge
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Shan-Jin Wang
- Department of Spinal Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
- Institute of Spinal Diseases, Jinggangshan University, Jiangxi, China.
- Department of Orthopedic, Shanghai East Hospital, Ji'An Hospital, Jiangxi, China.
- , 150# Jimo RD, Pudong New Area, Shanghai, 200120, China.
| |
Collapse
|
2
|
Martiniakova M, Biro R, Penzes N, Sarocka A, Kovacova V, Mondockova V, Omelka R. Links among Obesity, Type 2 Diabetes Mellitus, and Osteoporosis: Bone as a Target. Int J Mol Sci 2024; 25:4827. [PMID: 38732046 PMCID: PMC11084398 DOI: 10.3390/ijms25094827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Obesity, type 2 diabetes mellitus (T2DM) and osteoporosis are serious diseases with an ever-increasing incidence that quite often coexist, especially in the elderly. Individuals with obesity and T2DM have impaired bone quality and an elevated risk of fragility fractures, despite higher and/or unchanged bone mineral density (BMD). The effect of obesity on fracture risk is site-specific, with reduced risk for several fractures (e.g., hip, pelvis, and wrist) and increased risk for others (e.g., humerus, ankle, upper leg, elbow, vertebrae, and rib). Patients with T2DM have a greater risk of hip, upper leg, foot, humerus, and total fractures. A chronic pro-inflammatory state, increased risk of falls, secondary complications, and pharmacotherapy can contribute to the pathophysiology of aforementioned fractures. Bisphosphonates and denosumab significantly reduced the risk of vertebral fractures in patients with both obesity and T2DM. Teriparatide significantly lowered non-vertebral fracture risk in T2DM subjects. It is important to recognize elevated fracture risk and osteoporosis in obese and T2DM patients, as they are currently considered low risk and tend to be underdiagnosed and undertreated. The implementation of better diagnostic tools, including trabecular bone score, lumbar spine BMD/body mass index (BMI) ratio, and microRNAs to predict bone fragility, could improve fracture prevention in this patient group.
Collapse
Affiliation(s)
- Monika Martiniakova
- Department of Zoology and Anthropology, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia; (R.B.); (V.K.)
| | - Roman Biro
- Department of Zoology and Anthropology, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia; (R.B.); (V.K.)
| | - Noemi Penzes
- Department of Botany and Genetics, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia; (N.P.); (A.S.); (V.M.); (R.O.)
| | - Anna Sarocka
- Department of Botany and Genetics, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia; (N.P.); (A.S.); (V.M.); (R.O.)
| | - Veronika Kovacova
- Department of Zoology and Anthropology, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia; (R.B.); (V.K.)
| | - Vladimira Mondockova
- Department of Botany and Genetics, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia; (N.P.); (A.S.); (V.M.); (R.O.)
| | - Radoslav Omelka
- Department of Botany and Genetics, Faculty of Natural Sciences and Informatics, Constantine the Philosopher University in Nitra, 949 01 Nitra, Slovakia; (N.P.); (A.S.); (V.M.); (R.O.)
| |
Collapse
|
3
|
Peng Z, Lu S, Lou Z, Li Z, Li S, Yang K, Li C. Retracted Article: Exosomes from bone marrow mesenchymal stem cells promoted osteogenic differentiation by delivering miR-196a that targeted Dickkopf-1 to activate Wnt/β-catenin pathway. Bioengineered 2023; 14:1996015. [PMID: 34720039 PMCID: PMC10501159 DOI: 10.1080/21655979.2021.1996015] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/15/2021] [Accepted: 10/16/2021] [Indexed: 01/08/2023] Open
Abstract
Statement of RetractionWe, the Publisher of the journal Bioengineered, have retracted the following article:Zhi Peng et al - Exosomes from bone marrow mesenchymal stem cells promoted osteogenic differentiation by delivering miR-196a that targeted Dickkopf-1 to activate Wnt/β-catenin pathway, Bioengineered (2021) (DOI: https://www.10.1080/21655979.2021.1996015)Since publication, significant concerns have been raised about the integrity of the data and reported results in the article. When approached for an explanation, the authors checked their data and confirmed there are fundamental errors present. Therefore, they have agreed to the retraction of this article. The authors apologise for this oversight.We have been informed in our decision-making by our policy on publishing ethics and integrity and the COPE guidelines on retractions.The retracted article will remain online to maintain the scholarly record, but it will be digitally watermarked on each page as 'Retracted'.
Collapse
Affiliation(s)
- Zhi Peng
- Kunming Medical University, No. 1168 West Chunrong Road, Kunming, Yunnan650504, China
| | - Sheng Lu
- Department of OrthopaedicsThe First People’s Hospital of Yunnan Province, , No. 504 Qingnian Rd, Kunming, Yunnan650011, China
| | - Zhenkai Lou
- Department of Orthopaedics, The First Affiliated Hospital of Kunming Medical University, No.295 Xichang Rd, Kunming, Yunnan650032, China
| | - Zhongjie Li
- Department of Spinal Surgery, The First Affiliated of Dali University, No. 32 Jiashibo Rd, Dali, Yunnan, 671000, China
| | - Shaobo Li
- Department of Spinal Surgery, The First Affiliated of Dali University, No. 32 Jiashibo Rd, Dali, Yunnan, 671000, China
| | - Kaishun Yang
- Department of Spinal Surgery, The First Affiliated of Dali University, No. 32 Jiashibo Rd, Dali, Yunnan, 671000, China
| | - Chao Li
- Department of Spinal Surgery, The First Affiliated of Dali University, No. 32 Jiashibo Rd, Dali, Yunnan, 671000, China
| |
Collapse
|
4
|
Ma C, Mo L, Wang Z, Peng D, Zhou C, Niu W, Liu Y, Chen Z. Dihydrotanshinone I attenuates estrogen-deficiency bone loss through RANKL-stimulated NF-κB, ERK and NFATc1 signaling pathways. Int Immunopharmacol 2023; 123:110572. [PMID: 37572501 DOI: 10.1016/j.intimp.2023.110572] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 08/14/2023]
Abstract
Postmenopausal osteoporosis, a chronic condition that predominantly affects postmenopausal women, presents a significant impediment to their overall well-being. The condition arises from estrogen deficiency, leading to enhanced osteoclast activity. Salvia miltiorrhiza, a well-established Chinese herbal medicine with a history of clinical use for osteoporosis treatment, contains diverse active constituents that have shown inhibitory effects on osteoclast formation and bone loss. Dihydrotanshinone I (DTI), a phenanthrenonequinone compound derived from the root of Salvia miltiorrhiza, has been identified as a potential therapeutic agent, although its mechanism of action on osteoclasts remains elusive. In this study, we aimed to elucidate the inhibitory potential of DTI on RANKL-induced osteoclastogenesis. We observed the ability of DTI to effectively impede the expression of key osteoclast-specific genes and proteins, as assessed by Real-time PCR and Western Blotting analyses. Mechanistically, DTI exerted its inhibitory effects on osteoclast formation by modulating critical signaling pathways including NF-κB, ERK, and calcium ion signaling. Notably, DTI intervention disrupted the nuclear translocation and subsequent transcriptional activity of the NFATc1, thus providing mechanistic insights into its inhibitory role in osteoclastogenesis. To further assess the therapeutic potential of DTI, we employed an ovariectomized osteoporosis animal model to examine its impact on bone loss. Encouragingly, DTI demonstrated efficacy in mitigating bone loss induced by estrogen deficiency. In conclusion, our investigation elucidates the ability of DTI to regulate multiple signaling pathways activated by RANKL, leading to the inhibition of osteoclast formation and prevention of estrogen-deficiency osteoporosis. Consequently, DTI emerges as a promising candidate for the treatment of osteoporosis.
Collapse
Affiliation(s)
- Chao Ma
- Guangzhou University of Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Liang Mo
- Guangzhou University of Chinese Medicine, Guangzhou, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Zhangzheng Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Deqiang Peng
- Guangzhou University of Chinese Medicine, Guangzhou, China; The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chi Zhou
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Wei Niu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Yuhao Liu
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine.
| | - Zhenqiu Chen
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine.
| |
Collapse
|
5
|
Kjeldgaard HK, Holvik K, Abrahamsen B, Tell GS, Meyer HE, O'Flaherty M. Explaining declining hip fracture rates in Norway: a population-based modelling study. THE LANCET REGIONAL HEALTH. EUROPE 2023; 30:100643. [PMID: 37215491 PMCID: PMC10193007 DOI: 10.1016/j.lanepe.2023.100643] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/24/2023]
Abstract
Background Although age-standardised hip fracture incidence has declined in many countries during recent decades, the number of fractures is forecast to increase as the population ages. Understanding the drivers behind this decline is essential to inform policy for targeted preventive measures. We aimed to quantify how much of this decline could be explained by temporal trends in major risk factors and osteoporosis treatment. Methods We developed a new modelling approach, Hip-IMPACT, based on the validated IMPACT coronary heart disease models. The model applied sex- and age stratified hip fracture numbers and prevalence of pharmacologic treatments and risk/preventive factors in 1999 and 2019, and best available evidence for independent relative risks of hip fracture associated with each treatment and risk/preventive factor. Findings Hip-IMPACT explained 91% (2500/2756) of the declining hip fracture rates during 1999-2019. Two-thirds of the total decline was attributed to changes in risk/preventive factors and one-fifth to osteoporosis medication. Increased prevalence of total hip replacements explained 474/2756 (17%), increased body mass index 698/2756 (25%), and increased physical activity 434/2756 (16%). Reduced smoking explained 293/2756 (11%), and reduced benzodiazepine use explained (366/2756) 13%. Increased uptake of alendronate, zoledronic acid, and denosumab explained 307/2756 (11%), 104/2756 (4%) and 161/2756 (6%), respectively. The explained decline was partially offset by increased prevalence of type 2 diabetes and users of glucocorticoids, z-drugs, and opioids. Interpretation Two-thirds of the decline in hip fractures from 1999 to 2019 was attributed to reductions in major risk factors and approximately one-fifth to osteoporosis medication. Funding The Research Council of Norway.
Collapse
Affiliation(s)
- Helena Kames Kjeldgaard
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Kristin Holvik
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Bo Abrahamsen
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Grethe S. Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Haakon E. Meyer
- Department of Physical Health and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
6
|
High prevalence and risk factors for osteoporosis in 1839 patients with systemic sclerosis: a systematic review and meta-analysis. Clin Rheumatol 2023; 42:1087-1099. [PMID: 36474110 DOI: 10.1007/s10067-022-06460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Osteoporosis is prevalent in patients with systemic sclerosis (SSc). Updated evidence is required to complement the previous systematic review on this topic to provide best practices. This systematic review and meta-analysis aimed to quantitatively synthesize data from studies concerning the prevalence and risk factors for osteoporosis among patients with SSc. METHODS We searched PubMed, EMBASE, Web of Science, and ScienceDirect databases for potential studies published from inception to May 31, 2022. Eligibility screening, data extraction, and quality assessment of the retrieved articles were conducted independently by two reviewers. Then meta-analyses were performed to determine osteoporosis prevalence and risk factors in patients with SSc. Meta-regression analysis was conducted to explore the sources of heterogeneity. RESULTS The pooled prevalence of osteoporosis in patients with SSc was 27% (95% CI, 24-31), with moderate heterogeneity (I2 = 61.6%). Meta-regression revealed no significant difference among all variables. And the presence of SSc increased the likelihood of having osteoporosis (OR = 3.05, 95% CI, 2.32-4.01) compared to controls. These significant risk factors for osteoporosis in SSc patients were age > 50 years (OR = 2.94, 95% CI, 1.52-5.68), menopause (OR = 3.90; 95% CI, 1.94-7.84), aging (MD = 8.40; 95% CI,6.10-10.71) and longer disease duration (MD = 4.78; 95% CI,1.83-7.73). However, female (OR = 1.45; 95% CI, 0.75-2.77), pulmonary arterial hypertension (OR = 0.50; 95% CI, 0.17-1.54), and diffuse cutaneous SSc (OR = 1.05; 95% CI, 0.75-1.48) were not significant risk factors for osteoporosis in SSc patients. CONCLUSIONS Osteoporosis was highly prevalent in patients with SSc, and the prevalence seemed to be high and similar in many countries. The age > 50 years, menopause, aging, and longer disease duration were identified as risk factors for osteoporosis in patients with SSc.
Collapse
|
7
|
Clements M, Heffernan M, Ward M, Hoey L, Doherty LC, Hack Mendes R, Clarke MM, Hughes CF, Love I, Murphy S, McDermott E, Grehan J, McCann A, McAnena LB, Strain JJ, Brennan L, McNulty H. A 2-Year Randomized Controlled Trial With Low-Dose B-Vitamin Supplementation Shows Benefits on Bone Mineral Density in Adults With Lower B12 Status. J Bone Miner Res 2022; 37:2443-2455. [PMID: 36128889 PMCID: PMC10092614 DOI: 10.1002/jbmr.4709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/04/2022] [Accepted: 09/17/2022] [Indexed: 01/19/2023]
Abstract
Folate, vitamins B12, B6, and riboflavin are required for one-carbon metabolism and may affect bone health, but no previous randomized trial has investigated all four nutrients in this context. We investigated the effect of low-dose B-vitamins for 2 years on bone mineral density (BMD) in a dual-centered, 2-year randomized controlled trial (RCT) in adults aged ≥50 years. Eligible participants not consuming B-vitamin supplements or fortified foods >4 times weekly were randomized to receive daily either combined folic acid (200 μg), vitamin B12 (10 μg), vitamin B6 (10 mg), and riboflavin (5 mg), or "active" placebo, whereby both the intervention and placebo groups received vitamin D (10 μg). BMD was assessed before and after intervention using dual-energy X-ray absorptiometry (DXA) scanning of the total hip, femoral neck, and lumbar spine (L1 to L4). Of 205 eligible participants randomized, 167 completed the trial in full. B-vitamin intervention resulted in increases in serum folate (p < 0.001), serum B12 (p < 0.001), and plasma pyridoxal-5-phosphate (p < 0.001) and decreases in functional biomarkers of B-vitamin status, erythrocyte glutathione reductase activation coefficient (p < 0.001), serum methylmalonic acid (MMA; p < 0.001), and serum total homocysteine (p < 0.001). B-vitamin intervention had no overall effect on BMD, which declined in both treatment groups by approximately 1% (ranging from -0.7% to -1.4%). However, in participants with lower baseline B12 status (serum B12 <246 pmol/L or MMA ≥0.22 μmol/L), B-vitamin intervention reduced the 2-year BMD decline versus placebo: adjusted mean (95% confidence interval [CI]) change of -0.003 (-0.008, 0.002) versus -0.015 (-0.021, -0.010) g/cm2 at the total hip and -0.004 (-0.010, 0.001) versus -0.013 (-0.018, -0.007) g/cm2 at the femoral neck. In conclusion, the findings indicate that although low-dose B-vitamin intervention for 2 years had no overall effect on BMD, improving B-vitamin status appears to have specific benefits for bone health in adults with lower B12 status. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Michelle Clements
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Maria Heffernan
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Dublin, Ireland
| | - Mary Ward
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Leane Hoey
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Leanne C Doherty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Roberta Hack Mendes
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Dublin, Ireland
| | - Michelle M Clarke
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Dublin, Ireland
| | - Catherine F Hughes
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Ingrid Love
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Shauna Murphy
- Section of Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Eilish McDermott
- Section of Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | - Jennifer Grehan
- Section of Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Liadhan B McAnena
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - J J Strain
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| | - Lorraine Brennan
- UCD School of Agriculture and Food Science, Institute of Food and Health, Conway Institute, University College Dublin, Dublin, Ireland
| | - Helene McNulty
- Nutrition Innovation Centre for Food and Health (NICHE), School of Biomedical Sciences, Ulster University, Coleraine, Northern Ireland, UK
| |
Collapse
|
8
|
Lee SW, Han K, Kwon HS. Weight change and the risk of hip fractures in patients with type 2 diabetes: a nationwide cohort study. Osteoporos Int 2022; 33:1755-1767. [PMID: 35438308 DOI: 10.1007/s00198-022-06398-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/04/2022] [Indexed: 01/18/2023]
Abstract
UNLABELLED Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patients. INTRODUCTION In type 2 diabetes, patients are often asked to control their weight in order to reduce their diabetic morbidity. The American Diabetes Association recommends that diabetic patients conduct high-intensity interventions for regulating diet, physical activity, and behavior to reduce weight, followed by long-term comprehensive weight maintenance programs. Although such weight control attempts are required in diabetic patients, there are few studies on the effect of weight change on hip fracture in this population. We aim to investigate the association between body weight change and the incidence of hip fracture in subjects with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. MATERIALS AND METHODS A total of 1,447,579 subjects (894,204 men and 553,375 women) > 40 years of age, who were diagnosed with type 2 diabetes, were enrolled in this study. Weight change within 2 years was divided into five categories: from weight loss ≥ 10% to weight gain ≥ 10%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of hip fracture were analyzed, compared with the reference of the stable weight group (weight change < 5%). RESULTS Among 5 weight change groups, more than 10% weight loss showed the highest HR (HR, 1.605; 95% CI, 1.493 to 1.725), followed by more than 10% weight gain (HR, 1.457; 95% CI, 1.318 to 1.612). The effect of weight change on hip fracture risk was greater in males than in females, and those under 65 years of age were greater than those over 65 years of age. Baseline BMI did not play a role of weight change affecting the risk of hip fracture. The HR for hip fracture of subjects with regular exercise was lower than those without regular exercise. CONCLUSIONS In the type 2 diabetes population, both weight gain and weight loss were significantly associated with a higher risk of hip fracture, whereas maintaining body weight reduced the risk of hip fracture the most.
Collapse
Affiliation(s)
- S-W Lee
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K Han
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, 06978, Seoul, Republic of Korea.
| | - H-S Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, Yuksam-ro, Youngdeungpo-gu, 07345, Seoul, Republic of Korea.
| |
Collapse
|
9
|
Lee J, Han K, Park SH, Kim MK, Lim DJ, Yoon KH, Kang MI, Lee SH. Associations of variability in body weight and glucose levels with the risk of hip fracture in people with diabetes. Metabolism 2022; 129:155135. [PMID: 35032546 DOI: 10.1016/j.metabol.2022.155135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/06/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Diabetes is associated with a high risk of fragility fracture. However, there are controversies regarding the effect of fluctuations in metabolic parameters on the risk of fracture. We aimed to investigate the associations of body weight or glucose variability or their combination with the risk of hip fracture in people with diabetes. METHODS A population-based cohort study with 480,539 subjects over 40 years who had undergone three or more health examinations was performed. The degree of variability was evaluated using variability independent of the mean (VIM, 100 × standard deviation / meanbeta), coefficient of variation (CV), and average real variability (ARV, average of the absolute differences between consecutive values). High variability was defined as having values in the highest quartile. Cox proportional hazards models were used to estimate the risk of hip fracture. RESULTS There were 2834 hip fracture events (0.59%) during the mean follow-up of 8.1 years. After multivariable adjustment for age, sex, alcohol consumption, smoking, regular exercise, income, glucose, body mass index, hemoglobin, estimated glomerular filtration rate, diabetes duration, diabetes treatment with multiple agents, and osteoporosis, the HRs (95% CI) of hip fracture were 1.36 (1.24-1.50) and 1.29 (1.16-1.43) for high body weight VIM and high glucose VIM, respectively. The HR (95% CI) of both high VIM group was 1.63 (1.44-1.83), suggesting an additive effect of variabilities in body weight and glucose. The results were consistent when using CV and ARV and in various sensitivity analyses. CONCLUSIONS High variability in body weight and glucose levels is associated with an increased incidence rate and risk of hip fracture in people with diabetes.
Collapse
Affiliation(s)
- Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Sang Hyun Park
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Moo-Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
| |
Collapse
|
10
|
Han S, Park J, Jang HD, Han K, Lee C, Kim W, Hong JY. Changes in Underweight Status and Risk of Hip Fracture: A Korean Nationwide Population-Based Cohort Study. J Clin Med 2022; 11:jcm11071913. [PMID: 35407521 PMCID: PMC8999678 DOI: 10.3390/jcm11071913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
Being underweight is associated with a high risk of hip fracture. However, the impact of change in underweight status on the risk of hip fracture is unknown. This study is performed to investigate the relationship between change in underweight status and risk of hip fracture. This study included 1,713,225 subjects aged ≥40 years who underwent two consecutive national health screenings between 2007 and 2009. We prospectively assessed the risk of hip fracture between 2010 and 2018 according to changes in underweight status. We divided the participants into four groups according to the change in underweight status: consistent non-underweight (non-underweight to non-underweight), became non-underweight (underweight to non-underweight), became underweight (non-underweight to underweight), and consistent underweight (underweight to underweight). Compared with the consistent non-underweight group, the became non-underweight (0.74/1000 person years (PY) increase in incidence rate (IR); adjusted hazard ratio (HR) 1.72; 95% confidence interval (CI) 1.42−2.07), became underweight (1.71/1000 PY increase in IR; adjusted HR 2.22; 95% CI 1.96−2.53), and consistent underweight (1.3/1000 PY increase in IR; adjusted HR 2.18; 95% CI 1.89−2.53) groups had a significantly increased risk of hip fracture (p < 0.001). Change in underweight status was significantly associated with a risk of hip fracture.
Collapse
Affiliation(s)
- Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Korea;
| | - Jiwon Park
- Department of Orthopedics, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea; (J.P.); (W.K.)
| | - Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-ro, Bucheon 14584, Korea;
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul 06978, Korea;
| | - Choungah Lee
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, 7 Keunjaebong-gil, Hwaseong-si 18450, Korea;
| | - Wonseok Kim
- Department of Orthopedics, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea; (J.P.); (W.K.)
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si 15355, Korea; (J.P.); (W.K.)
- Correspondence: ; Tel.: +82-31-412-6577
| |
Collapse
|
11
|
Sarcopenic obesity defined by visceral adiposity was associated with osteoporotic vertebral fracture. Arch Osteoporos 2022; 17:41. [PMID: 35249182 DOI: 10.1007/s11657-022-01087-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous studies have reported that the fracture risk related to sarcopenic obesity (SO) may be influenced by the distribution of fat mass. Therefore, it is useful to explore a body component suitable for defining obesity when predicting fracture risk. This study was an attempt to explore the contribution of SO defined by visceral adiposity on the incidence of osteoporotic fracture. METHODS We enrolled 736 Chinese patients aged > 60 years in this prospective study. Sarcopenia was defined as low skeletal muscle index (SMI) with muscle strength or low SMI with low physical performance. Obesity was categorized as follows: (1) android to gynoid ratio (A/G ratio, men > 0.82, women > 0.65) as an indicator of visceral adiposity; (2) body fat percentage (men > 27.8%; women > 34.5%); and (3) body mass index (≥ 25 kg/m2). A Cox proportional hazard model was used to determine the association between SO and the risk of osteoporotic fracture. RESULTS The incidence of SO was 8.7%; 9.0% in females and 8.1% in males. Of 223 (30.2%) patients with self-reported fractures. SO classified by A/G was associated with an increased risk of osteoporotic vertebral fracture (HR: 1.71, 95% CI: 1.07-2.72). High SMI was associated with a reduced risk of osteoporotic vertebral fracture (HR: 0.82, 95% CI: 0.72-0.93), higher BMI was associated with a higher risk vertebral fracture (HR: 1.12, 95% CI: 0.94-1.63), and higher A/G ratio was associated with a higher risk of any fracture (HR: 1.28, 95% CI: 1.14-1.43) and osteoporotic vertebral fracture (HR: 1.19, 95% CI: 1.05-1.36). CONCLUSIONS Our findings suggest that SO, defined by visceral adiposity, was associated with the risk of osteoporotic vertebral fracture. Moreover, low SMI, low muscle strength and visceral adiposity were independently associated with osteoporotic fracture.
Collapse
|
12
|
The Relationship between Body Composition and Bone Mineral Density of Female Workers in A Unit of Tai’an. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1011768. [PMID: 35178110 PMCID: PMC8847031 DOI: 10.1155/2022/1011768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 11/17/2022]
Abstract
Objective. To explore the relationship between body composition and bone mineral density (BMD) of female workers in a university of Tai’an. Methods. This study randomly selected 90 female employees in a university of Tai’an. The body composition was monitored by body composition analyzer (inbody770), and the lumbar bone mineral density was monitored by dual energy X-ray absorptiometry (BMD model). The data were analyzed by SPSS 22.0 statistical software. Results. With the increasing of body mass index (BMI), BMD of female lumbar spines 1-4 (L1-4) increased gradually. Spearman correlation analysis showed that BMI, skeletal muscle mass, upper limb muscle mass, trunk muscle mass, lower limb muscle mass, and whole-body phase angle were positively correlated with L1-4BMD. Age was negatively correlated with L1-4BMD. Linear regression analysis showed that age was a negative factor of L1-4BMD, and skeletal muscle mass was a protective factor of abnormal bone mass, especially lower limb muscle mass. Conclusions. Lower limb muscle mass is a protective factor of female BMD. Strengthening physical exercise to improve lower limb muscle mass is conducive to the prevention of female osteoporosis.
Collapse
|
13
|
Hajizadeh H, Sefidmooye Azar P, Nadrian H, Soltani Bejestani F, Kolahi S, Gupta K. Cognitive determinants of weight control by dietary patterns among postmenopausal women with osteoporosis: An application of theory of planned behavior. Health Promot Perspect 2022; 11:452-459. [PMID: 35079590 PMCID: PMC8767087 DOI: 10.34172/hpp.2021.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/18/2021] [Indexed: 12/04/2022] Open
Abstract
Background: In this study, we aimed to assess the cognitive determinants of weight control behaviors by dietary patterns among postmenopausal women with osteoporosis. Methods: This cross-sectional study, based on the theory of planned behavior (TPB) was conducted from July to December 2017 among 240 postmenopausal women with osteoporosis in Tabriz, Iran. A validated and reliable TPB-based instrument, namely Weight-CuRB, and the food frequency questionnaire (FFQ) were used. Results: The results of exploratory factor analysis (EFA) indicated three dietary patterns (total variance explained=24.44%); healthy (n=71), mixed (n=78), and western (n=91). In addition, food items consumed by participants were classified into twenty-two food groups for dietary pattern analysis. In the healthy and western dietary patterns, attitude (β: 0.140, P <0.001) and subjective norms (SNs) (β: 0.498, P <0.01) were the only predictors of weight control behavior, respectively. In the women with healthy and western patterns, the TPB-based variables altogether explained 11% and 16% of variations in the behavior, respectively. Among all patients, the TPB-based variables explained 12.2% of variations in weight control behavior, within which SNs were the only significant predictor of the behavior (β=-0.199, P <0.01). Conclusion: Our findings highlighted the remarkable role of dietary patterns in the associations between weight control and its cognitive determinants. Dietary patterns should be considered while designing weight control educational interventions among women with osteoporosis. In such interventions, promoting SNs and perceived behavioral control (PBC) should be considered as the core strategies to promote the behaviors among the patients who follow an unhealthy diet.
Collapse
Affiliation(s)
- Hossein Hajizadeh
- Nutrition Research Center, Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Pouria Sefidmooye Azar
- Department of Nutrition, School of Applied Sciences, The University of Mississippi, Oxford, MS, USA
| | - Haidar Nadrian
- Social Determinanta of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farhang Soltani Bejestani
- Department of Rheumatology, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Sousan Kolahi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kritika Gupta
- Department of Nutrition and Hospitality Management, School of Applied Sciences, The University of Mississippi, Oxford, MS, USA
| |
Collapse
|
14
|
Van Hulten V, Rasmussen N, Driessen JHM, Burden AM, Kvist A, van den Bergh JP. Fracture Patterns in Type 1 and Type 2 Diabetes Mellitus: A Narrative Review of Recent Literature. Curr Osteoporos Rep 2021; 19:644-655. [PMID: 34931295 PMCID: PMC8716348 DOI: 10.1007/s11914-021-00715-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW In this narrative review, we have summarized the literature on fracture risk in T1DM and T2DM with a special focus on fracture site, time patterns, glucose-lowering drugs, and micro- and macrovascular complications. RECENT FINDINGS T1DM and T2DM were associated with an overall increased fracture risk, with preferent locations at the hip, vertebrae, humerus, and ankle in T1DM and at the hip, vertebrae, and likely humerus, distal forearm, and foot in T2DM. Fracture risk was higher with longer diabetes duration and the presence of micro- and macrovascular complications. In T2DM, fracture risk was higher with use of insulin, sulfonylurea, and thiazolidinediones and lower with metformin use. The increased fracture risk in T1DM and T2DM concerns specific fracture sites, and is higher in subjects with longer diabetes duration, vascular complications, and in T2DM with the use of specific glucose-lowering medication.
Collapse
Affiliation(s)
- V Van Hulten
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | | | - J H M Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - A M Burden
- Department of Chemistry and Applied Biosciences, Institute for Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
| | - A Kvist
- Steno Diabetes Center North Denmark, Aalborg, Denmark
- Department of Chemistry and Applied Biosciences, Institute for Pharmaceutical Sciences, ETH Zurich, Zurich, Switzerland
- Department of Endocrinology and Metabolism, Molecular Endocrinology & Stem Cell Research Unit (KMEB), Odense University Hospital, Odense, Denmark
| | - J P van den Bergh
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands.
- Department of Internal Medicine, Subdivision of Endocrinology, VieCuri Medical Center, Venlo, The Netherlands.
| |
Collapse
|
15
|
Trabecular Bone Score and Bone Mineral Density in Postmenopausal Women with Morbid Obesity-A Clinical Paradox. Med Sci (Basel) 2021; 9:medsci9040069. [PMID: 34842748 PMCID: PMC8628953 DOI: 10.3390/medsci9040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/19/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022] Open
Abstract
Obesity has long been considered to have a protective effect on bone, but specific complications in those with morbid obesity are known to have a detrimental impact on bone architecture. We aimed to study the bone microarchitecture (TBS—trabecular bone score) and bone mineral density (BMD) in postmenopausal women with morbid obesity compared to obese and non-obese age-matched women. Eighty-five consecutive postmenopausal women with morbid obesity (body mass index (BMI) ≥ 35 kg/m2) were enrolled and compared to age-matched obese (n = 80) and non-obese postmenopausal controls (n = 85). The BMD and TBS were assessed in all subjects using a Hologic-QDR 4500-W Discovery-A DXA scanner. The mean BMD (gm/cm2) at the femoral neck in women with morbid obesity was found to be significantly lower as compared to the age-matched postmenopausal obese controls (0.723 versus 0.762, p-value = 0.002). The BMD at the lumbar spine and hip showed similar trends but were not statistically significant. The bone microarchitecture was found to be significantly lower in those with morbid obesity (1.205) as compared to the other two groups (obesity 1.244; non-obese 1.228) (p < 0.013). Though obesity was associated with a better bone density and bone microarchitecture in postmenopausal women, a paradoxical lower value was seen in those with morbid obesity.
Collapse
|
16
|
Nordklint AK, Almdal TP, Vestergaard P, Lundby-Christensen L, Boesgaard TW, Breum L, Gade-Rasmussen B, Sneppen SB, Gluud C, Hemmingsen B, Perrild H, Madsbad S, Mathiesen ER, Tarnow L, Thorsteinsson B, Vestergaard H, Lund SS, Eiken P. Effect of metformin and insulin vs. placebo and insulin on whole body composition in overweight patients with type 2 diabetes: a randomized placebo-controlled trial. Osteoporos Int 2021; 32:1837-1848. [PMID: 33594488 DOI: 10.1007/s00198-021-05870-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
UNLABELLED Some studies indicate potential beneficial effects of metformin on body composition and bone. This trial compared metformin + insulin vs placebo + insulin. Metformin treatment had a small but positive effect on bone quality in the peripheral skeleton, reduced weight gain, and resulted in a more beneficial body composition compared with placebo in insulin-treated patients with type 2 diabetes. INTRODUCTION Glucose-lowering medications affect body composition. We assessed the long-term effects of metformin compared with placebo on whole body bone and body composition measures in patients with type 2 diabetes mellitus. METHODS This was a sub-study of the Copenhagen Insulin and Metformin Therapy trial, which was a double-blinded randomized placebo-controlled trial assessing 18-month treatment with metformin compared with placebo, in combination with different insulin regimens in patients with type 2 diabetes mellitus (T2DM). The sub-study evaluates the effects on bone mineral content (BMC), density (BMD), and body composition from whole body dual-energy X-ray absorptiometry (DXA) scans which were assessed at baseline and after 18 months. RESULTS Metformin had a small, but positive, (p < 0.05) effect on subtotal, appendicular, and legs BMC and BMD compared with placebo. After adjustment for sex, age, vitamin D, smoking, BMI, T2DM duration, HbA1c, and insulin dose, the effects on appendicular BMC and BMD persisted (p < 0.05 for both). The changes in appendicular BMC and BMD corresponded approximately to a 0.7% and 0.5% increase in the metformin group and 0.4% and 0.4% decrease in the placebo group, respectively. These effects were mostly driven by an increase in BMC and BMD in the legs and a loss of BMC and BMD in the arms. During 18 months, all participants increased in weight, fat mass (FM), FM%, and lean mass (LM), but decreased in LM%. The metformin group increased less in weight (subtotal weight (weight-head) - 2.4 [- 3.5, - 1.4] kg, p value < 0.001) and FM (- 1.5 [- 2.3, - 0.8] kg, p value < 0.001) and decreased less in LM% (0.6 [0.2, 1.1] %, p value < 0.001) compared with the placebo group. CONCLUSION Metformin treatment had a small positive effect on BMC and BMD in the peripheral skeleton and reduced weight gain compared with placebo in insulin-treated patients with T2DM.
Collapse
Affiliation(s)
- A K Nordklint
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerod, Denmark.
- Department of Ophthalmology, Rigshopitalet - Glostrup, Copenhagen, Denmark.
| | - T P Almdal
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Vestergaard
- Departments of Clinical Medicine and Endocrinology, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Aalborg, Denmark
| | | | | | - L Breum
- Department of Medicine, Zealand University Hospital, Koge, Denmark
| | - B Gade-Rasmussen
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - S B Sneppen
- Department of Medicine, Gentofte, Copenhagen University Hospital, Hellerup, Denmark
| | - C Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - B Hemmingsen
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerod, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Perrild
- Department of Endocrinology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark
| | - S Madsbad
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Copenhagen University Hospital, Hvidovre, Denmark
| | - E R Mathiesen
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L Tarnow
- Steno Diabetes Center Zealand, Holbak, Denmark
| | - B Thorsteinsson
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerod, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Vestergaard
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Medicine, Bornholms Hospital, Ronne, Denmark
- The Novo Nordisk Foundation Center for Basic Metabolic Research, Section of Metabolic Genetics, University of Copenhagen, Copenhagen, Denmark
| | - S S Lund
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany
| | - P Eiken
- Department of Nephrology and Endocrinology, Nordsjællands University Hospital, Hillerod, Denmark
- Department of Endocrinology, Bispebjerg, Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
17
|
Dance practice modifies functional fitness, lipid profile, and self-image in postmenopausal women. ACTA ACUST UNITED AC 2021; 28:1117-1124. [PMID: 34284435 DOI: 10.1097/gme.0000000000001818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the present study was to analyze the effects of dance practice on body composition, metabolic profile, functional fitness, and self-image/self-esteem in postmenopausal women. METHODS A total of 36 postmenopausal participants (mean age 57 years) danced three times per week for 90 minutes each day and were evaluated before and after 16 weeks. The parameters evaluated were body composition (body fat and lean mass), blood lipids, functional fitness, self-image, and self-esteem. RESULTS Statistical analysis was done using Student t test for paired samples and the Wilcoxon test with P values less than 0.05 considered statistically significant. Lower triglycerides (baseline = 156.5 ± 17.0 mg/dL; after 16-weeks = 131.5 ± 12.9 mg/dL; P < 0.01), higher high-density lipoprotein cholesterol (baseline = 55.4 ± 15.9 mg/dL; after 16 weeks = 60.0 ± 15.4 mg/dL; P < 0.001), and higher total cholesterol (baseline = 199.5 ± 26.8 mg/dL; after 16 weeks = 211.8 ± 35.7 mg/dL; P < 0.01) levels were observed in postmenopausal women. Dance intervention improved coordination (baseline = 8.6 ± 2.6; after 16 weeks = 6.7 ± 1.6; P < 0.001), agility (baseline = 55.9 ± 8.8; after 16 weeks = 64.1 ± 8.3; P < 0.001), and aerobic capability (baseline = 446.8 ± 63.4; after 16 weeks = 377.4 ± 53.8; P < 0.001). Classification of general function fitness index (GFFI) was considered regular at baseline (GFFI of 200-299), but improved after 16 weeks of dance practice (GFFI of 300-399, P < 0.001). CONCLUSION The 16-week dance intervention was effective in improving not only the lipid profile and functional fitness of postmenopausal women, but also self-image and self-esteem.
Collapse
|
18
|
Velioglu A, Kaya B, Aykent B, Ozkan B, Karapinar MS, Arikan H, Asicioglu E, Bugdaycı O, Yavuz DG, Tuglular S. Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study. PLoS One 2021; 16:e0251035. [PMID: 33930070 PMCID: PMC8087085 DOI: 10.1371/journal.pone.0251035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients. Patients-method Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD. Results One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX. Conclusion Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.
Collapse
Affiliation(s)
- Arzu Velioglu
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Burcu Kaya
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Basar Aykent
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Bige Ozkan
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Melis Sevil Karapinar
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Hakki Arikan
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ebru Asicioglu
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Onur Bugdaycı
- Department of Radiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Dilek Gogas Yavuz
- Division of Endocrinology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Serhan Tuglular
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| |
Collapse
|
19
|
Sampaio LG, Marques J, Petterle RR, Moreira CA, Borba VZC. Association between fractures and traditional risk factors for osteoporosis and low bone mineral density in patients with obesity. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:152-163. [PMID: 33905627 PMCID: PMC10065326 DOI: 10.20945/2359-3997000000331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective To evaluate the reasons for request of bone mineral density (BMD) evaluation and correlate the BMD results with previous fractures, risk factors for osteoporosis, and clinical characteristics in patients with obesity. Methods Cross-sectional, retrospective, single-site study including adult patients with body mass index (BMI) ≥ 30 kg/m2 and BMD evaluation between January 2015 and May 2016 selected from a BMD database. Data on demographic characteristics, lifestyle habits, comorbidities, medications, risk factors, previous fractures, and indications for BMD evaluation were collected from the participants' medical records. Results The study included 619 patients (89.9% women, mean BMI 34.79 ± 4.05 kg/m2). In all, 382 (61.7%), 166 (26.8%), and 71 (11.5%) patients had class 1, 2, and 3 obesity, respectively. The most frequent (29.9%) reason for BMD evaluation was for osteoporosis monitoring. In all, 69.4% of the patients had low BMD. Multivariate analysis showed that age, calcium supplementation, and previous osteoporosis or osteopenia were associated with low BMD, while age, vitamin D supplementation, use of proton pump inhibitors (PPIs), and low BMD were associated with previous fractures (p < 0.05 for all). Conclusion Among patients with obesity identified from a tertiary hospital database, those with low bone mass and risk factors traditionally associated with fractures had an increased history of fractures. Patients with greater BMI had better bone mass and fewer fractures. These findings indicate that the association between reduced weight, risk factors for osteoporosis, and fractures remained despite the presence of obesity in our population.
Collapse
Affiliation(s)
| | | | | | - Carolina Aguiar Moreira
- Departamento de Medicina Interna, Universidade Federal do Paraná (UFPR); Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da UFPR (SEMPR), Curitiba, PR, Brasil
| | - Victoria Zeghbi Cochenski Borba
- Departamento de Medicina Interna, Universidade Federal do Paraná (UFPR); Serviço de Endocrinologia e Metabologia do Hospital de Clínicas da UFPR (SEMPR), Curitiba, PR, Brasil,
| |
Collapse
|
20
|
Kim J, Lee S, Kim SS, Lee JP, Kim JS, Jung JG, Yoon SJ, Kim KP, Park CK, Kim YH. Association between body mass index and fragility fracture in postmenopausal women: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2008-2009 (KNHANES IV). BMC WOMENS HEALTH 2021; 21:60. [PMID: 33563259 PMCID: PMC7871625 DOI: 10.1186/s12905-021-01209-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/03/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND The present study examined the relationship between body mass index (BMI) and the risk for fragility fractures in postmenopausal Korean women. METHODS Among subjects who participated in the 4th Korea National Health and Nutrition Examination Survey (2008-2009), 2114 women ≥ 40 years of age were included. BMI was based on standards set by the Korean Society for the Study of Obesity, as follows: < 18.5 kg/m2, underweight; 18.5 ≤ to < 25 kg/m2, normal weight; and ≥ 25 kg/m2, obese. Subjects were also divided into three groups according to the location of fragility fracture: spine, hip, or wrist. RESULTS The mean (± SD) rate of fragility fracture was significantly different among the three groups: 5.9 ± 2.9% (underweight), 1.1 ± 0.3% (normal weight), and 3.0 ± 0.7% (obese) (p = 0.001). After correcting for age, family history, and treatment history of osteoporosis and rheumatoid arthritis, smoking and drinking status, and level of exercise, multivariable regression analysis revealed that the odds ratio for fragility fracture in the underweight group was 5.48 [95% confidence interval (CI) 1.80-16.73] and 3.33 (95% CI 1.61-6.87) in the obese group. After subdividing fragility fractures into vertebral and non-vertebral, the odds ratio for vertebral fracture in the underweight group was 5.49 (95% CI 1.31-23.09) times higher than that in the normal weight group; in the obese group, the non-vertebral fracture odds ratio was 3.87 (95% CI 1.45-10.33) times higher. Analysis of non-vertebral fractures in the obese group revealed an odds ratio for fracture 22.05 (95% CI 1.33-365.31) times higher for hip fracture and 3.85 (95% CI 1.35-10.93) times higher for wrist fracture. CONCLUSIONS Obesity and underweight increased the risk for fragility fractures in postmenopausal Korean women.
Collapse
Affiliation(s)
- Jihan Kim
- Department of Family Medicine, Sejong Trinium Woman's Hospital, Sejong, Korea.,Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea
| | - Sami Lee
- Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea.
| | - Sung Soo Kim
- Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea
| | - Jong-Pyo Lee
- Department of Obstetrics and Gynecology, Sejong Trinium Woman's Hospital, Sejong, Korea
| | - Jong Sung Kim
- Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea
| | - Jin Gyu Jung
- Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea
| | - Seok Jun Yoon
- Department of Family Medicine, Research Institute for Medical Science, Chungnam National University School of Medicine, 282 Munhwa-ro, Jung-Gu, Daejeon, 35015, Korea
| | - Kyu Pil Kim
- Department of Family Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Chan-Keol Park
- Division of Rheumatology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Yong-Hwan Kim
- Department of Orthopedic Surgery, Chungnam National University Hospital, Daejeon, Korea
| |
Collapse
|
21
|
Li G, Compston JE, Leslie WD, Thabane L, Papaioannou A, Lau A, Wang X, Qin C, Chen B, Chen M, Adachi JD. Relationship Between Obesity and Risk of Major Osteoporotic Fracture in Postmenopausal Women: Taking Frailty Into Consideration. J Bone Miner Res 2020; 35:2355-2362. [PMID: 32717113 DOI: 10.1002/jbmr.4139] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 07/02/2020] [Accepted: 07/19/2020] [Indexed: 12/13/2022]
Abstract
The role of obesity in fracture risk remains uncertain and inconclusive in postmenopausal women. Our study aimed to assess the relationship between obesity and risk of major osteoporotic fracture (MOF; ie, a clinical fracture of upper arm or shoulder, hip, spine, or wrist) in postmenopausal women, after taking frailty into consideration. We used the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 5-year Hamilton cohort for this study. Frailty was measured by a frailty index (FI) of deficit accumulation at baseline. We incorporated an interaction term (obesity × FI) in the Cox proportional hazards regression model. We included 3985 women (mean age 69.4 years) for analyses, among which 29% were obese (n = 1118). There were 200 (5.02%) MOF events documented during follow-up: 48 (4.29%) in obese women and 152 (5.65%) in the nonobese group. Significant relationships between obesity, frailty, and MOF risk were found: hazard ratio (HR) = 0.72 (95% confidence interval [CI] 0.67-0.78) for those with an FI of zero regarding MOF risk among obese women, and HR = 1.34 (95% CI 1.11-1.62) per SD increase in the FI among nonobese women. The interaction term was also significant: HR = 1.16 (95% CI 1.02-1.34) per SD increase in the FI among obese women. Increased HRs were found with higher FIs regarding the relationship between obesity and MOF risk, indicating increasing frailty attenuated the protective effect of obesity. For example, although the HR for obesity and MOF risk among those who were not frail (FI = 0) was 0.72 (95% CI 0.67-0.78), among those who were very frail (FI = 0.70), the HR was 0.91 (95% CI 0.85-0.98). To conclude, after taking frailty into consideration, obesity was significantly associated with decreased risk of MOF in postmenopausal women among those who were not frail; however, increasing frailty attenuated this protective effect of obesity. Evaluating frailty status may aid in understanding of the complex relationship between obesity and fracture risk. © 2020 American Society for Bone and Mineral Research (ASBMR).
Collapse
Affiliation(s)
- Guowei Li
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China.,Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
| | | | - William D Leslie
- Departments of Medicine and Radiology, University of Manitoba, Winnipeg, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada
| | | | - Arthur Lau
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Xiaojie Wang
- Center for Clinical Epidemiology and Methodology (CCEM), Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Chenghe Qin
- Department of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Bo Chen
- Department of Endocrinology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Maoshui Chen
- Department of Orthopedics No. 2 (Spinal Surgery), Guangdong Provincial Hospital of Chinese Medicine, Zhuhai, China
| | - Jonathan D Adachi
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Canada.,Department of Medicine, McMaster University, Hamilton, Canada
| |
Collapse
|
22
|
Namikawa T, Yokota K, Iwabu J, Munekage M, Uemura S, Tsujii S, Maeda H, Kitagawa H, Karashima T, Kumon M, Inoue K, Kobayashi M, Hanazaki K. Incidence and risk factors of osteoporotic status in outpatients who underwent gastrectomy for gastric cancer. JGH OPEN 2020; 4:903-908. [PMID: 33102762 PMCID: PMC7578282 DOI: 10.1002/jgh3.12347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/14/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
Background and Aim Disorders in bone metabolism have long been recognized as typical sequelae of gastrectomy; however, the pathogenesis has not been fully elucidated, resulting in a variation of reported incidence. This study aimed to evaluate current bone health by measuring bone mineral density (BMD) in patients treated by gastrectomy for gastric cancer, with a focus on incidence and risk factors of osteoporosis. Methods The study enrolled 81 patients who underwent gastrectomy for gastric cancer at Kochi Medical School. BMD of the lumbar spine was measured by dual‐energy X‐ray mineral absorptiometry, with the results expressed as a percentage of the young adult mean (YAM). Clinical data were also obtained to investigate associations with BMD. Results Of the 81 study patients, 12 (14.8%) were deemed to have osteoporosis, defined by a percentage of YAM <70, with a dominance of females over males (66.7% vs 17.4%; P < 0.001). The median body weight, hemoglobin concentration, and serum alkaline phosphatase (ALP) level of the patients with osteoporosis was significantly lower than in those with a percentage of YAM ≥70 group (39.6 kg vs 53.1 kg, P < 0.001; 10.9 mg/dL vs 12.5 mg/dL, P = 0.010; 210 U/L vs 251 U/L, P = 0.002). Further analyses revealed a significant positive correlation between body weight and percentage of YAM (r = 0.441, P < 0.001). Despite the administration of bisphosphonates in these patients during this study, one acquired a bone fracture. Conclusion Osteoporosis was found in 14.8% of postoperative gastric cancer patients, with female gender, low body weight, and low ALP proposed as risk factors for osteoporosis and thus future bone fracture.
Collapse
Affiliation(s)
| | | | - Jun Iwabu
- Department of Surgery Kochi Medical School Nankoku Japan
| | | | - Sunao Uemura
- Department of Surgery Kochi Medical School Nankoku Japan
| | | | | | | | | | | | - Keiji Inoue
- Department of Urology Kochi Medical School Nankoku Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences Kochi Medical School Nankoku Japan
| | | |
Collapse
|
23
|
Sridharan K, Cherian KE, Kurian ME, Asha HS, Paul TV, Kapoor N. Utility of anthropometric indicators in predicting osteoporosis in ambulant community dwelling rural postmenopausal women from southern India. Trop Doct 2020; 50:228-232. [PMID: 32419634 DOI: 10.1177/0049475520922769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Osteoporosis is characterised by low bone mineral density (BMD) and is a significant public health problem in India. This cross-sectional study was done to assess the relationship between various anthropometric measures and BMD in 308 rural dwelling South Indian postmenopausal women. Anthropometric variables such as weight, body mass index (BMI), waist circumference (WC), hip circumference (HC) and neck circumference (NC) were measured. BMD was assessed by dual-energy X-ray absorptiometry (DXA) scan at the lumbar spine (LS) and femoral neck (NOF). The mean age ± SD of study participants was 60.7 ± 7.8 years. All anthropometric variables showed positive correlation with BMD at NOF and LS (P < 0.05). Weight showed the best correlation (r = 0.482 for NOF and 0.412 for LS; P < 0.001). On multivariate logistic regression, age and weight remained significant for predicting femoral neck osteoporosis while weight and WC were the best predictors for LS osteoporosis. These anthropometric measures may serve as surrogate markers for osteoporosis and thus be used to screen postmenopausal women for referral to a centre with fewer limited resources.
Collapse
Affiliation(s)
- Kalyani Sridharan
- Assistant professor, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Kripa E Cherian
- Assistant professor, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Mathews E Kurian
- Research officer, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Hesarghatta S Asha
- Professor, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Thomas V Paul
- Professor, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Associate Professor, Department of Endocrinology, Diabetes and Metabolism, Christian Medical College & Hospital, Vellore, Tamil Nadu, India
| |
Collapse
|
24
|
Dietary carbohydrate intake and risk of bone fracture: a systematic review and meta-analysis of observational studies. Public Health 2020; 181:102-109. [DOI: 10.1016/j.puhe.2019.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 09/26/2019] [Accepted: 12/02/2019] [Indexed: 02/07/2023]
|
25
|
Association between Body Fatness and Vitamin D 3 Status in a Postmenopausal Population. Nutrients 2020; 12:nu12030667. [PMID: 32121398 PMCID: PMC7146150 DOI: 10.3390/nu12030667] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 12/15/2022] Open
Abstract
Vitamin D is a micronutrient that plays a key role in phosphocalcic metabolism. The postmenopausal population presents a risk of deficiency in this vitamin due to hormonal alterations which, in the case of obesity, would be exacerbated. The objective was to assess the status of vitamin D in a postmenopausal population and determine the relationship of 25-hydroxivitamin D [25(OH)D] and its metabolites with anthropometric parameters. The study included 78 healthy postmenopausal women aged from 44 to 76. The nutrient intake assessment was carried out using the 24 h reminder (R24h). 25(OH)D was analyzed using ultra-high-performance liquid chromatography (UHPLC). A total of 80% and 68% of the women studied did not reach sufficient values of 25(OH)D and 25-hydroxivitamin D3 [25(OH)D3], respectively, which was inversely correlated with Body Mass Index (BMI) (r = −0.25, p = 0.04), hip perimeter (r = −0.26 and r = −0.24, all p < 0.05), arm circumference (r = −0.29, p = 0.01) and fat mass (r = −0.28 and r = −0.26, all p < 0.05). 25(OH)D3 is the metabolite that contributed most to this association. In conclusion, 25(OH)D3 levels are related to anthropometric parameters in the postmenopausal women in this study, confirming insufficient status in the majority of the population. Approach strategies are necessary to correct and avoid this risk in order to ensure future quality of life.
Collapse
|
26
|
Chen L, Liu R, Zhao Y, Shi Z. High Consumption of Soft Drinks Is Associated with an Increased Risk of Fracture: A 7-Year Follow-Up Study. Nutrients 2020; 12:E530. [PMID: 32092922 PMCID: PMC7071508 DOI: 10.3390/nu12020530] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 12/25/2022] Open
Abstract
(1) Background: Fracture causes a substantial burden to society globally. Some studies have found that soft drinks consumption was associated with the risk of fractures. We aimed to assess the association in the Chinese population; (2) Methods: Data from 17,383 adults aged 20 to 75 years old attending the China Health and Nutrition Survey (CHNS) between 2004 and 2011 were analyzed. Soft drinks consumption and fracture occurrence were self-reported. The cross-sectional and longitudinal associations between soft drink and fracture was assessed using multivariable mixed-effect logistic regression and Cox regression; (3) Results: After adjusting for sociodemographic and lifestyle factors and dietary patterns, compared with those who did not consume soft drinks, participants with daily consumption of soft drinks had an odds ratio (95%CI) of 2.72 (95%CI: 1.45-5.09) for fracture. During a mean 5-year follow-up, there were 569 incident fracture cases. Compared with non-consumers, those with daily soft drinks consumption had a hazard ratio (95%CI) of 4.69 (95%CI: 2.80-7.88) for incident fracture; (4) Conclusions: Soft drinks consumption is directly associated with the risk of fracture. Reducing soft drinks consumption should be considered as an important strategy for individual and population levels to maintain bone health.
Collapse
Affiliation(s)
- Li Chen
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (L.C.); (R.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China
- Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400016, China
| | - Ruiyi Liu
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (L.C.); (R.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China
- Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400016, China
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing 400016, China; (L.C.); (R.L.)
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing 400016, China
- The Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing 400016, China
- Chongqing Key Laboratory of Child Nutrition and Health, Chongqing 400016, China
| | - Zumin Shi
- Human Nutrition Department, College of Health Science, QU Health, Qatar University, Doha 2713, Qatar;
| |
Collapse
|
27
|
Li Y, Lu L, Xie Y, Chen X, Tian L, Liang Y, Li H, Zhang J, Liu Y, Yu X. Interleukin-6 Knockout Inhibits Senescence of Bone Mesenchymal Stem Cells in High-Fat Diet-Induced Bone Loss. Front Endocrinol (Lausanne) 2020; 11:622950. [PMID: 33679606 PMCID: PMC7933660 DOI: 10.3389/fendo.2020.622950] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/31/2020] [Indexed: 02/05/2023] Open
Abstract
Obesity, a chronic low-grade inflammatory state, not only promotes bone loss, but also accelerates cell senescence. However, little is known about the mechanisms that link obesity, bone loss, and cell senescence. Interleukin-6 (IL-6), a pivotal inflammatory mediator increased during obesity, is a candidate for promoting cell senescence and an important part of senescence-associated secretory phenotype (SASP). Here, wild type (WT) and (IL-6 KO) mice were fed with high-fat diet (HFD) for 12 weeks. The results showed IL-6 KO mice gain less weight on HFD than WT mice. HFD induced trabecular bone loss, enhanced expansion of bone marrow adipose tissue (BMAT), increased adipogenesis in bone marrow (BM), and reduced the bone formation in WT mice, but it failed to do so in IL-6 KO mice. Furthermore, IL-6 KO inhibited HFD-induced clone formation of bone marrow cells (BMCs), and expression of senescence markers (p53 and p21). IL-6 antibody inhibited the activation of STAT3 and the senescence of bone mesenchymal stem cells (BMSCs) from WT mice in vitro, while rescued IL-6 induced senescence of BMSCs from IL-6 KO mice through the STAT3/p53/p21 pathway. In summary, our data demonstrated that IL-6 KO may maintain the balance between osteogenesis and adipogenesis in BM, and restrain senescence of BMSCs in HFD-induced bone loss.
Collapse
Affiliation(s)
- Yujue Li
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology and Metabolism, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
- Department of General Practice, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyun Lu
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology and Metabolism, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
- Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Xie
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology and Metabolism, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiang Chen
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology and Metabolism, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Li Tian
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology and Metabolism, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Liang
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Li
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, China
| | - Jie Zhang
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Liu
- Department of Rheumatology and Immunology, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xijie Yu
- Department of Endocrinology and Metabolism, Laboratory of Endocrinology and Metabolism, Rare Disease Center, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Xijie Yu, ;
| |
Collapse
|
28
|
Jiang J, Liu X, Lai B, Hu D, Lai L, Xu J, Chen S, Li X. Correlational analysis between neutrophil granulocyte levels and osteonecrosis of the femoral head. BMC Musculoskelet Disord 2019; 20:393. [PMID: 31470845 PMCID: PMC6717348 DOI: 10.1186/s12891-019-2778-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/22/2019] [Indexed: 12/13/2022] Open
Abstract
Background The correlation between peripheral blood neutrophil level and osteonecrosis of the femoral head (ONFH) has not been extensively studied. Thus, we aimed to investigate the correlation between neutrophil level in the peripheral blood (neutrophil granulocyte) and ONFH. Methods A total of 984 cases of ONFH and femoral neck fractures (non-ONFH) diagnosed at the Department of Orthopedics at our institution between January 1, 2011 and December 31, 2016 were retrospectively reviewed. The ONFH and non-ONFH groups comprised 488 and 496 cases, respectively. Basic information and peripheral blood cell levels of the two groups were compared. Results The patients’ mean age was 59.89 ± 17.06 years (range: 38–82 years). There were 457 male and 527 female patients, with a male-to-female ratio of 1:1.15. We found that neutrophil granulocyte levels and percentage of neutrophil granulocytes were significantly different between the ONFH and non-ONFH groups. Multimodal regression analysis showed that the percentage of neutrophil granulocytes was an independent protective factor against ONFH. Conclusions The factors influencing ONFH are neutrophil granulocyte levels and percentage of neutrophil granulocytes. Percentage of neutrophil granulocytes has a significant correlation with aseptic femoral head necrosis, providing a new perspective and direction for further study of femoral head necrosis.
Collapse
Affiliation(s)
- Jiang Jiang
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Xuqiang Liu
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Baojian Lai
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Dengjiong Hu
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Lizhen Lai
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Jiaxiang Xu
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Songqing Chen
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China
| | - Xiaofeng Li
- Department of Orthopedics, the First Affiliated Hospital of Nanchang University, Artificial Joints Engineering and Technology Research Center of Jiangxi Province, No. 17 Yongwaizheng Street, Nanchang City, Jiangxi Province, China.
| |
Collapse
|
29
|
Hajizadeh H, Nadrian H, Farin N, Jafarabadi MA, Hezaveh SJG, Kolahi S, Azar PSM, Brennan-Olsen S. Development and validation of a theory of planned behavior-based weight control behavior questionnaire among postmenopausal women with osteoporosis. Health Care Women Int 2019; 40:1101-1116. [PMID: 31335306 DOI: 10.1080/07399332.2019.1640700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Our aim was to develop a framework-based weight control behavior questionnaire (Weight-CuRB) and test its psychometric properties among a non-probability sample of 240 postmenopausal women with osteoporosis. Appropriate validity, simplicity, functionality and reliability were observed for the Weight-CuRB. The explanatory model fits the data well (χ2 [139] = 245.835, p < .001, CFI = 0.950, NFI = 0.901, IFI = 0.950, RMSEA = 0.057[(0.045-0.068]). To our knowledge, this was the first study to develop and validate a framework-based instrument aiming at cognitive needs assessment of postmenopausal women with osteoporosis. The weight-CuRB may be useful in addressing the core cognitive determinants of weight control among the patients.
Collapse
Affiliation(s)
- Hossein Hajizadeh
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences , Tabriz , Iran
| | - Haidar Nadrian
- Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences , Tabriz , Iran
| | - Nazila Farin
- Nutrition Research Center, Tabriz University of Medical Sciences , Tabriz , Iran
| | | | | | - Sousan Kolahi
- Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences , Tabriz , Iran
| | - Pouria Sefid Mooye Azar
- Department of Nutrition, Faculty of Nutrition and Food Sciences, Tabriz University of Medical Sciences , Tabriz , Iran
| | - Sharon Brennan-Olsen
- Department of Medicine-Western Health, University of Melbourne , St Albans , Australia.,Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health , St Albans , Australia
| |
Collapse
|
30
|
|
31
|
Anagnostis P, Siolos P, Gkekas NK, Kosmidou N, Artzouchaltzi AM, Christou K, Paschou SA, Potoupnis M, Kenanidis E, Tsiridis E, Lambrinoudaki I, Stevenson JC, Goulis DG. Association between age at menopause and fracture risk: a systematic review and meta-analysis. Endocrine 2019; 63:213-224. [PMID: 30203119 DOI: 10.1007/s12020-018-1746-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/03/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Early menopause (EM, age at menopause < 45 years) and premature ovarian insufficiency (POI, age at menopause < 40 years) are associated with an increased risk of osteoporosis. However, their association with increased fracture risk has not been established, with studies yielding conflicting results. The primary aim of this systematic review and meta-analysis was to synthesize studies evaluating the association between age at menopause and fracture risk. The secondary aim was to evaluate this effect concerning the site of fractures. METHODS A comprehensive search was conducted in PubMed, CENTRAL and Scopus, up to 31 January 2018. Data were expressed as odds ratio (OR) with 95% confidence intervals (CI). The I2 index was employed for quantifying heterogeneity. RESULTS Eighteen studies were included in the qualitative and quantitative analysis (462,393 postmenopausal women, 12,130 fractures). Compared with women with age at menopause > 45 years, women with EM demonstrated higher fracture risk (OR 1.36, 95% CI 1.11-1.66, p < 0.002, I² 81.5%). Women with POI did not display any difference in fracture risk compared either with women with age at menopause > 40 (OR 1.23, 95% CI 0.72-2.09, p = 0.436, I² 62.5%) or >45 years (OR 0.54, 95% CI 0.22-1.29, p = 0.17, I2 0%). No difference was evident when a separate analysis was performed for vertebral, non-vertebral and hip fractures. CONCLUSIONS This is the first meta-analysis showing that EM is associated with increased fracture risk compared with normal age at menopause, without any distinct effect on the site of the fracture.
Collapse
Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Police Medical Center of Thessaloniki, Thessaloniki, Greece.
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Pavlos Siolos
- Police Medical Center of Thessaloniki, Thessaloniki, Greece
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nifon K Gkekas
- Police Medical Center of Thessaloniki, Thessaloniki, Greece
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikoletta Kosmidou
- Police Medical Center of Thessaloniki, Thessaloniki, Greece
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini-Maria Artzouchaltzi
- Police Medical Center of Thessaloniki, Thessaloniki, Greece
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Christou
- Police Medical Center of Thessaloniki, Thessaloniki, Greece
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Potoupnis
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
- Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Eustathios Kenanidis
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
- Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Eleftherios Tsiridis
- Centre of Orthopedic and Regenerative Medicine Research (CORE), Center for Interdisciplinary Research and Innovation (CIRI), Aristotle University of Thessaloniki, Thessaloniki, Greece
- Academic Orthopaedic Unit, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - John C Stevenson
- National Heart and Lung Institute, Imperial College London, Royal Brοmpton and Harefield NHS Foundation Trust, London, SW3 6NP, UK
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
32
|
We JS, Han K, Kwon HS, Kil K. Effect of Childbirth Age on Bone Mineral Density in Postmenopausal Women. J Korean Med Sci 2018; 33:e311. [PMID: 30473652 PMCID: PMC6249168 DOI: 10.3346/jkms.2018.33.e311] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 08/30/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In postmenopausal women, there is rapid bone loss due to estrogen depletion. In women, reproductive factors such as age at menarche, breastfeeding, and parity are considered risk factors of osteoporosis. Many reports suggest that obesity is associated with a reduced risk of osteoporosis. This nationwide, population-based study aims to identify the association between maternal age and osteoporosis risk in postmenopausal women of different obesity classifications. METHODS We assessed data from the Korean National Health and Nutrition Examination Survey 2010-2012. The study included 1,328 postmenopausal women, after excluding women with missing data for reproductive history among 4,546 postmenopausal women in the survey. Multivariate regression was used to identify the association between childbirth age and postmenopausal bone mineral density after adjustments for confounding factors. RESULTS The prevalence of postmenopausal osteoporosis was 35.24% (n = 468). After dividing the subjects into obese and non-obese groups based on body mass index (BMI) and waist circumference, there were significant differences between non-osteoporosis and osteoporosis groups with regard to age at first childbirth, age at last childbirth, and parity in the BMI-based general obesity group. The prevalence of osteoporosis was highest in women older than 35 years old at last childbirth. The prevalence of osteoporosis was also greater in women with parity ≥ 4 compared to those with lower parity levels. CONCLUSION Postmenopausal women of older age at last childbirth and higher parity were at increased risk of osteoporosis in the BMI-based non-general obesity group.
Collapse
Affiliation(s)
- Ji Sun We
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea
| | - Kyungdo Han
- Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea
| | - Kicheol Kil
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Yeouido St. Mary's Hospital, Seoul, Korea
| |
Collapse
|
33
|
Osteoporosis in patients with intestinal insufficiency and intestinal failure: Prevalence and clinical risk factors. Clin Nutr 2018; 37:1654-1660. [DOI: 10.1016/j.clnu.2017.07.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/20/2017] [Accepted: 07/30/2017] [Indexed: 02/07/2023]
|
34
|
Rosendahl-Riise H, Sulo G, Karlsson T, Drevon CA, Dierkes J, Tell GS. The Limited Benefit of Fish Consumption on Risk of Hip Fracture among Men in the Community-Based Hordaland Health Study. Nutrients 2018; 10:E873. [PMID: 29986400 PMCID: PMC6073237 DOI: 10.3390/nu10070873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 07/03/2018] [Indexed: 12/20/2022] Open
Abstract
Hip fractures have a high prevalence worldwide. Few studies have investigated whether fish consumption is associated with risk of hip fractures. The objective of the present study was to investigate the effect of fish intake on the subsequent risk of a hip fracture because of the low number of studies on this topic. A community-based prospective cohort study of 2865 men and women from Hordaland county in Norway, born between 1925⁻1927 and enrolled in the study in 1997⁻1999. Information on hip fracture cases was extracted from hospital records until 31 December 2009. Baseline information on the intake of fish was obtained from a semi-quantitative food frequency questionnaire. Cox proportional hazard regression models with death as a competing risk were used to evaluate the association of fish intake with risk of hip fracture. During a mean (SD) follow-up time of 9.6 (2.7) years, 226 hip fractures (72 in men, 154 in women) were observed. The mean (SD) fish intake was 48 (25) g/1000 kcal. The association between fish intake and risk of hip fracture was not linear and displayed a threshold, with low intake of fish being associated with an increased risk of hip fracture in men (HR (Hazard Ratio) = 1.84, 95% CI 1.10, 3.08). In this community-based prospective study of men and women, a low intake of fish was associated with the risk of a hip fracture in men.
Collapse
Affiliation(s)
- Hanne Rosendahl-Riise
- Department of Clinical Science, Faculty of Medicine, University of Bergen, 5020 Bergen, Norway.
| | - Gerhard Sulo
- Center for Disease Burden, Norwegian Institute of Public Health, 5020 Bergen, Norway.
| | - Therese Karlsson
- Department of Clinical Science, Faculty of Medicine, University of Bergen, 5020 Bergen, Norway.
| | - Christian A Drevon
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, 3017 Oslo, Norway.
| | - Jutta Dierkes
- Center for Nutrition, Department of Clinical Medicine, Faculty of Medicine, University of Bergen, 5020 Bergen, Norway.
- Laboratory Medicine and Pathology, Haukeland University Hospital, 5021 Bergen, Norway.
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, 5021 Bergen, Norway.
| |
Collapse
|
35
|
Anagnostis P, Paschou SA, Gkekas NN, Artzouchaltzi AM, Christou K, Stogiannou D, Vryonidou A, Potoupnis M, Goulis DG. Efficacy of anti-osteoporotic medications in patients with type 1 and 2 diabetes mellitus: a systematic review. Endocrine 2018; 60:373-383. [PMID: 29411304 DOI: 10.1007/s12020-018-1548-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 01/25/2018] [Indexed: 01/11/2023]
Abstract
PURPOSE Both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) have been associated with bone fragility and increased fracture risk. However, little is known regarding the effect of anti-osteoporotic treatment on bone mineral density (BMD) and/or fracture risk in these patients. We aimed to systematically investigate the efficacy of anti-osteoporotic medications in patients with diabetes in comparison with non-diabetic subjects. METHODS MEDLINE and Scopus databases were searched (up to 31st October 2017). RESULTS Nine studies fulfilled the pre-defined inclusion criteria [patients with T2DM (n = 8) or either T1DM or T2DM (n = 1)]. Regarding fracture risk, five studies were identified. Alendronate demonstrated comparable vertebral anti-fracture efficacy in patients with and without diabetes (n = 2), whereas non-vertebral fracture risk was either the same (n = 1) or higher in diabetic patients (n = 1). Raloxifene also demonstrated comparable vertebral anti-fracture efficacy in both groups (n = 2), without any effect on non-vertebral fractures in either group. In one study, diabetic patients exposed to raloxifene demonstrated the same vertebral and non-vertebral fracture risk with non-diabetic patients. Teriparatide (n = 1) demonstrated the same non-vertebral fracture rates in both patients with and without T2DM. Regarding BMD, equal increases in spine BMD were observed with alendronate (n = 4), risedronate (n = 1), and teriparatide (n = 1). With respect to hip BMD, similar increases were observed with teriparatide (n = 1), whereas data regarding alendronate were controversial (n = 3). No eligible study was found for zoledronic acid, ibandronate, strontium ranelate, denosumab, or bazedoxifene. CONCLUSIONS The presence of diabetes does not alter anti-osteoporotic treatment response, regarding BMD increase and vertebral fracture risk reduction.
Collapse
Affiliation(s)
- Panagiotis Anagnostis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
- Police Medical Center of Thessaloniki, Thessaloniki, Greece.
| | - Stavroula A Paschou
- Division of Endocrinology and Diabetes, "Aghia Sophia" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nifon N Gkekas
- Police Medical Center of Thessaloniki, Thessaloniki, Greece
| | | | | | | | - Andromachi Vryonidou
- Department of Endocrinology and Diabetes, Hellenic Red Cross Hospital, Athens, Greece
| | - Michael Potoupnis
- Academic Orthopaedic Unit, General Hospital Papageorgiou, Aristotle University Medical School, Thessaloniki, Greece
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
36
|
Tay YKD, Cusano NE, Rubin MR, Williams J, Omeragic B, Bilezikian JP. Trabecular Bone Score in Obese and Nonobese Subjects With Primary Hyperparathyroidism Before and After Parathyroidectomy. J Clin Endocrinol Metab 2018; 103:1512-1521. [PMID: 29373705 PMCID: PMC6276655 DOI: 10.1210/jc.2017-02169] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/10/2018] [Indexed: 01/06/2023]
Abstract
CONTEXT Obesity has been shown to be unfavorable to skeletal microarchitecture when assessed by trabecular bone score (TBS). The influence of adiposity on skeletal microstructure in primary hyperparathyroidism (PHPT) has not yet been evaluated. OBJECTIVE To investigate the effect of obesity on TBS and bone mineral density (BMD) in subjects with PHPT at baseline and through 2 years after parathyroidectomy. DESIGN Prospective observational study. SETTING Referral center. PATIENTS OR OTHER PARTICIPANTS Thirty men and women with PHPT undergoing parathyroid surgery. MAIN OUTCOME MEASURES TBS and BMD by dual-energy X-ray absorptiometry (DXA). RESULTS There were notable improvements in lumbar spine and femoral neck BMD in the obese (lumbar spine: 4.3 ± 4.7%, femoral neck: 3.8 ± 6.6%; P < 0.05 for both) and nonobese subjects (lumbar spine: 3.8 ± 5.6%, femoral neck 3.1 ± 5.0%; P < 0.05 for both) but no marked change in TBS in either group at 24 months postparathyroidectomy. Obese subjects had fully degraded TBS values compared with the nonobese subjects, whose TBS values were minimally below normal throughout the study (baseline: 1.199 ± 0.086 vs 1.327 ± 0.099, respectively; P = 0.003; 24 months: 1.181 ± 0.061 vs 1.352 ± 0.114, respectively; P = 0.001), despite improvements in BMD. CONCLUSIONS The detrimental effect of obesity on TBS, an index of bone quality, was demonstrated in subjects with PHPT. Obesity was associated with fully degraded skeletal microarchitecture as measured by TBS in PHPT, despite similar values in bone density by DXA compared with nonobese subjects. TBS values did not improve postparathyroidectomy in either obese or nonobese subjects.
Collapse
Affiliation(s)
- Yu-Kwang Donovan Tay
- Department of Medicine, Division of Endocrinology, College of Physicians &
Surgeons, Columbia University, New York, New York
- Department of Medicine, Sengkang Health, Singapore
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore
General Hospital, Singapore
| | - Natalie E Cusano
- Department of Medicine, Division of Endocrinology, College of Physicians &
Surgeons, Columbia University, New York, New York
| | - Mishaela R Rubin
- Department of Medicine, Division of Endocrinology, College of Physicians &
Surgeons, Columbia University, New York, New York
| | - John Williams
- Department of Medicine, Division of Endocrinology, College of Physicians &
Surgeons, Columbia University, New York, New York
| | - Beatriz Omeragic
- Department of Medicine, Division of Endocrinology, College of Physicians &
Surgeons, Columbia University, New York, New York
| | - John P Bilezikian
- Department of Medicine, Division of Endocrinology, College of Physicians &
Surgeons, Columbia University, New York, New York
- Correspondence and Reprint Requests: John P. Bilezikian, MD,
Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons,
Columbia University, 630 West 168th Street, New York, New York 10032. E-mail:
| |
Collapse
|
37
|
Guglielmi V, Bellia A, Gentileschi P, Lombardo M, D'Adamo M, Lauro D, Sbraccia P. Parathyroid hormone in surgery-induced weight loss: no glucometabolic effects but potential adaptive response to skeletal loading. Endocrine 2018; 59:288-295. [PMID: 29168114 DOI: 10.1007/s12020-017-1477-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE Increased parathyroid hormone (PTH) is commonly associated with obesity, and its role in the pathogenesis of obesity-related glucometabolic abnormalities is uncertain. We aimed to explore the relationships of PTH with glucose/insulin homeostasis parameters before and after bariatric surgery-induced weight loss, and whether they depend or not on 25-hydroxyvitamin D (25OHD) status. METHODS We included 42 subjects (27 women, aged 40 ± 5 years, BMI 48.5 ± 7.3 kg/m2) without diabetes, chronic kidney disease, or hyperparathyroidism undergoing sleeve gastrectomy. The following parameters were evaluated before and 6 months after surgery: circulating levels of PTH, calcium, phosphorus, 25OHD, leptin, insulin growth factor (IGF)-1; 75-g oral glucose tolerance test to derive measures of insulin sensitivity (ISI) and secretion (Stumvoll index); dual-energy X-ray absorptiometry to assess fat distribution and bone mineral density. RESULTS Weight loss was accompanied by significant reduction of PTH levels (77.9 ± 19.1 vs. 60.5 ± 13.4 pg/ml; p = 0.005), without concomitant modification of 25OHD status. Both baseline PTH and its postoperative percent change resulted associated, with baseline fat mass (β = 0.615, p = 0.003) and its concurrent postoperative reduction (r = 0.419; p = 0.006), but neither with glucose homeostasis parameters nor their respective variations after weight loss. Interestingly, leptin reduction after weight loss was independently related to PTH change (β = 0.396, p = 0.015) and IGF-1 levels (β = 0.176, p = 0.059). CONCLUSIONS Circulating PTH decreases with fat mass reduction independent of 25OHD status, but it is not associated with improvement of insulin resistance and related metabolic parameters. Leptin and PTH may mediate the cross-talk between adipose tissue and parathyroid glands, which possibly contributes to bone adaptation to excess body weight.
Collapse
Affiliation(s)
- Valeria Guglielmi
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
- Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy.
| | - Paolo Gentileschi
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy
| | - Mauro Lombardo
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy
| | - Monica D'Adamo
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
- Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paolo Sbraccia
- Department of Systems Medicine, Laboratory of Molecular Medicine, University of Rome Tor Vergata, Rome, Italy
- Obesity Center and Internal Medicine Unit, University Hospital Policlinico Tor Vergata, Rome, Italy
| |
Collapse
|
38
|
McGinty T, Mallon P. Protecting bone in long-term HIV positive patients receiving antiretrovirals. Expert Rev Anti Infect Ther 2017; 14:587-99. [PMID: 27189695 DOI: 10.1080/14787210.2016.1184570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION As the population of people living with HIV ages, the increase in non-AIDs morbidities is expected to increase in parallel. Maintaining bone health in those with HIV will be an important area of focus for the HIV clinician to prevent the morbidity and mortality associated with fragility fractures, the principal clinical sequela of low bone mineral density (BMD). Rates of fractures and prevalence of low bone mineral density, a risk factor for future fragility fractures, are already increased in the HIV positive population. AREAS COVERED This review examines the strategies to maintain bone health in those living with HIV from screening through to managing those with established low BMD or fracture, including the role for choice of or modification of antiretroviral therapy to maintain bone health. Expert commentary: The increasing complexity of managing bone health in the age of succesful antiretroviral therapy and an aging patient population as well as future perspectives which may help achieve the long term aim of minimising the impact of low BMD in those with HIV are discussed and explored.
Collapse
Affiliation(s)
- Tara McGinty
- a School of Medicine , University College Dublin , Dublin , Ireland
| | - Patrick Mallon
- a School of Medicine , University College Dublin , Dublin , Ireland
| |
Collapse
|
39
|
Verroken C, Zmierczak HG, Goemaere S, Kaufman JM, Lapauw B. Insulin Resistance Is Associated With Smaller Cortical Bone Size in Nondiabetic Men at the Age of Peak Bone Mass. J Clin Endocrinol Metab 2017; 102:1807-1815. [PMID: 28001453 DOI: 10.1210/jc.2016-3609] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/19/2016] [Indexed: 01/27/2023]
Abstract
CONTEXT In type 2 diabetes mellitus, fracture risk is increased despite preserved areal bone mineral density. Although this apparent paradox may in part be explained by insulin resistance affecting bone structure and/or material properties, few studies have investigated the association between insulin resistance and bone geometry. OBJECTIVE We aimed to explore this association in a cohort of nondiabetic men at the age of peak bone mass. DESIGN, SETTING, AND PARTICIPANTS Nine hundred ninety-six nondiabetic men aged 25 to 45 years were recruited in a cross-sectional, population-based sibling pair study at a university research center. MAIN OUTCOME MEASURES Insulin resistance was evaluated using the homeostasis model assessment of insulin resistance (HOMA-IR), with insulin and glucose measured from fasting serum samples. Bone geometry was assessed using peripheral quantitative computed tomography at the distal radius and the radial and tibial shafts. RESULTS In age-, height-, and weight-adjusted analyses, HOMA-IR was inversely associated with trabecular area at the distal radius and with cortical area, periosteal and endosteal circumference, and polar strength strain index at the radial and tibial shafts (β ≤ -0.13, P < 0.001). These associations remained essentially unchanged after additional adjustment for dual-energy X-ray absorptiometry-derived body composition, bone turnover markers, muscle size or function measurements, or adiponectin, leptin, insulin-like growth factor 1, or sex steroid levels. CONCLUSION In this cohort of nondiabetic men at the age of peak bone mass, insulin resistance is inversely associated with trabecular and cortical bone size. These associations persist after adjustment for body composition, muscle size or function, or sex steroid levels, suggesting an independent effect of insulin resistance on bone geometry.
Collapse
Affiliation(s)
- Charlotte Verroken
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Hans-Georg Zmierczak
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Stefan Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Jean-Marc Kaufman
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Bruno Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Endocrinology, Ghent University Hospital, 9000 Ghent, Belgium
| |
Collapse
|
40
|
Harper C, Pattinson AL, Fernando HA, Zibellini J, Seimon RV, Sainsbury A. Effects of obesity treatments on bone mineral density, bone turnover and fracture risk in adults with overweight or obesity. Horm Mol Biol Clin Investig 2017; 28:133-149. [PMID: 27665425 DOI: 10.1515/hmbci-2016-0025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/04/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND New evidence suggests that obesity is deleterious for bone health, and obesity treatments could potentially exacerbate this. MATERIALS AND METHODS This narrative review, largely based on recent systematic reviews and meta-analyses, synthesizes the effects on bone of bariatric surgery, weight loss pharmaceuticals and dietary restriction. RESULTS AND CONCLUSIONS All three obesity treatments result in statistically significant reductions in hip bone mineral density (BMD) and increases in bone turnover relative to pre-treatment values, with the reductions in hip BMD being strongest for bariatric surgery, notably Roux-en Y gastric bypass (RYGB, 8%-11% of pre-surgical values) and weakest for dietary restriction (1%-1.5% of pre-treatment values). Weight loss pharmaceuticals (orlistat or the glucagon-like peptide-1 receptor agonist, liraglutide) induced no greater changes from pre-treatment values than control, despite greater weight loss. There is suggestive evidence that liraglutide may increase bone mineral content (BMC) - but not BMD - and reduce fracture risk, but more research is required to clarify this. All three obesity treatments have variable effects on spine BMD, probably due to greater measurement error at this site in obesity, suggesting that future research in this field could focus on hip rather than spine BMD. Various mechanisms have been proposed for BMD loss with obesity treatments, notably reduced nutritional intake/absorption and insufficient exercise, and these are potential avenues for protection against bone loss. However, a pressing outstanding question is whether this BMD reduction contributes to increased fracture risk, as has been observed after RYGB, and whether any such increase in fracture risk outweighs the risks of staying obese (unlikely).
Collapse
|
41
|
Kharroubi A, Saba E, Smoom R, Bader K, Darwish H. Serum 25-hydroxyvitamin D and bone turnover markers in Palestinian postmenopausal osteoporosis and normal women. Arch Osteoporos 2017; 12:13. [PMID: 28124221 PMCID: PMC5266783 DOI: 10.1007/s11657-017-0306-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 12/30/2016] [Indexed: 02/06/2023]
Abstract
UNLABELLED This study evaluated the association of vitamin D and bone markers with the development osteoporosis in Palestinian postmenopausal women. Even though vitamin D deficiency was very high for the recruited subjects, it was not associated with osteoporosis except for bones of the hip. Age and obesity were the strongest determining factors of the disease. PURPOSE The purpose of this study was to investigate the association of bone mineral density (BMD) with serum vitamin D levels, parathyroid hormone (PTH), calcium, obesity, and bone turnover markers in Palestinian postmenopausal women. METHODS Three hundred eighty-two postmenopausal women (≥45 years) were recruited from various women clinics for BMD assessment (131 women had osteoporosis and 251 were normal and served as controls). Blood samples were obtained for serum calcium, PTH, 25(OH)D, bone formation (N-terminal propeptide (PINP)), and bone resorption (serum C-terminal telopeptide of type I collagen (CTX1)) markers. RESULTS Women with osteoporosis had statistically significant lower mean weight, height, body mass index (BMI), and serum calcium (p < 0.05) compared to controls. No significant differences were detected between the mean values of bone turnover markers (CTX and PINP), 25(OH)D, and PTH of the two groups. Women with vitamin D deficiency (severe and insufficiency) represented 85.9% of the study subjects. Multiple and logistic regression showed that age and BMI significantly affected BMD and vitamin D had a significant association with BMD only at the lumbar spine. BMI was positively correlated with BMD and PTH but negatively correlated with vitamin D. Logistic regression showed that the odds ratio (OR) for having osteoporosis decreased with increasing BMI (overweight OR = 0.11, p = 0.053; obese OR = 0.05, p = 0.007). CONCLUSIONS There was no direct correlation between BMD and PTH, bone turnover markers, and vitamin D except at the lumbar spine. A negative correlation between BMD and age and a positive correlation with BMI were observed. The protective effect of obesity on osteoporosis was complicated by the effect of obesity on vitamin D and PTH.
Collapse
Affiliation(s)
- Akram Kharroubi
- Faculty of Health Professions, Al-Quds University, Jerusalem, Palestine
| | - Elias Saba
- Palestinian Osteoporosis Prevention Society [POPS], Bethlehem, Palestine
| | - Riham Smoom
- Medical Research Center, Al-Quds University, Jerusalem, Palestine
| | - Khaldoun Bader
- Faculty of Public Health, Al-Quds University, Jerusalem, Palestine
| | - Hisham Darwish
- Palestinian Osteoporosis Prevention Society [POPS], Bethlehem, Palestine.
- Medical Research Center, Al-Quds University, Jerusalem, Palestine.
- Faculty of Allied Medical Sciences, Arab American University-Jenin AAUJ, Jenin, Palestine.
| |
Collapse
|
42
|
Chang YF, Chang CS, Wang MW, Wu CF, Chen CY, Chang HJ, Kuo PH, Wu CH. Effects of Age and Body Mass Index on Thoracolumbar Spine X-Ray for Diagnosing Osteoporosis in Elderly Women: Tianliao Old People (TOP) Study 07. PLoS One 2016; 11:e0161773. [PMID: 27606706 PMCID: PMC5015868 DOI: 10.1371/journal.pone.0161773] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 08/11/2016] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The aim of this study was to determine the effects of diagnostic discordance with or without a thoracolumbar spine lateral view X-ray in patients with osteoporosis. METHODS We randomly enrolled 368 women over 65 years old (74.3 ± 6.0 years) from Tianliao Township in 2009 (response rate: 75.7%). A diagnosis of osteoporosis was confirmed using one of these criteria: (1) a history of non-traumatic fracture, (2) vertebral fractures based on a thoracolumbar spine lateral view X-ray, or (3) a bone mineral density T-score ≤ -2.5 for the total hip, the femoral neck, the lumbar spine, or all 3 sites. The prevalence of osteoporosis in three groups was compared based on Model I (criteria 1+2) vs. Model II (criteria 1+3) vs. Model III (criteria 1+2+3). The role of thoracolumbar X-ray reflected by the diagnostic discordance of osteoporosis between Models II and III was evaluated. RESULTS The overall prevalence of osteoporosis was 78.3% (Model III, age-standardized 78.1%). The diagnostic discordance was 17.4% in the 368 participants. A logistic regression model showed that age was negatively associated with diagnostic discordance (odds ratio [OR] = 0.93, 95% confidence interval [CI]: 0.88-0.98, p < 0.05), but body mass index was positively associated (OR = 1.07, 95% CI: 1.00-1.15, p < 0.05). CONCLUSIONS A thoracolumbar spine lateral view X-ray should be added for women ≥ 65 years old or with a body mass index ≥ 25 kg/m2 to minimize the diagnostic discordance in osteoporosis, especially in highly endemic regions.
Collapse
Affiliation(s)
- Yin-Fan Chang
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Chin-Sung Chang
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Mei-Wen Wang
- Department of Radiology, Tainan Hospital Xinhua Branch, Department of Health, Tainan, Taiwan
| | - Chun-Feng Wu
- Department of Family Medicine, Kuo General Hospital, Tainan, Taiwan
| | | | - Hsuan-Jui Chang
- Department of Family Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Po-Hsiu Kuo
- Department of Public Health & Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chih-Hsing Wu
- Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| |
Collapse
|
43
|
Effectiveness of a flamenco and sevillanas program to enhance mobility, balance, physical activity, blood pressure, body mass, and quality of life in postmenopausal women living in the community in Spain: a randomized clinical trial. Menopause 2016; 23:965-73. [DOI: 10.1097/gme.0000000000000652] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
44
|
Iwaniec UT, Turner RT. Influence of body weight on bone mass, architecture and turnover. J Endocrinol 2016; 230:R115-30. [PMID: 27352896 PMCID: PMC4980254 DOI: 10.1530/joe-16-0089] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/27/2016] [Indexed: 12/11/2022]
Abstract
Weight-dependent loading of the skeleton plays an important role in establishing and maintaining bone mass and strength. This review focuses on mechanical signaling induced by body weight as an essential mechanism for maintaining bone health. In addition, the skeletal effects of deviation from normal weight are discussed. The magnitude of mechanical strain experienced by bone during normal activities is remarkably similar among vertebrates, regardless of size, supporting the existence of a conserved regulatory mechanism, or mechanostat, that senses mechanical strain. The mechanostat functions as an adaptive mechanism to optimize bone mass and architecture based on prevailing mechanical strain. Changes in weight, due to altered mass, weightlessness (spaceflight), and hypergravity (modeled by centrifugation), induce an adaptive skeletal response. However, the precise mechanisms governing the skeletal response are incompletely understood. Furthermore, establishing whether the adaptive response maintains the mechanical competence of the skeleton has proven difficult, necessitating the development of surrogate measures of bone quality. The mechanostat is influenced by regulatory inputs to facilitate non-mechanical functions of the skeleton, such as mineral homeostasis, as well as hormones and energy/nutrient availability that support bone metabolism. Although the skeleton is very capable of adapting to changes in weight, the mechanostat has limits. At the limits, extreme deviations from normal weight and body composition are associated with impaired optimization of bone strength to prevailing body size.
Collapse
Affiliation(s)
- Urszula T Iwaniec
- Skeletal Biology LaboratorySchool of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon, USA Center for Healthy Aging ResearchOregon State University, Corvallis, Oregon, USA
| | - Russell T Turner
- Skeletal Biology LaboratorySchool of Biological and Population Health Sciences, Oregon State University, Corvallis, Oregon, USA Center for Healthy Aging ResearchOregon State University, Corvallis, Oregon, USA
| |
Collapse
|
45
|
Mpalaris V, Anagnostis P, Anastasilakis AD, Goulis DG, Doumas A, Iakovou I. Serum leptin, adiponectin and ghrelin concentrations in post-menopausal women: Is there an association with bone mineral density? Maturitas 2016; 88:32-6. [PMID: 27105694 DOI: 10.1016/j.maturitas.2016.03.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/29/2016] [Accepted: 03/03/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Adipokines and ghrelin exert well-documented effects on energy expenditure and glucose metabolism. Experimental data also support a role in bone metabolism, although data from clinical studies are conflicting. The purpose of this cross-sectional study was to investigate the association of serum concentrations of leptin, adiponectin and ghrelin with bone mineral density (BMD) in post-menopausal women. METHODS BMD in lumbar spine and femoral neck, and circulating leptin, adiponectin and ghrelin concentrations were measured in 110 healthy post-menopausal women. Patients with secondary causes of osteoporosis were excluded. RESULTS Osteoporosis was diagnosed in 30 (27%) women and osteopenia in 54 (49%). Serum leptin concentrations were positively correlated with both lumbar spine (r=0.343, p<0.01) and femoral neck BMD (r=0.370, p<0.01). Adiponectin concentrations were negatively associated with BMD at both sites (r=-0.321, p<0.01 and r=-0.448, p<0.01 respectively). No significant correlation between ghrelin concentrations and BMD was found. Osteoporotic women had lower body weight, body mass index (BMI) and leptin concentrations, but higher adiponectin concentrations compared with non-osteoporotic women. In multivariate stepwise regression analysis, the association of adiponectin concentrations with BMD remained significant only for femoral neck, after adjustment for body weight or BMI. CONCLUSIONS An inverse association between adiponectin and femoral neck BMD was found in post-menopausal women, independently of body weight. The positive association between leptin and BMD was dependent on body weight, whereas no effect of ghrelin on BMD was evident.
Collapse
Affiliation(s)
- V Mpalaris
- Department of Nuclear Medicine, Aristotle University, Papageorgiou Hospital, 56403 Thessaloniki, Greece
| | - P Anagnostis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - A D Anastasilakis
- Department of Endocrinology, 424 General Military Hospital, Thessaloniki, Greece
| | - D G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - A Doumas
- Department of Nuclear Medicine, Aristotle University, Papageorgiou Hospital, 56403 Thessaloniki, Greece
| | - I Iakovou
- Department of Nuclear Medicine, Aristotle University, Papageorgiou Hospital, 56403 Thessaloniki, Greece.
| |
Collapse
|
46
|
Hypovitaminosis D in pregnancy in the Mediterranean region: a systematic review. Eur J Clin Nutr 2016; 70:979-86. [PMID: 26931671 DOI: 10.1038/ejcn.2016.12] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/03/2016] [Accepted: 01/07/2016] [Indexed: 12/12/2022]
Abstract
Despite high levels of sunshine, maternal hypovitaminosis D during pregnancy is prevalent in the Mediterranean region. The aim of this study is to systematically review trials that investigated vitamin D concentrations during pregnancy in this region, in order to determine predictors of hypovitaminosis D and explain this phenomenon. After applying inclusion/exclusion criteria, 15 studies were entered into the systematic review involving 2649 pregnant women and 820 neonates. The main outcome was maternal vitamin D status, assessed by serum 25-hydroxy-vitamin D (25(OH)D) concentrations. Possible predictors of the outcome included maternal age, body mass index (BMI), race, socioeconomic status, skin type, gestational age, sun exposure, calcium and vitamin D intake and supplementation, smoking status, parity and season of delivery. Studies differed widely in vitamin D deficiency criteria, method of measurement and outcomes. The prevalence of vitamin D insufficiency ranges from 9.3 to 41.4%, whereas that of vitamin D deficiency from 22.7 to 90.3%. A positive association with 25(OH)D concentrations exists for light skin color, white race, uncovered dressing pattern, maternal vitamin D supplementation and season of gestation (spring/summer). An inverse association exists for BMI and gestational age, whereas data for smoking and socioeconomic status are controversial. We concluded that vitamin D deficiency in pregnancy seems to be quite common, even in the Mediterranean region. Racial, social and cultural habits, as well as the absence of preventive supplementation/dietary strategies, seem to negate the benefits of sun exposure.
Collapse
|
47
|
Hofmeister M. Account for Increased Fat Mass. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:99. [PMID: 26931626 DOI: 10.3238/arztebl.2016.0099a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
48
|
Tang Y, Li S, Zhang P, Zhu J, Meng G, Xie L, Yu Y, Ji Y, Han Y. Soy Isoflavone Protects Myocardial Ischemia/Reperfusion Injury through Increasing Endothelial Nitric Oxide Synthase and Decreasing Oxidative Stress in Ovariectomized Rats. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:5057405. [PMID: 27057277 PMCID: PMC4753344 DOI: 10.1155/2016/5057405] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 01/16/2023]
Abstract
There is a special role for estrogens in preventing and curing cardiovascular disease in women. Soy isoflavone (SI), a soy-derived phytoestrogen, has similar chemical structure to endogenous estrogen-estradiol. We investigate to elucidate the protective mechanism of SI on myocardial ischemia/reperfusion (MI/R) injury. Female SD rats underwent bilateral ovariectomy. One week later, rats were randomly divided into several groups, sham ovariectomy (control group), ovariectomy with MI/R, or ovariectomy with sham MI/R. Other ovariectomy rats were given different doses of SI or 17β-estradiol (E2). Four weeks later, they were exposed to 30 minutes of left coronary artery occlusion followed by 6 or 24 hours of reperfusion. SI administration significantly reduced myocardial infarct size and improved left ventricle function and restored endothelium-dependent relaxation function of thoracic aortas after MI/R in ovariectomized rats. SI also decreased serum creatine kinase and lactate dehydrogenase activity, reduced plasma malonaldehyde, and attenuated oxidative stress in the myocardium. Meanwhile, SI increased phosphatidylinositol 3 kinase (PI3K)/Akt/endothelial nitric oxide synthase (eNOS) signal pathway. SI failed to decrease infarct size of hearts with I/R in ovariectomized rats if PI3K was inhibited. Overall, these results indicated that SI protects myocardial ischemia/reperfusion injury in ovariectomized rats through increasing PI3K/Akt/eNOS signal pathway and decreasing oxidative stress.
Collapse
Affiliation(s)
- Yan Tang
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Nanjing Medical University, Nanjing 210029, China
| | - Shuangyue Li
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Nanjing Medical University, Nanjing 210029, China
| | - Ping Zhang
- Department of Gynaecology, The First Public Hospital of Zhangjiagang, Zhangjiagang 215699, China
| | | | - Guoliang Meng
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Nanjing Medical University, Nanjing 210029, China
- Department of Pharmacology, School of Pharmacy, Nantong University, Nantong 226001, China
| | - Liping Xie
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Nanjing Medical University, Nanjing 210029, China
| | - Ying Yu
- Key Laboratory of Food Safety Research, Institute for Nutritional Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai 200031, China
| | - Yong Ji
- Key Laboratory of Cardiovascular Disease and Molecular Intervention, Nanjing Medical University, Nanjing 210029, China
| | - Yi Han
- Department of Geriatrics, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| |
Collapse
|
49
|
Zibellini J, Seimon RV, Lee CMY, Gibson AA, Hsu MSH, Shapses SA, Nguyen TV, Sainsbury A. Does Diet-Induced Weight Loss Lead to Bone Loss in Overweight or Obese Adults? A Systematic Review and Meta-Analysis of Clinical Trials. J Bone Miner Res 2015; 30:2168-78. [PMID: 26012544 DOI: 10.1002/jbmr.2564] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/03/2015] [Accepted: 05/02/2015] [Indexed: 12/26/2022]
Abstract
Diet-induced weight loss has been suggested to be harmful to bone health. We conducted a systematic review and meta-analysis (using a random-effects model) to quantify the effect of diet-induced weight loss on bone. We included 41 publications involving overweight or obese but otherwise healthy adults who followed a dietary weight-loss intervention. The primary outcomes examined were changes from baseline in total hip, lumbar spine, and total body bone mineral density (BMD), as assessed by dual-energy X-ray absorptiometry (DXA). Secondary outcomes were markers of bone turnover. Diet-induced weight loss was associated with significant decreases of 0.010 to 0.015 g/cm(2) in total hip BMD for interventions of 6, 12, or 24 (but not 3) months' duration (95% confidence intervals [CIs], -0.014 to -0.005, -0.021 to -0.008, and -0.024 to -0.000 g/cm(2), at 6, 12, and 24 months, respectively). There was, however, no statistically significant effect of diet-induced weight loss on lumbar spine or whole-body BMD for interventions of 3 to 24 months' duration, except for a significant decrease in total body BMD (-0.011 g/cm(2); 95% CI, -0.018 to -0.003 g/cm(2)) after 6 months. Although no statistically significant changes occurred in serum concentrations of N-terminal propeptide of type I procollagen (P1NP), interventions of 2 or 3 months in duration (but not of 6, 12, or 24 months' duration) induced significant increases in serum concentrations of osteocalcin (0.26 nmol/L; 95% CI, 0.13 to 0.39 nmol/L), C-terminal telopeptide of type I collagen (CTX) (4.72 nmol/L; 95% CI, 2.12 to 7.30 nmol/L) or N-terminal telopeptide of type I collagen (NTX) (3.70 nmol/L; 95% CI, 0.90 to 6.50 nmol/L bone collagen equivalents [BCEs]), indicating an early effect of diet-induced weight loss to promote bone breakdown. These data show that in overweight and obese individuals, a single diet-induced weight-loss intervention induces a small decrease in total hip BMD, but not lumbar spine BMD. This decrease is small in comparison to known metabolic benefits of losing excess weight.
Collapse
Affiliation(s)
- Jessica Zibellini
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Radhika V Seimon
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Crystal M Y Lee
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Alice A Gibson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Michelle S H Hsu
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| | - Sue A Shapses
- Department of Nutritional Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Tuan V Nguyen
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia.,Centre for Health Technologies, University of Technology, Sydney, Ultimo, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
50
|
Kushnir MM, Rockwood AL, Strathmann FG, Frank EL, Straseski JA, Meikle AW. LC-MS/MS Measurement of Parathyroid Hormone-Related Peptide. Clin Chem 2015; 62:218-26. [PMID: 26578690 DOI: 10.1373/clinchem.2015.244012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 10/19/2015] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Parathyroid hormone-related peptide (PTHrP) is involved in activating pathways, allowing tumor cells to form bone metastases. Measurement of PTHrP is used for the diagnosis and clinical management of patients suspected of hypercalcemia of malignancy. We developed an LC-MS/MS method for measuring PTHrP, established sex-specific reference intervals, and assessed the method's performance. METHODS PTHrP was enriched from plasma samples with rabbit polyclonal anti-PTHrP antibody conjugated to magnetic beads. Enriched PTHrP was digested with trypsin, and PTHrP-specific tryptic peptide was analyzed with 2-dimensional LC-MS/MS in multiple reaction monitoring mode. RESULTS The lower limit of quantification was 0.6 pmol/L, and the upper limit of linearity was 600 pmol/L. Total imprecision was <10%. Very poor agreement was observed with the RIA (n = 207; Deming regression RIA = 0.059 × LC-MS/MS - 1.8, r = 0.483; Sy|x = 3.9). Evaluation of the clinical performance of the assay using samples from patients with and without hypercalcemia (n = 199) resulted in an area under the ROC curve of 0.874. In sets of consecutively analyzed routine samples of patients assessed for hypercalcemia, the PTHrP positivity rate by RIA (n = 1376) was 1.9%, and 26.6% by LC-MS/MS (n = 1705). Concentrations were below the lower limit of quantification in 95.6% of the samples by RIA and 2.0% by LC-MS/MS. CONCLUSIONS PTHrP is a normal constituent in circulating blood and its concentrations are substantially underestimated by commercial RIAs, causing false-negative results in samples from patients suspected of hypercalcemia. Our observations suggest a link between increased concentrations of PTHrP in postmenopausal women with low body mass index and increased incidence of osteoporosis.
Collapse
Affiliation(s)
- Mark M Kushnir
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Department of Pathology and
| | - Alan L Rockwood
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Department of Pathology and
| | - Frederick G Strathmann
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Department of Pathology and
| | - Elizabeth L Frank
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Department of Pathology and
| | - Joely A Straseski
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT; Department of Pathology and
| | - A Wayne Meikle
- Department of Pathology and Department of Medicine, University of Utah, Salt Lake City, UT
| |
Collapse
|