Predictors of Beagley–Gibson skin cast grade in older adults

Prior nonmelanoma skin cancer is associated with fewer fractures, more vitamin D sufficiency, greater bone mineral density and improved bone microarchitecture in older adults

INTRODUCTION

Prior nonmelanoma skin cancer (NMSC), a biomarker of cumulative lifetime sun exposure, is associated with reduced fracture risk later in life. The mechanism is unknown.

METHODS

Prospective cohort analysis of 1,099 community-dwelling adults aged 50-80 years with baseline and 10 year follow up assessments. Histopathologically-confirmed NMSC diagnosis was established by linkage with the Tasmanian Cancer Registry. Bone mineral density (BMD) and vertebral deformity were quantified by DXA, 25(OH)D by radioimmunoassay, bone microarchitecture by high resolution peripheral quantitative CT, melanin density by spectrophotometry and skin photosensitivity and clinical fracture by questionnaire. 25(OH)D <50 nmol/L was considered deficient.

RESULTS

Participants with a NMSC reported prior to baseline were less likely to sustain an incident vertebral deformity over 10 years (RR=0.74, p=0.036). There were similar reductions for other fracture types but these did not reach significance. Prior NMSC was associated with baseline (RR=1.23, p=0.005) and 10 year longitudinal (RR=5.9, p=0.014) vitamin D sufficiency and greater total body BMD (β=0.021g/cm2, p=0.034), but not falls risk or muscle strength. The relationship between prior NMSC and bone microarchitecture was age dependent (pinteraction<0.05). In the oldest age tertile, prior NMSC was associated with greater volumetric BMD (β=57.8-62.6, p=0.002-0.01) and less porosity (β= -4.6 - -5.2, p=0.002-0.009) at cortical, compact cortical and outer transitional zones.

CONCLUSION

Prior NMSC was associated with fewer incident fractures in community-dwelling older adults. This protective association is most likely mediated by modifiable fracture risk factors associated with an outdoor lifestyle, including 25(OH)D, BMD and bone microarchitecture.

Population Vitamin D Stores Are Increasing in Tasmania, and This Is Associated With Less BMD Loss Over 10 Years

CONTEXT

Vitamin D deficiency is a common, modifiable determinant of musculoskeletal health.

OBJECTIVE

There are limited data that examine the longitudinal change in population 25-hydroxyvitamin D (25[OH]D) and none that evaluate the long-term skeletal outcomes of longitudinal vitamin D status.

METHODS

A prospective cohort analysis was conducted of community-dwelling adults aged 50 to 80 years who had 25(OH)D assessed by radioimmunoassay and bone mineral density (BMD) by dual-energy x-ray absorptiometry at baseline (n = 1096), 2.5 (n = 870), and 10 (n = 565) years. Sun exposure was quantified by questionnaire and supplement use at clinic review. 25(OH)D less than 50 nmol/L was considered deficient. Participants were provided with their 25(OH)D results.

RESULTS

Over 10 years 25(OH)D increased (52.2 ± 17.0 to 63.5 ± 23.6 nmol/L, P < .001). Participants with baseline deficiency had larger 25(OH)D increases than baseline sufficient participants (19.2 ± 25.3 vs 1.6 ± 23.3 nmol/L, P < .001). Longitudinal change in 25(OH)D was associated with baseline summer (β = 1.46, P < .001) and winter (β = 1.29, P = .003) sun exposure, change in summer (β = 1.27, P = .002) and winter (β = 1.47, P < .001) sun exposure, and vitamin D supplement use (β = 25.0-33.0, P < .001). Persistent vitamin D sufficiency was associated with less BMD loss at the femoral neck (β = 0.020, P = .027), lumbar spine (β = 0.033, P = .003), and total hip (β = 0.023, P = .021) compared to persistent vitamin D deficiency. Achieving vitamin D sufficiency was associated with less BMD loss at the lumbar spine (β = 0.045, P < .001) compared to persistent vitamin D deficiency.

CONCLUSIONS

Population 25(OH)D concentration increased because of a combination of increased sun exposure and supplement use. Maintaining or achieving vitamin D sufficiency was associated with less BMD loss over 10 years.

Skin Photosensitivity is Associated with 25-Hydroxyvitamin D and BMD but not Fractures Independent of Melanin Density in Older Caucasian Adults

Whether skin photosensitivity modulates sun exposure behaviours, consequent vitamin D status and skeletal health outcomes independently of constitutive pigmentation have not been systematically investigated. 1072 community-dwelling adults aged 50-80 years had skin photosensitivity quantified by questionnaire and melanin density by spectrophotometry. Bone mineral density (BMD), falls risk and 25-hydroxyvitamin D (25OHD) were measured using DXA, short form physiological profile assessment and radioimmunoassay, respectively. Sun exposure and symptomatic fractures were assessed by questionnaire. Participants were followed up at 2.5 (n = 879), 5 (n = 767) and 10 (n = 571) years. Higher resistance to sunburn and greater ability to tan were associated with reduced sun protection behaviours (RR 0.87, p < 0.001 & RR 0.88, p < 0.001), higher lifetime discretionary sun exposure in summer (RR 1.05, p = 0.001 & RR 1.07, p = 0.001) and winter (RR 1.07, p = 0.001 & RR 1.08, p = 0.02) and fewer lifetime sunburns (RR 0.86, p < 0.001 & RR 0.91, p = 0.001). Higher resistance to sunburn was associated with lower total body (β =  - 0.006, p = 0.047) and femoral neck (β = - 0.006, p = 0.038) BMD, but paradoxically, fewer prevalent fractures (RR 0.94, p = 0.042). Greater ability to tan was associated with higher 25OHD (β = 1.43, p = 0.04), lumbar spine (β = 0.014, p = 0.046) and total body (β = 0.013, p = 0.006) BMD, but not fracture or falls risk. These associations were independent of constitutive melanin density. Cutaneous photosensitivity was associated with sun exposure behaviours, cutaneous sequelae and, consequently, 25OHD and BMD in older Caucasian adults independent of constitutive melanin density. There was no consistent association with fracture outcomes, suggesting environmental factors are at least as important.

Constitutive melanin density is associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults

Higher cutaneous melanin reduces vitamin D3 production. This may increase fracture risk. We found that cutaneous melanin density was associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults. Melanin density either acts as a surrogate marker or its relationship with fracture changes with time.

INTRODUCTION

Higher cutaneous melanin reduces vitamin D3 production. This may impact lifetime vitamin D status and increase fracture risk. This study aimed to describe the relationship between spectrophotometrically determined constitutive melanin density, prevalent and incident fractures in a cohort of exclusively older Caucasian adults.

METHODS

1072 community-dwelling adults aged 50-80 years had constitutive melanin density quantified using spectrophotometry. Participants were followed up at 2.5 (n = 879), 5 (n = 767), and 10 (n = 571) years after the baseline assessment. Prevalence and number of symptomatic fractures were assessed by questionnaire.

RESULTS

Higher melanin density was independently associated with greater prevalence of any fracture (RR 1.08, p = 0.03), vertebral fracture (RR 1.41, p = 0.04) and major fracture (RR 1.12, p = 0.04) and the number of fractures (RR 1.09, p = 0.04) and vertebral fractures (RR 1.47, p = 0.04) in cross-sectional analysis. At the 2.5-year follow-up, higher melanin density was associated with incident fractures (RR 1.42, p = 0.01) and major fractures (RR 1.81, p = 0.01) and the number of incident fractures (RR 1.39, p = 0.02) and major fractures (RR 2.14, p = 0.01). The relationship between melanin density and incident fracture attenuated as the duration of follow-up increased and was not significant at the 5- or 10-year follow-up.

CONCLUSIONS

Constitutive melanin density was associated with prevalent and short-term, but not long-term, incident fracture risk in older Caucasian adults. This suggests melanin density either acts as a surrogate marker for an unmeasured fracture risk factor or the relationship between melanin density and fracture changes with time.

Skin aging: the dermal perspective

The world population of adults aged 60 years or more is increasing globally, and this development can impact skin disease morbidity and mortality, as well as being reflected in the health care system organization. There is substantial evidence that the burden from a remarkable number of skin nonmalignant and malignant conditions is greater in the elderly. Dermatologic research and clinical education in dermatology should focus on both challenges and opportunities created by aging. Skin aging due to intrinsic and extrinsic factors can alter significantly epidermal and dermal structure and functions. Dermal aging can be linked to a great number of complications in routine dermatologic conditions, with slow healing as an example of a severe complication in the elderly. This may be attributed to aged dermal fibroblasts modifying the tissue microenvironment via a shift in their soluble factors and extracellular matrix repertoire. This senescence-associated secretory phenotype can explain the particular proclivity of aged skin to develop malignancies.

Ageing profiles of Caucasian and Chinese cohorts - focus on hands skin

OBJECTIVE

In spite of hand care being a dynamic segment of skin care, hands skin physiology has been receiving little attention in comparison to facial skin. In the present study, we aimed at gathering a comprehensive set of skin data from the dorsal part of the hand to study age related-changes in two ethnic groups (Caucasian and Chinese).

METHODS

Skin topographic, skin colour/colour heterogeneities, skin chromophores and skin biophysical measurements of 116 Caucasian and Chinese female volunteers aged 30-65 years old were collected in Ireland and in China as part of a cross-sectional study.

RESULTS

Topographic alterations happened at both micro and macro scales with a noticeable delay in the onset of 10 years for the Chinese cohort. Similar evolution of skin colour with ageing was observed between the two cohorts and strong dissimilarities were seen when it came to colour heterogeneities and melanin hyper concentration, with a 20-year delay in severity for the Chinese cohort. A similar sharp drop of skin hydration occurred when reaching the 60's regardless of the group and substantial differences were recorded for skin biomechanical properties of the skin.

CONCLUSION

These results provide additional insights about hand skin physiology in relation to ageing and ethnic differences, especially when put into perspective with what is currently known about facial ageing. This research yield additional material for hand cream product rationale and strategies for mitigating the appearance of ageing hands.

Constitutive melanin density is associated with higher 25-hydroxyvitamin D and potentially total body BMD in older Caucasian adults via increased sun tolerance and exposure

Greater skin pigmentation reduces dose equivalent cutaneous vitamin D3 production, potentially impacting lifetime vitamin D status and fracture risk. We show that melanin density was positively associated with 25-hydroxyvitamin D and total body bone mineral density. These relationships were partially explained by greater sun exposure due to more permissive skin phenotype.

INTRODUCTION

Higher cutaneous melanin reduces vitamin D3 production. This may impact lifetime vitamin D status and increase fracture risk. This study aimed to describe the relationship between spectrophotometrically determined constitutive melanin density, osteoporotic risk factors and potential intermediaries in a cohort of exclusively older Caucasian adults.

METHODS

One thousand seventy-two community-dwelling adults aged 50-80 years had constitutive melanin density quantified using spectrophotometry. Sun exposure, skin phenotype, non-melanoma skin cancer (NMSC) prevalence and smoking status were assessed by questionnaire. Bone mineral density (BMD), falls risk, physical activity and 25-hydroxyvitamin D were measured using DXA, the short form Physiological Profile Assessment, pedometer and radioimmunoassay, respectively.

RESULTS

Higher melanin density was independently associated with greater ability to tan (RR = 1.27, p < 0.001), less propensity to sunburn (RR = 0.92, p < 0.001), fewer lifetime sunburns (RR = 0.94, p = 0.01), current smoking (RR = 1.41, p < 0.001), female sex (RR = 1.24, p < 0.001) and less photodamage (RR = 0.98, p = 0.01). The associations between melanin density and sun exposure (RR = 1.05-1.11, p < 0.001-0.01), sun protection behaviours (RR = 0.89, p < 0.001) and NMSC prevalence (RR = 0.75, p = 0.001) were no longer significant after taking into account skin phenotype and sun exposure, respectively. 25-Hydroxyvitamin D was strongly associated with higher melanin density (β = 1.71-2.05, p = 0.001). The association between melanin density and total body BMD (β = 0.007, p = 0.04) became non-significant after adjustment for 25-hydroxyvitamin D. There was no association between melanin density and physical activity, falls risk or BMD at other sites.

CONCLUSIONS

Our data support a model of higher constitutive melanin density underpinning a less photosensitive skin phenotype, permitting greater sun exposure with fewer sequelae and yielding higher 25-hydroxyvitamin D and, potentially, total body BMD.

The relationship between cumulative lifetime ultraviolet radiation exposure, bone mineral density, falls risk and fractures in older adults

Data linking cumulative lifetime vitamin D status with skeletal outcomes are lacking. We show that increasing cumulative sun exposure was associated with higher bone mineral density in younger males and protective against fractures in females independent of current vitamin D. This supports the concept that cumulative sun exposure is an important contributor to skeletal health.

INTRODUCTION

While low 25-hydroxyvitamin D levels are associated with increased fracture risk, this reflects only recent sun exposure. The Beagley-Gibson (BG) method utilises microtopographical skin changes to quantify cumulative lifetime ultraviolet radiation (sun) exposure. This study aimed to describe the relationship between BG grade, BMD, falls risk and fractures in older adults.

METHODS

Eight hundred thirty-five community-dwelling adults aged 53-83 years had silicone casts from the dorsum of both hands graded by the BG method. BMD was measured using DXA and falls risk using the short form of the Physiological Profile Assessment. Vertebral deformities and symptomatic fractures were assessed by DXA and questionnaire, respectively.

RESULTS

The relationship between BG grade, spine BMD and vertebral fracture varied depending upon sex. In females, increasing grade was associated with lower vertebral fracture prevalence (OR = 0.44/grade, p = 0.018) and fewer fractures (OR = 0.82/grade, p = 0.021), particularly major fractures (OR = 0.75/grade, p = 0.03). In males, increasing grade was associated with more DXA-detected vertebral deformities (RR = 1.28/grade, p = 0.001), but not symptomatic fractures. These relationships were independent of BMD, falls risk, smoking and current 25-hydroxyvitamin D. BG grade was not associated with falls risk. For BMD, there were interactions between BG grade and both age and sex and a positive trend with hip BMD in younger males.

CONCLUSIONS

BG grade demonstrated beneficial associations with fracture outcomes in females and BMD in younger males independent of current 25-hydroxyvitamin D. These data support the concept that cumulative ultraviolet radiation exposure is an important determinant of skeletal health. The association with vertebral deformities in males may reflect outdoor physical trauma in younger life.