Utility of the Serum Cystatin C Level for Diagnosis of Osteoporosis among Middle-Aged and Elderly People

Obesity Is Associated with Asymptomatic Vertebral Fractures: A Yakumo Study

(1) Background: Patients with primary vertebral fracture (VF) are at high risk of re-fracture and mortality. However, approximately two-thirds of patients with VFs receive minimal clinical attention. (2) Methods: The current study aimed to investigate the factors associated with asymptomatic VFs in middle-aged and elderly individuals who underwent resident health examinations. (3) Results: The current study included 217 participants aged > 50 years. VFs were diagnosed based on lateral radiographic images using Genant's semiquantitative (SQ) method. The participants were divided into non-VF (N; SQ grade 0) and asymptomatic VF (F; SQ grades 1-3) groups. Data on body composition, blood tests, quality of life measures, and radiographic parameters were assessed. A total of 195 participants were included in the N group (mean age, 64.8 ± 7.8 years), and 22 were in the F group (mean age, 66.1 ± 7.9 years). The F group had a significantly higher body mass index (BMI), body fat percentage (BF%), and proportion of patients with knee osteoarthritis (KOA) than the N group. The F group had a significantly higher knee joint pain visual analog scale (VAS) score and painDETECT score than the N group. Logistic regression analysis showed that BF% was associated with asymptomatic VFs. (4) Conclusions: Middle-aged and elderly individuals with asymptomatic VF presented with high BMIs, BF%, and incidence of KOA.

Nutritional Influences on Locomotive Syndrome

Healthy dietary habits are important to prevent locomotive syndrome (LS). We investigated the relationship between LS and nutritional intake using community health checkup data. We included 368 participants who underwent LS staging, blood sampling, and nutritional intake assessments. Participants (163 adults < 65: 205 older adults ≥ 65) were divided into normal (N; LS stage 0) and LS (L; LS stage 1–2) groups, and blood sample data and nutritional intake were compared between groups. Among adults (N group, 71; L group, 92), low-density lipoprotein cholesterol (LDL-C) was significantly lower, and Vitamin B₁ intake was significantly higher in the L than in the N group; LDL-C, p = 0.033; Vitamin B1, 0.029. Among older adults (N group, 85; L group, 120), hemoglobin (Hb), albumin, and calcium levels were significantly lower, and sodium, monounsaturated fatty acids (MUFA), and n-6 polyunsaturated fatty acids (n-6 PUFA) were significantly higher in the L than the N group; Hb, p = 0.036; albumin, 0.030; calcium, 0.025; sodium; 0.029; MUFA; 0.047, n-6 PUFA; 0.0233). Logistic regression analysis indicated that sodium was the risk factor for the L group (exp (B) 1.001, 95% CI: 1–1.001, p = 0.032). In conclusion, salt intake was associated with LS.

Differences in the prevalence of locomotive syndrome and osteoporosis in Japanese urban and rural regions: The Kashiwara and Yakumo studies

OBJECTIVES

To clarify whether the prevalence of locomotive syndrome (LS) and osteoporosis differed according to region, gender, and physical functions in Japan.

METHODS

Data were collected in Kashiwara City (urban region) and Yakumo Town (rural region). Totally, 208 participants from the urban region and 782 participants from the rural region were included in this study. LS was assessed using the 25-item Geriatric Locomotive Function Scale and osteoporosis was assessed using a quantitative ultrasound. Physical functions were measured using grip strength and the 3-m timed up-and-go test. Differences between urban and rural regions were investigated using standardized incidence ratio and multivariate analysis.

RESULTS

The prevalence of LS and osteoporosis was 24.5% and 42.8% in the urban region and 10.9% and 28.8% in the rural region, respectively. The standardized incidence ratio of the urban region versus the rural region was 1.80 (95% confidence intervals [CI] = 1.35-2.39) for LS and 1.21 (95% CI = 1.32-2.43) for osteoporosis, showing that the prevalence of LS was significantly higher in the urban region. Multivariate analysis indicated that LS was significantly associated with the urban sample and timed up-and-go was significantly longer in the urban sample.

CONCLUSION

Regional differences may be considered when evaluating LS in health checkups. Understanding the results of this study may help reduce LS prevalence.

Causal Effects of Genetically Predicted Cystatin C on Osteoporosis: A Two-Sample Mendelian Randomization Study

Objectives: Although it has long been reported that high levels of cystatin C could contribute to the development of osteoporosis in some studies, no evidence has established a causal association between them thus far. Methods: A Mendelian randomization (MR) study was conducted to determine the causal effect of cystatin C on osteoporosis based on public databases obtained from separately published genome-wide association studies (GWASs). The single-nucleotide polymorphisms (SNPs) for cystatin C were extracted from the MR-Base (CKDGen, 33,152 participants), and the SNPs for osteoporosis were extracted from the United Kingdom Biobank project (United Kingdom Biobank, including 5,266 osteoporosis cases and 331,893 controls). We defined the odds ratio (OR) of IVW methods as the primary outcome. In addition, weighted median and MR-Egger regressions were used in the sensitivity analysis. Results: In IVW, we found that genetically predicted cystatin C was causally associated with the risk of osteoporosis with an OR of 1.02 [95% confidence interval (CI) = 1.003-1.025, p = 0.01]. In the further sensitivity analysis, weighted median regression also showed directionally similar estimates (OR = 1.02, 95% CI = 1.005-1.03, p = 0.005), and MR-Egger regression (OR = 1.02, 95% CI = 1.000-1.036, p = 0.15) revealed similar estimates but with lower precision. The funnel plot, MR-Egger intercept, and MR-PRESSO all indicate that no directional pleiotropic effect was observed. Conclusion: In conclusion, our MR study showed evidence of a causal association between serum cystatin C levels and osteoporosis, which also needs to be verified by studies with larger sample sizes in the future. Early monitoring of cystatin C may enable us to prevent osteoporosis-related diseases.

Human Nonmercaptalbumin Is a New Biomarker of Motor Function

The ratio of human nonmercaptalbumin (HNA) and reduced albumin (HMA) may be a new marker for oxidative stress. Locomotive syndrome (LS) is reduced mobility due to impairment of locomotive organs. We investigated whether the HNA/HMA ratio could be a new biomarker of LS. This study included 306 subjects (mean age 64.24 ± 10.4 years) who underwent LS tests, grip strength, walking speed, and tests for HNA and HMA. Oxidative stress was measured by the ratio of HMA (f(HMA) = (HMA/(HMA + HNA) × 100)), and the subjects were divided into normal (N group; f[HMA] ≥ 70%) and low (L group; f[HMA] < 70%) groups. There were 124 non-elderly (<65 years) and 182 elderly subjects (≥65 years). There were no significant differences in LS, grip strength, and walking speed between the L and N groups in the non-elderly subjects. However, significant differences were found in the elderly subjects. In logistic regression analysis, there was an association between f(HMA) and the LS severity at older ages. LS in the elderly is associated with a decline in HMA and, thus, an increase in oxidative stress. Thus, f(HMA) is a new biomarker of LS.

Biomarkers of Senescence during Aging as Possible Warnings to Use Preventive Measures

Human life expectancy is increasing significantly over time thanks to the improved possibility for people to take care of themselves and the higher availability of food, drugs, hygiene, services, and assistance. The increase in the average age of the population worldwide is, however, becoming a real concern, since aging is associated with the rapid increase in chronic inflammatory pathologies and degenerative diseases, very frequently dependent on senescent phenomena that occur alongside with senescence. Therefore, the search for reliable biomarkers that can diagnose the possible onset or predict the risk of developing a disease associated with aging is a crucial target of current medicine. In this review, we construct a synopsis of the main addressable biomarkers to study the development of aging and the associated ailments.

Association between locomotive syndrome and the Japanese version of the EQ-5D-5L in middle-aged and elderly people in Japan

The Japanese version of the EuroQol 5 dimension, 5 level version (EQ-5D-5L) can now be used to quantitatively evaluate the health-related quality of life (QoL) in Japan. Locomotive syndrome (LS) is a concept advocated in Japan to describe a condition requiring care for musculoskeletal disorders. However, no detailed study on the relationship between this index and LS in Japanese health checkup has been reported. We aimed to evaluate the relationship between the Japanese version of the EQ-5D-5L and LS. We enrolled 477 participants who were undergoing health checkups in Japan. All participants were administered the 25-question Geriatric Locomotive Functional Scale for the diagnosis of LS and the Japanese version of the EQ-5D-5L. We performed statistical analysis to compare the non-LS and LS patients; moreover, the risk factors and cut-off values were calculated and verified. The Japanese version of the EQ-5D-5L index was significantly lower in patients with LS than in non-LS patients and was significantly related to LS in logistic regression analysis. In subgroup analysis targeting the five dimensions of the EQ-5D-5L, it was seen that mobility, pain/discomfort, and self-care were significantly involved in LS. The cut-off value of the EQ-5D-5L index for LS was 0.875. The Japanese version of the EQ-5D-5L index was significantly related to LS in Japan. This index will be a useful tool that can easily measure health-related quality of life in middle-aged and elderly Japanese people. Future studies should investigate the relationship of not only LS but also various diseases with the Japanese version of the EuroQol 5 dimension, 5 level version.

Locomotive syndrome and the power spectral characteristics of body sway

AIM

In Japan, nursing care is advised for patients with locomotive syndrome (LS) because of musculoskeletal disorders. Balance tests have indicated an association between LS risk and sway size related to center of pressure (COP) movement. Here, the power spectrum represents the energy contained in each frequency of COP sway. Although balance tests are often performed during health checkups, no studies have investigated the relationship between the power spectrum and LS. This study investigated this relationship.

METHODS

In total, 605 recipients of health checkups were evaluated for LS using the 25-item Geriatric Locomotive Function Scale. Power spectrums were calculated by applying fast Fourier transform to COP sway time-series data. These were classified into three sections (0.02-0.2 Hz [low-frequency band; LFB], 0.2-2 Hz [mid-frequency band], and 2-10 Hz [high-frequency band; HFB]). Power spectrums were evaluated in left-right and front-back directions.

RESULTS

LS was associated with significantly lower ratios for both the HFB (P = 0.001) in the left-right direction and LFB (P = 0.007) in the front-back direction. In addition, men had significantly lower HFB ratios in the left-right direction (P = 0.032) and LFB ratios in the front-back (P = 0.013), whereas women had significantly lower HFB ratios in the left-right direction (P = 0.007).

CONCLUSIONS

LS was associated with significantly lower ratios for both the HFB in the left-right direction and LFB in the front-back direction. This understanding of the power spectral characteristics of LS may be useful in the context of pathology and therapeutic intervention. Geriatr Gerontol Int ••; ••: ••-•• Geriatr Gerontol Int 2020; ••: ••-••.

Higher extracellular water-to-total body water ratio more strongly reflects the locomotive syndrome risk and frailty than sarcopenia

OBJECTIVE

Among body composition parameters measured by bioelectrical impedance analysis, the extracellular water-to-total body water (ECW/TBW) ratio is a known prognostic or related factor for various diseases. While concepts such as locomotive syndrome risk, frailty, and sarcopenia are gaining popularity in Japan, their relationship with the ECW/TBW ratio has not been examined in detail. This study aimed to investigate the relationships between them.

METHODS

Of 1081 individuals who underwent health checkups, 550 were included in this study. The evaluations included a two-step test, stand-up test, and a 25-question geriatric locomotive function scale questionnaire. Frailty was diagnosed based on the Japanese version of the Cardiovascular Health Study criteria. Sarcopenia was evaluated according to the Asian Working Group for Sarcopenia criteria. The aforementioned ratio was measured using bioelectrical impedance analysis.

RESULTS

The ECW/TBW ratio significantly increased with locomotive syndrome risk, frailty, and sarcopenia (p < 0.001 each). Nevertheless, no significant difference was found between robust and pre-frailty groups (p = 0.71) and normal and pre-sarcopenia groups (p = 0.93). Furthermore, after correcting for age, sex, and body mass index, multiple regression analysis revealed that locomotive syndrome risk (p < 0.001) and frailty (p = 0.001) were significantly associated with an increase in the ECW/TBW ratio, whereas sarcopenia was not (p = 0.97).

CONCLUSIONS

An increase in the ECW/TBW ratio may reflect locomotive syndrome risk and frailty, but not sarcopenia. In bioelectric impedance analysis, this ratio is an important indicator; if it is high, it is necessary to consider locomotive syndrome risk and frailty.

Waist Circumference Measured by Bioelectrical Impedance Analysis Is Interchangeable with Manual Measurement: Increased Waist Circumference Is Associated with Locomotive Syndrome Risk

Objectives

The importance of preventive medicine in an aging society is increasing. Locomotive syndrome (LS) is attracting increasing attention. Recently, advances in bioelectrical impedance analysis (BIA) devices have made it possible to automatically measure waist circumference (WC). Nevertheless, there have been no reports evaluating the agreement or interchangeability between WC measured manually and using BIA. Therefore, we aimed to perform these analyses in the context of health checkups and investigated the associations with LS risk.

Methods

We enrolled 597 participants who underwent the following: two-step tests and stand-up tests; evaluations using a 25-question geriatric locomotive function scale for the LS risk test; anthropometric marker measurements including WC measured by manual and BIA; and measurements of total cholesterol and triglycerides. We used Bland–Altman analysis to calculate agreement and interchangeability of the WC measurement using BIA and the manual method. A statistical comparative study was then conducted between normal and LS risk groups. Subsequently, significant risk factors for LS were investigated using multivariate analysis.

Results

The Bland–Altman analysis showed that bias (BIA-manual) was negative overall (−2.024), for males (−1.418) and for females (−2.460), suggesting underestimation using BIA compared with manual measurements. Interchangeability was found between WC measurement by BIA and by manual methods, because the percentage error was less than 15% overall (12.3%), for males (10.2%) and for females (13.8%). Univariate analysis showed that WC was significantly higher in the LS risk group than in the normal group. Multivariate analysis adjusted for confounding factors showed that increase in WC significantly correlated with LS risk.

Conclusions

BIA and manual methods for measuring WC are interchangeable. The increase in WC measured by BIA was significantly associated with LS risk. It is important to continue focusing on increased WC and early detection of LS risk.

Declining neck circumference is an anthropometric marker related to frailty in middle-aged and elderly women

Objectives: Neck circumference (NC) has been associated with cardiovascular disease and metabolic syndrome. However, the association between NC and frailty remains unknown. We aimed to determine the relationship between frailty and NC in middle-aged and elderly women.Methods: Frailty was diagnosed based on the Japanese version of the Cardiovascular Health Study criteria. Of women who underwent health checkup, 295 women with the following measurements were targeted: four trunk circumferences and appendicular skeletal muscle index (aSMI) measured using bioelectrical impedance analysis; albumin, total cholesterol, triglycerides, and C-reactive protein levels measured using a blood test; and physical function measured using back muscle strength and timed up-and-go test (TUG). Normal and frailty group comparisons were conducted using a statistical method.Results: Significant differences were observed between the two groups in terms of age, body mass index, all trunk circumferences, aSMI, back muscle strength, and TUG. Logistic regression analysis showed that NC was more related with frailty among the four trunk circumferences. In multiple regression analysis, declining NC was significantly associated with frailty.Conclusion: In middle-aged and elderly women, NC has a significant association with frailty. Declining NC was shown to be an anthropometric marker of frailty, and may be a frailty risk factor.

Low Bioelectrical Impedance Phase Angle Is a Significant Risk Factor for Frailty

The phase angle, which is measured via bioelectrical impedance analysis (BIA), is a clinically important bioimpedance parameter used for nutritional assessment and evaluating the risk of various diseases, such as locomotive syndrome (LS). It remains unclear if the phase angle is associated with frailty (fragile state of physical and mental health). We therefore examined this association in a large prospective sample. Of 1081 individuals receiving health checkups, 550 (male; 235, female; 365) were enrolled in this study. We applied the Japanese version of the Cardiovascular Health Study criteria to evaluate frailty and administered the 25-Item Geriatric Locomotive Function Scale to diagnose LS. The phase angle was measured via BIA. Multiple logistic regression analysis was used to evaluate the relationship between the phase angle and frailty. For all participants and for each sex, the phase angle was significantly lower among individuals with frailty. After controlling for age, sex, and body mass index, we found that a low phase angle was a significant risk factor of frailty. As a result of multiple regression analysis including other confounding factors, among male participants, a low phase angle was significantly related with both frailty (P = 0.015) and LS (P < 0.001), whereas among female participants, the low phase angle had a stronger association with frailty (P = 0.001) than with LS (P = 0.52). Our findings suggest that a low angle is a risk factor of frailty. Furthermore, among female participants, frailty has a stronger relation with the phase angle than does LS. Therefore, the phase angle may be considered a useful indicator of frailty that does not require lengthy or costly assessment.