1
|
Armutcu F, McCloskey E. Insulin resistance, bone health, and fracture risk. Osteoporos Int 2024:10.1007/s00198-024-07227-w. [PMID: 39264439 DOI: 10.1007/s00198-024-07227-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/07/2024] [Indexed: 09/13/2024]
Abstract
Insulin resistance, defined as an impaired biological response to insulin stimulation in target tissues, arises most frequently in the presence of central obesity. Although obesity is generally associated with increased bone mass, recent data challenge this view and, if complicated by T2DM, obese patients are at high risk for fragility fractures. IR may play a key role in this increased fracture risk through effects on bone quality rather than bone quantity. Further understanding of the mechanisms and approaches to prevent osteoporotic fractures in IR-related diseases is needed. CLINICAL RELEVANCE The dramatic increase in obesity and metabolic syndrome (MetS) over the last half-century has led to a worldwide epidemic of type 2 diabetes mellitus (T2DM) as well as in the incidence of insulin resistance (IR). IR is defined as an impaired biological response to insulin stimulation in target tissues and is primarily related to the liver, muscle, and adipose tissue. The most frequent underlying cause is central obesity, and it is known that excess abdominal adipose tissue secretes increased amounts of free fatty acids, which directly affects insulin signalling, reduces glucose uptake in muscle, and triggers excessive triglyceride synthesis and gluconeogenesis in the liver. When pancreatic β cells are unable to secrete the higher levels of insulin needed, T2DM, the main complication of IR, occurs. OBSERVATIONS Although obesity is generally associated with increased bone mass, recent data challenge this view and highlight the multifaceted nature of the obesity-bone relationship. Patients with T2DM are at significant risk for well-known complications of diabetes, including retinopathy, nephropathy, macrovascular disease, and neuropathy, but it is clear that they are also at high risk for fragility fractures. Moreover, recent data provide strong evidence that IR may key role in the increased fracture risk observed in both obesity and T2DM. CONCLUSIONS In this concise review article, the role of IR in increased risk of osteoporotic fractures in MetS, obesity, and T2DM is discussed and summarised, including consideration of the need for fracture risk assessment as a 'preventive measure', especially in patients with T2DM and chronic MetS with abdominal obesity. Personalised and targeted diagnostic and therapeutic approaches to prevent osteoporotic fractures in IR-related diseases are needed and could make significant contributions to health outcomes.
Collapse
Affiliation(s)
- Ferah Armutcu
- Sanctuary International Visitor Support Scheme, Sheffield, UK.
- Division of Clinical Medicine, School of Medicine and Population Health, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK.
| | - Eugene McCloskey
- Division of Clinical Medicine, School of Medicine and Population Health, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| |
Collapse
|
2
|
Chen H, Hu J, Li J, Li Q, Lan L. Association between triglyceride-glucose index and femoral bone mineral density in community-dwelling, nondiabetic men and women: a NHANES analysis of 1,928 US individuals. Menopause 2024; 31:626-633. [PMID: 38814194 DOI: 10.1097/gme.0000000000002374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To determine the potential association between the triglyceride-glucose (TyG) index and bone mineral density (BMD) in community-dwelling adults without diabetes using a nationally representative database from the United States (US). METHODS Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005-2010, 2013-2014, and 2017-2018. Men and postmenopausal women aged ≥50 years with complete data on femoral neck BMD, triglycerides, and fasting plasma glucose levels were eligible for inclusion. Participants with diabetes, history of malignancy, thyroid disease, underweight status, end-stage kidney disease, rheumatoid arthritis, estrogen/selective estrogen receptor modulators, bisphosphonate or bone resorption inhibitors, or missing dataset weight values were excluded. Univariate and multivariable logistic regression analyses were performed to determine the associations between low BMD, TyG index, and other study variables. RESULTS A total of 1,844 participants (1,161 men and 683 women) were included, representing 31,517,106 community-dwelling individuals in the US. The mean age of the study population was 60.7 years old, and 26.7% of the men and 60.4% of the women had low bone density. In both males and females, the mean TyG index was 8.6. After adjusting for demographic, lifestyle, and clinical factors, no significant association was observed between TyG and femoral neck BMD among men (adjusted odds ratio [aOR] = -0.0002, 95% confidence interval [CI]: -0.02 to 0.02) and women (aBeta = 0.005, 95% CI: -0.02 to 0.04). Similarly, no significant association was observed between TyG index and the odds for low bone density among men (aOR = 1.09, 95% CI: 0.73-1.63) and women (aOR = 0.99, 95% CI: 0.49-2.01). CONCLUSIONS Based on data from a large sample in the US, this study did not find an association between the TyG index and femoral neck BMD or the occurrence of low bone density in community-dwelling males and females without diabetes.
Collapse
Affiliation(s)
- Hailing Chen
- From the Department of Osteoporosis, Beijing Jishuitan Hospital, Capital Medical University, 4th Medical College of Peking University, Beijing, China
| | - Jianpeng Hu
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, 4th Medical College of Peking University, Beijing, China
| | - Jufen Li
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, 4th Medical College of Peking University, Beijing, China
| | - Quan Li
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, 4th Medical College of Peking University, Beijing, China
| | - Ling Lan
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, 4th Medical College of Peking University, Beijing, China
| |
Collapse
|
3
|
Khanmohammadi S, Kuchay MS. Effects of Metabolic Dysfunction-Associated Steatotic Liver Disease on Bone Density and Fragility Fractures: Associations and Mechanisms. J Obes Metab Syndr 2024; 33:108-120. [PMID: 38740429 PMCID: PMC11224928 DOI: 10.7570/jomes24004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 05/16/2024] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) has profound adverse effects on bone health and homeostasis. MASLD appears to be associated with changes in bone mineral density (BMD) and fracture rate. However, the data are ambiguous and conflicting. Although several studies have shown that children and adolescents with MASLD have decreased BMD, the data on the prevalence of fragility fractures among children are scarce. In adults, increasing evidence suggests that MASLD decreases BMD and increases the risk of fragility fractures, which appears to be due to deterioration of bone architecture in addition to a decrease in BMD. Effects of MASLD on bone health may also be age- and race-specific. MASLD does not seem to increase fracture risk in children and adolescents but increases the risk of fractures in elderly men, especially those of Asian origin. From a mechanistic perspective, bone remodeling is a continuous process between osteoblasts (bone-forming) and osteoclasts (bone-resorbing), with any imbalance resulting in metabolic bone disease. In individuals with MASLD, loss of anabolic insulin receptor signaling (insulin resistance) in osteoblasts and increased receptor activator of nuclear factor κB (RANK)/RANK ligand signaling in osteoclasts (proinflammatory cytokines) swings the pendulum toward accelerated bone loss. These processes are further complicated by the concomitant presence of obesity, type 2 diabetes mellitus, or sarcopenia in individuals with MASLD. This study reviews the current literature associated with the effects of MASLD on BMD and fragility fractures in children/adolescents and adults. This review also discusses the pathomechanisms that link MASLD with changes in BMD and fragility fractures.
Collapse
Affiliation(s)
- Shaghayegh Khanmohammadi
- Research Center for Immunodeficiencies, Children’s Medical Center, Tehran University of Medical Science, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Shafi Kuchay
- Division of Endocrinology and Diabetes, Medanta The Medicity Hospital, Gurugram, India
| |
Collapse
|
4
|
Schinas G, Schinas I, Ntampanlis G, Polyzou E, Gogos C, Akinosoglou K. Bone Disease in HIV: Need for Early Diagnosis and Prevention. Life (Basel) 2024; 14:522. [PMID: 38672792 PMCID: PMC11051575 DOI: 10.3390/life14040522] [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: 02/29/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
The transformation of HIV into a manageable chronic condition has unveiled new clinical challenges associated with aging-related pathologies, including bone disease. This review explores the intricate relationship between HIV, antiretroviral therapy (ART), and bone disease, highlighting the necessity of early diagnosis and preventative strategies to mitigate the increased risk of osteopenia, osteoporosis, and fractures in people living with HIV (PLWHIV). It synthesizes the current literature to elucidate the multifactorial etiology of bone pathology in this population, that includes direct viral effects, chronic immune activation, ART-associated risks, and the impact of traditional risk factors for bone loss. Through a critical examination of modern diagnostic methods, lifestyle modifications, evidence-based preventive actions, and pharmacological treatments, the necessity for comprehensive management is highlighted, along with recommendations for integrated healthcare approaches vital for achieving optimal patient outcomes. By advocating for a proactive, patient-centered, and multidisciplinary strategy, this review proposes a plan to integrate bone health into standard HIV care through active risk identification, vigilant screening, effective preventive measures, tailored treatments, and informed decision-making, in an effort to ultimately enhance the quality of life for PLWHIV.
Collapse
Affiliation(s)
- Georgios Schinas
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Ioannis Schinas
- School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece;
| | - Georgios Ntampanlis
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Eleni Polyzou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Charalambos Gogos
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
| | - Karolina Akinosoglou
- School of Medicine, University of Patras, 26504 Rio, Greece; (G.S.); (G.N.); (E.P.); (C.G.)
- Department of Internal Medicine and Infectious Diseases, University General Hospital of Patras, 26504 Rio, Greece
| |
Collapse
|
5
|
Emerzian SR, Johannesdottir F, Yu EW, Bouxsein ML. Use of noninvasive imaging to identify causes of skeletal fragility in adults with diabetes: a review. JBMR Plus 2024; 8:ziae003. [PMID: 38505529 PMCID: PMC10945731 DOI: 10.1093/jbmrpl/ziae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/21/2023] [Accepted: 01/04/2024] [Indexed: 03/21/2024] Open
Abstract
Diabetes, a disease marked by consistent high blood glucose levels, is associated with various complications such as neuropathy, nephropathy, retinopathy, and cardiovascular disease. Notably, skeletal fragility has emerged as a significant complication in both type 1 (T1D) and type 2 (T2D) diabetic patients. This review examines noninvasive imaging studies that evaluate skeletal outcomes in adults with T1D and T2D, emphasizing distinct skeletal phenotypes linked with each condition and pinpointing gaps in understanding bone health in diabetes. Although traditional DXA-BMD does not fully capture the increased fracture risk in diabetes, recent techniques such as quantitative computed tomography, peripheral quantitative computed tomography, high-resolution quantitative computed tomography, and MRI provide insights into 3D bone density, microstructure, and strength. Notably, existing studies present heterogeneous results possibly due to variations in design, outcome measures, and potential misclassification between T1D and T2D. Thus, the true nature of diabetic skeletal fragility is yet to be fully understood. As T1D and T2D are diverse conditions with heterogeneous subtypes, future research should delve deeper into skeletal fragility by diabetic phenotypes and focus on longitudinal studies in larger, diverse cohorts to elucidate the complex influence of T1D and T2D on bone health and fracture outcomes.
Collapse
Affiliation(s)
- Shannon R Emerzian
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, United States
| | - Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, United States
| | - Elaine W Yu
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, United States
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, United States
| |
Collapse
|
6
|
Pan R, Ji H, Xu Y, Zhang Y, Wang R, Liang X, Zhao Y. The association between prediabetes and bone mineral density: A meta-analysis. Diabetes Metab Res Rev 2023; 39:e3691. [PMID: 37415428 DOI: 10.1002/dmrr.3691] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/06/2023] [Accepted: 06/20/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Prediabetes is an intermediate metabolic state between euglycaemia and diabetes, including three different definitions: impaired fasting glucose, impaired glucose tolerance, and mildly elevated glycated haemoglobin (HbA1c) (range 5.7%-6.4%). The effect of prediabetes on bone mineral density (BMD) has not been established. Therefore, we performed a meta-analysis to evaluate the association between prediabetes and BMD. METHODS We retrieved studies related to prediabetes and BMD from PubMed, Web of Science, and Embase databases from January 1990 to December 2022. All data were analysed using the random effects model. Statistical heterogeneity was tested by I2 . Subgroup analysis was performed after each study-level variable was pre-defined by meta-regression. RESULTS A total of 17 studies were included involving 45,788 patients. We detected a significant overall association of prediabetes with increased spine BMD (weighted mean difference [WMD] = 0.01, 95% CI [0.00, 0.02], p = 0.005; I2 = 62%), femur neck (FN) BMD (WMD = 0.01, 95% CI [0.00, 0.01], p < 0.001; I2 = 19%), and femur total (FT) BMD (WMD = 0.02, 95% CI [0.01, 0.03], p < 0.001; I2 = 51%). Several variables leading to heterogeneity were defined by meta-regression, including age, sex, region, study type, dual-energy X-ray absorptiometry scanner manufacturer, and prediabetes definition. Subgroup analyses indicated that the association of prediabetes with increased BMD was stronger in men, Asians, and older adults over 60 years of age. CONCLUSIONS Current evidence shows that prediabetes is strongly associated with increased BMD of the spine, FN, and FT. The association was stronger among males, Asians, and older adults over 60 years of age.
Collapse
Affiliation(s)
- Runzhou Pan
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| | - Hong Ji
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| | - Yao Xu
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| | - Yan Zhang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| | - Rongrong Wang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| | - Xue Liang
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| | - Yongcai Zhao
- Department of Endocrinology, Cangzhou Central Hospital, Cangzhou, Hebei Province, China
| |
Collapse
|
7
|
Hu Z, Xiong T, Chen C, Chen T, Li M, Liang J, Chen K, Zhang J, Chen X, Chen Q, Li G. Association between the triglyceride-glucose index and calcified aortic stenosis in elderly patients: a cross-sectional study. Sci Rep 2023; 13:14928. [PMID: 37697065 PMCID: PMC10495325 DOI: 10.1038/s41598-023-42206-x] [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: 05/25/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023] Open
Abstract
Insulin resistance (IR) is associated with a variety of cardiovascular diseases, but there are few studies on the correlation between IR and calcified aortic stenosis (CAS). In this study, the triglyceride-glucose (TyG) index, which reflects IR, was used to investigate the correlation between IR and CAS. The study included 183 elderly patients who were diagnosed with CAS by transthoracic echocardiography. The patients were matched 1:1 according to age and sex, and elderly patients who were hospitalized during the same period and underwent transthoracic echocardiography without aortic stenosis were included as the control group. The relationship between the TyG index and CAS was analyzed by a multivariable logistic regression model, curve fitting and trend test. Multivariate logistic regression analysis showed that the TyG index as a continuous variable was negatively associated with CAS (P < 0.001); trend tests and curve fitting further supported this association. Our study showed that the TyG index was negatively associated with CAS in elderly patients, which may be related to the impairment of insulin receptors and signaling pathways in IR.
Collapse
Affiliation(s)
- Zhihui Hu
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | | | | | - Tao Chen
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Ming Li
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jia Liang
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Kunying Chen
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jialing Zhang
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xu Chen
- Guangdong Medical University, Zhanjiang, China
| | - Qi Chen
- Guangdong Medical University, Zhanjiang, China
| | - Guoming Li
- The Affiliated Hospital of Guangdong Medical University, Zhanjiang, China.
| |
Collapse
|
8
|
Ye S, Shi L, Zhang Z. Effect of insulin resistance on gonadotropin and bone mineral density in nondiabetic postmenopausal women. Front Endocrinol (Lausanne) 2023; 14:1235102. [PMID: 37670878 PMCID: PMC10475931 DOI: 10.3389/fendo.2023.1235102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
Objective The effects of insulin resistance (IR) on bone mineral density (BMD) are unclear. This investigation aimed to assess the impact of IR and hyperinsulinemia on bone health. Determine whether IR mediates the link between follicle-stimulating hormone (FSH) and bone mass in nondiabetic postmenopausal women. Design Retrospective cross-sectional study. Setting Health checkup center of Hangzhou Women's Hospital. Methods This study comprised 437 nondiabetic postmenopausal women. BMD was evaluated using dual-energy X-rays. Fasting sera were analyzed for insulin and glucose levels, and indicators related to IR were determined. By pathway analysis, we examined the indirect effects of FSH on BMD via the mediators Homeostatic Model Assessment for insulin resistance (HOMA-IR) and fasting insulin (FINS) after correction for confounding factors. Result After adjusting for age and body mass index (BMI) in linear regression, HOMA-IR and FINS were linked with FSH (P<0.05). IR was stronger among women in the normal BMD group than those in the osteoporosis or osteopenia group. In unadjusted models, BMD was greater in those with higher HOMA-IR and FINS (β=0.027, P=0.006 and β=0.033, P=0.003, respectively). After correcting for BMI and other possible variables, these associations remained. In addition, path models for FSH demonstrated a negative association with BMD by HOMA-IR (95% confidence interval [CI]: -0.0174 to -0.0014) and FINS (95% CI: -0.0188 to -0.002). Conclusion Greater IR was associated with increased BMD in nondiabetic postmenopausal women, regardless of BMI and other variables. HOMA-IR or FINS could play a novel mediating role in FSH-induced BMD suppression.
Collapse
Affiliation(s)
- Shujin Ye
- Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Lan Shi
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhifen Zhang
- Department of the Fourth Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Obstetrics and Gynecology, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, Zhejiang, China
| |
Collapse
|
9
|
Greere D, Grigorescu F, Manda D, Lautier C, Poianã C. INSULIN RESISTANCE AND PATHOGENESIS OF POSTMENOPAUSAL OSTEOPOROSIS. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2023; 19:349-363. [PMID: 38356971 PMCID: PMC10863952 DOI: 10.4183/aeb.2023.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Osteoporosis (OP) is a disease predisposing postmenopausal women to fractures, and often accompanied by insulin resistance (IR) and metabolic syndrome (MetS). Previous studies provided contradictory results concerning prevalence of MetS in postmenopausal OP. To better understand the pathogenesis of IR, we reviewed cellular and molecular aspects and systematically reviewed studies providing homeostasis model assessment (HOMA) index. Bone is an active endocrine organ maintaining its integrity by orchestrated balance between bone formation and resorption. Both osteoblasts and osteoclasts contain receptors for insulin and insulin-like growth factor-1 (IGF-1) operating in skeletal development and in the adult life. Defects in this system generate systemic IR and bone-specific IR, which in turn regulates glucose homeostasis and energy metabolism through osteocalcin. Examination of genetic syndromes of extreme IR revealed intriguing features namely high bone mineral density (BMD) or accelerated growth. Studies of moderate forms of IR in postmenopausal women reveal positive correlations between HOMA index and BMD while correlations with osteocalcin were rather negative. The relation with obesity remains complex involving regulatory factors such as leptin and adiponectin to which the contribution of potential genetic factors and in particular, the correlation with the degree of obesity or body composition should be added.
Collapse
Affiliation(s)
- D.I.I. Greere
- “C.I. Parhon” National Institute of Endocrinology - Clinical Endocrinology, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy - Endocrinology, Bucharest, Romania
| | - F. Grigorescu
- Institut Convergences Migrations - Molecular - Endocrinology, Montpellier, France
| | - D. Manda
- “C.I. Parhon” National Institute of Endocrinology - Molecular Cellular and Structural Endocrinology Laboratory, Bucharest, Romania
| | - C. Lautier
- Université de Montpellier, Montpellier, France
| | - C. Poianã
- “C.I. Parhon” National Institute of Endocrinology - Clinical Endocrinology, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy - Endocrinology, Bucharest, Romania
| |
Collapse
|
10
|
Shieh A, Greendale GA, Cauley JA, Karvonen-Gutierrez CA, Karlamangla AS. Prediabetes and Fracture Risk Among Midlife Women in the Study of Women's Health Across the Nation. JAMA Netw Open 2023; 6:e2314835. [PMID: 37219902 PMCID: PMC10208145 DOI: 10.1001/jamanetworkopen.2023.14835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/09/2023] [Indexed: 05/24/2023] Open
Abstract
Importance Whether prediabetes is associated with fracture is uncertain. Objective To evaluate whether prediabetes before the menopause transition (MT) is associated with incident fracture during and after the MT. Design, Setting, and Participants This cohort study used data collected between January 6, 1996, and February 28, 2018, in the Study of Women's Health Across the Nation cohort study, an ongoing, US-based, multicenter, longitudinal study of the MT in diverse ambulatory women. The study included 1690 midlife women in premenopause or early perimenopause at study inception (who have since transitioned to postmenopause) who did not have type 2 diabetes before the MT and who did not take bone-beneficial medications before the MT. Start of the MT was defined as the first visit in late perimenopause (or first postmenopausal visit if participants transitioned directly from premenopause or early perimenopause to postmenopause). Mean (SD) follow-up was 12 (6) years. Statistical analysis was conducted from January to May 2022. Exposure Proportion of visits before the MT that women had prediabetes (fasting glucose, 100-125 mg/dL [to convert to millimoles per liter, multiply by 0.0555]), with values ranging from 0 (prediabetes at no visits) to 1 (prediabetes at all visits). Main Outcomes and Measures Time to first fracture after the start of the MT, with censoring at first diagnosis of type 2 diabetes, initiation of bone-beneficial medication, or last follow-up. Cox proportional hazards regression was used to examine the association (before and after adjustment for bone mineral density) of prediabetes before the MT with fracture during the MT and after menopause. Results This analysis included 1690 women (mean [SD] age, 49.7 [3.1] years; 437 Black women [25.9%], 197 Chinese women [11.7%], 215 Japanese women [12.7%], and 841 White women [49.8%]; mean [SD] body mass index [BMI] at the start of the MT, 27.6 [6.6]). A total of 225 women (13.3%) had prediabetes at 1 or more study visits before the MT, and 1465 women (86.7%) did not have prediabetes before the MT. Of the 225 women with prediabetes, 25 (11.1%) sustained a fracture, while 111 of the 1465 women without prediabetes (7.6%) sustained a fracture. After adjustment for age, BMI, and cigarette use at the start of the MT; fracture before the MT; use of bone-detrimental medications; race and ethnicity; and study site, prediabetes before the MT was associated with more subsequent fractures (hazard ratio for fracture with prediabetes at all vs no pre-MT visits, 2.20 [95% CI, 1.11-4.37]; P = .02). This association was essentially unchanged after controlling for BMD at the start of the MT. Conclusions and Relevance This cohort study of midlife women suggests that prediabetes was associated with risk of fracture. Future research should determine whether treating prediabetes reduces fracture risk.
Collapse
Affiliation(s)
- Albert Shieh
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Gail A Greendale
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Arun S Karlamangla
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| |
Collapse
|
11
|
Ahmed M, Mital D, Abubaker NE, Panourgia M, Owles H, Papadaki I, Ahmed MH. Bone Health in People Living with HIV/AIDS: An Update of Where We Are and Potential Future Strategies. Microorganisms 2023; 11:789. [PMID: 36985362 PMCID: PMC10052733 DOI: 10.3390/microorganisms11030789] [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: 02/19/2023] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
The developments in Human Immunodeficiency Virus (HIV) treatment and in the care of people living with HIV (PLWHIV) and Acquired Immunodeficiency Syndrome (AIDS) over the last three decades has led to a significant increase in life expectancy, on par with HIV-negative individuals. Aside from the fact that bone fractures tend to occur 10 years earlier than in HIV-negative individuals, HIV is, per se, an independent risk factor for bone fractures. A few available antiretroviral therapies (ARVs) are also linked with osteoporosis, particularly those involving tenofovir disoproxil fumarate (TDF). HIV and hepatitis C (HCV) coinfection is associated with a greater risk of osteoporosis and fracture than HIV monoinfection. Both the Fracture Risk Assessment Tool (FRAX) and measurement of bone mineral density (BMD) via a DEXA scan are routinely used in the assessment of fracture risk in individuals living with HIV, as bone loss is thought to start between the ages of 40 and 50 years old. The main treatment for established osteoporosis involves bisphosphonates. Supplementation with calcium and vitamin D is part of clinical practice of most HIV centers globally. Further research is needed to assess (i) the cut-off age for assessment of osteoporosis, (ii) the utility of anti-osteoporotic agents in PLWHIV and (iii) how concomitant viral infections and COVID-19 in PLWHIV can increase risk of osteoporosis.
Collapse
Affiliation(s)
- Musaab Ahmed
- College of Medicine, Ajman University, Ajman P.O. Box 346, United Arab Emirates
- Center of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates
| | - Dushyant Mital
- Department of HIV and Blood Borne Virus, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Nuha Eljaili Abubaker
- Clinical Chemistry Department, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum P.O. Box 407, Sudan
| | - Maria Panourgia
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Henry Owles
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Ioanna Papadaki
- Department of Rheumatology, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| | - Mohamed H. Ahmed
- Department of Geriatric Medicine, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
- Department of Medicine and HIV Metabolic Clinic, Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, Milton Keynes MK6 5LD, UK
| |
Collapse
|