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Kherrab A, Toufik H, Ghazi M, Benhima MA, Chbihi-Kaddouri A, Chergaoui I, Niamane R, El Maghraoui A. Prevalence of postmenopausal osteoporosis in Morocco: a systematic review and meta-analysis. Arch Osteoporos 2024; 19:61. [PMID: 39026053 DOI: 10.1007/s11657-024-01421-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/05/2024] [Indexed: 07/20/2024]
Abstract
INTRODUCTION This systematic review and meta-analysis was conducted as part of the update of Moroccan recommendations for the management of postmenopausal osteoporosis. Its aim was to estimate the prevalence of postmenopausal osteoporosis in Morocco, based on available bibliographic data. METHODS We conducted a systematic search of the Medline/PubMed, Scopus, and Embase databases to identify articles published between January 2000 and January 2024. We included all observational studies reporting the prevalence of osteoporosis in postmenopausal women in Morocco. Two reviewers independently contributed to the study selection and data extraction. We assessed the risk of bias in the included studies using the Joanna Briggs Institute tool. Statistical analyses were performed using Stata with the Freeman-Tukey double arcsine transformation. Heterogeneity was assessed using the I2 test statistic. Meta-regression analysis was used to investigate the effect of the date on the prevalence. Publication bias was assessed by DOI plots and the LFK index. RESULTS An electronic search found a total of 161 citations from the databases. After excluding the irrelevant articles, 17 eligible studies were included. This meta-analysis included 5097 postmenopausal women. The pooled prevalence of postmenopausal osteoporosis was 32% (95% CI 28-36). Heterogeneity was statistically significant (I2 = 89.67%). There was no significant difference between subgroup analyses performed by risk of bias and sample size. The prevalence rate was significantly higher in 2006-2012 (36%; 95% CI 31-42; I2 = 88.7%; p < 0.001) than in 2013-2019 (27%; 95% CI 22-32; I2 = 85.9%; p < 0.001). Meta-regression showed that the prevalence of osteoporosis decreases very slightly (0.016% per year). This decrease becomes nonsignificant if only studies with a low risk of bias are included in the meta-regression (coefficient - 7.77, p = 0.667, I2 0%). No publication bias was detected in this meta-analysis. CONCLUSION Our results indicate that postmenopausal osteoporosis is prevalent in Morocco, which is a developing country; however, the prevalence of this disease is aligned with that of industrialized countries.
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Affiliation(s)
- Anass Kherrab
- Department of Rheumatology, Avicenne Military Hospital, Cadi Ayyad University, Marrakesh, Morocco.
| | - Hamza Toufik
- Department of Rheumatology, Mohammed V Military Hospital, Mohammed V University, Rabat, Morocco
| | - Mirieme Ghazi
- Department of Rheumatology, Avicenne Military Hospital, Cadi Ayyad University, Marrakesh, Morocco
| | - Mohamed Amine Benhima
- Department of Orthopaedic Surgery and Traumatology, Arrazi Hospital, VI University Hospital, Cadi Ayyad University, Marrakesh, Mohammed, Morocco
| | - Anass Chbihi-Kaddouri
- Department of Rheumatology, Avicenne Military Hospital, Cadi Ayyad University, Marrakesh, Morocco
| | - Ilyass Chergaoui
- Department of Rheumatology, Avicenne Military Hospital, Cadi Ayyad University, Marrakesh, Morocco
| | - Radouane Niamane
- Department of Rheumatology, Avicenne Military Hospital, Cadi Ayyad University, Marrakesh, Morocco
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Lin YC, Yan HT. Impact of dietary sodium restriction on falls among middle-aged and older adults: Results of an 8-year longitudinal study. Geriatr Gerontol Int 2024; 24 Suppl 1:292-299. [PMID: 37718504 DOI: 10.1111/ggi.14669] [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: 07/18/2023] [Revised: 08/14/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
AIM This study aimed to understand the relationship between dietary sodium restriction (DSR) and falling experiences in middle-aged and older adults. METHODS The 8-year follow-up data from the Taiwan Longitudinal Study on Aging, covering 5131 individuals aged ≥50 years, were analyzed using random-effects panel logit models. Participants were asked to indicate whether they were told by a physician to reduce or avoid sodium intake from food and whether they had had fall experiences during the past year. We modelled falling experiences as a function of DSR (independent variable), involuntary body weight loss and walking difficulty (mediators), and chronic diseases (moderator), adjusting for individual-level characteristics. RESULTS Individuals with DSR were at a higher risk of falls compared with those with no DSR (adjusted odds ratio [AOR] = 1.30, 95% confidence interval [CI] = 1.11-1.53). This effect was more prevalent in individuals with a history of stroke (AOR = 1.85, 95% CI = 1.19-2.87). Those told to reduce sodium intake by a physician were likely to lose weight involuntarily (AOR = 1.20, 95% CI = 1.05-1.36) and had difficulty walking up two or three flights of stairs alone (AOR = 2.38, 95% CI = 1.73-3.27), which mediated the effect of DSR on increased fall risk (AOR = 1.15, 95% CI = 0.95-1.38). We found a temporal effect: participant reactions to short- and mid-term DSR were significant. CONCLUSIONS DSR was associated with a greater likelihood of falls among middle-aged and older adults, particularly those with a history of stroke. Geriatr Gerontol Int 2024; 24: 292-299.
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Affiliation(s)
- Yu-Chun Lin
- Department of Chinese Medicine, China Medical University Hospital, Taichung City, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung City, Taiwan
| | - Huang-Ting Yan
- Institute of Political Science, Academia Sinica, Taipei City, Taiwan
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Capato LL, Mendes Cangussu-Oliveira L, Mello Porto J, Jerônimo B, Santos Guilherme Ribeiro JD, Ferrioli E, Albuquerque de Paula FJ, Carvalho de Abreu DC. Contribution of Hip Abductors Muscles on Bone Mineral Density and Functionality in Older Women. J Clin Densitom 2023; 26:97-103. [PMID: 36543669 DOI: 10.1016/j.jocd.2022.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/21/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite the well-established role of muscle in maintaining bone mass and physical performance, there are still few studies that assess the relationship between muscle groups and specific bone sites and its contribution to physical function in older people. The aim of the study is to verify the association between hip and knee's muscle strength and bone mineral density of the femoral neck (BMD-FN) and investigated which muscle strength that are related with BMD-FN is associated with physical function in older women. METHODOLOGY This is a cross-sectional study of 94 women over the age of 60 years, physically independent. Muscle strength of the hip and knee was evaluated using an isokinetic dynamometer (Biodex, USA) to obtain peak torque (PT). The BMD-FN was obtained using dual-energy x-ray absorption densitometry (DXA). Physical function was evaluated by the Timed Up and Go (TUG), gait speed (GS), five times stand to sit (5TSS) and single-leg stance (SS). To verify the association between muscle strength (independent variable) and the BMD-FN (dependent variable) and the relationship between muscle strength (independent variable) and clinical tests (dependent variable), the multiple linear regression was carried out, adjusted for age, time of menopause, height and level of physical activity. All of the analyses were carried out by the SPSS 17.0 software, with a level of p < 0.05 significance. RESULTS We found an association between the hip abductors PT and the BMD-FN and between hip abductors PT and all clinical tests. CONCLUSION We observe that hip abductor muscle strength contributes to BMD-FN and to performance in several clinical tests in older women. These findings reinforce the importance of this musculature not only for improving balance and gait, but also it can be a strategy to maintain/improve bone mass in the femoral neck in this population.
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Affiliation(s)
- Luana Leticia Capato
- Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto SP, Brazil.
| | - Luciana Mendes Cangussu-Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto SP, Brazil
| | - Jaqueline Mello Porto
- Postgraduate Program in Rehabilitation and Functional Performance, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto SP, Brazil
| | - Beatriz Jerônimo
- Department of Health Sciences, University of São Paulo (USP), Ribeirão Preto School of Medicine, Ribeirão Preto, SP, Brazil
| | | | - Eduardo Ferrioli
- Department of Internal Medicine, Ribeirão Preto School of Medicine, University of São Paulo (USP), Ribeirão Preto SP, Brazil
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Tiftik T, Kara M, Koyuncu EG, Kaymak B, Çelik ÖF, Çiftçi İ, Korkmaz GO, Analay P, Aksakal MF, Ocak H, Mülkoğlu C, Genç H, Akıncı A, Özçakar L. The relationship between sarcopenia-related measurements and osteoporosis: The SARCOP study. Osteoporos Int 2023; 34:53-58. [PMID: 36194277 DOI: 10.1007/s00198-022-06563-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/21/2022] [Indexed: 01/07/2023]
Abstract
UNLABELLED As muscle and bone are closely-related, we have explored the association between sarcopenia-related measurements and bone mineral density (BMD) (and osteoporosis) in postmenopausal women. Grip strength, anterior thigh muscle thickness and chair stand test were found to be related with BMD. Additionally, grip strength < 22 kg increased the odds ratio of osteoporosis 1.6 times. INTRODUCTION As muscle and bone are two closely related tissues, we aimed to investigate the association between sarcopenia-related measurements (i.e., sonographic anterior thigh muscle thickness, grip strength, chair stand test (CST), gait speed) and clinical factors, lumbar/femoral BMD, and the presence of osteoporosis (OP) in postmenopausal women. METHODS Community dwelling postmenopausal women from two physical and rehabilitation medicine outpatient clinics were consecutively included in this cross-sectional study. Demographic data, age, weight, height, education/exercise status, smoking, and comorbidities were registered. BMD measurements were performed from lumbar vertebrae (L1-4) and femoral neck using dual energy X-ray absorptiometry (DXA). A T-score of ≤ -2.5 SD in the lumbar vertebrae (L1-L4) and/or femoral neck was accepted as OP. Anterior thigh muscle thickness (MT) at the midthigh level was measured sonographically using a linear probe. Grip strength was measured from the dominant side. Physical performance was assessed by CST and gait speed. RESULTS Among 546 postmenopausal women, 222 (40.7%) had OP. Among sarcopenia-related parameters, grip strength and anterior thigh MT were positively associated with lumbar vertebral BMD. CST performance was positively associated with femoral neck BMD. After adjusting for confounding factors, low grip strength (< 22 kg) increased 1.6 times the risk of OP. CONCLUSION Loss of muscle mass/function (i.e., sarcopenia) can coexist with loss of trabecular and cortical bone. To this end, grip strength and anterior thigh MT seem to be associated with the lumbar vertebral BMD, while CST is associated with the femoral neck BMD. Lastly, low grip strength might have an association with postmenopausal OP.
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Affiliation(s)
- Tülay Tiftik
- Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, Ankara, Turkey.
| | - Murat Kara
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Esra Gizem Koyuncu
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Bayram Kaymak
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Ömer Faruk Çelik
- Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, Ankara, Turkey
| | - İrem Çiftçi
- Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, Ankara, Turkey
| | - Gizem Olgu Korkmaz
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Pelin Analay
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Mahmud Fazıl Aksakal
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Hasan Ocak
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, Ankara, Turkey
| | - Hakan Genç
- Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, Ankara, Turkey
| | - Ayşen Akıncı
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
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Fujita Y, Iki M, Yura A, Harano A, Kouda K, Tamaki J, Sato Y, Tachiki T, Kajita E, Ishizuka R, Moon JS, Okamoto N, Kurumatani N. Combined results of three physical performance tests predict incident fracture independently of aBMD in community-dwelling elderly Japanese men: Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study. Bone 2022; 154:116240. [PMID: 34678493 DOI: 10.1016/j.bone.2021.116240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/07/2021] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Several studies have examined the association between physical performance and fracture in women, but few such studies have targeted elderly men. This study aimed to determine whether the combined results of several physical performance tests can predict the subsequent incidence of fractures in elderly men after adjusting for confounding factors. METHODS Of the 2174 elderly men who participated in this study, 2012 completed the baseline study visit, including physical performance tests (walking speed, hand grip strength, and one-leg standing) and measurement of bone mineral density by dual-energy X-ray absorptiometry. Follow-up study visits were conducted five and ten years later, during which incident fractures were identified by detailed interviews. We excluded 140 men with diseases or who took medications known to affect bone metabolism at baseline, 185 with missing values for predictors and potential confounding factors, and one who did not participate in any of the follow-up study visits. The remaining 1686 men were analyzed. Each physical performance test was analyzed by quartiles. Poor performance was defined as belonging to the worst quartile of performance. The association between physical performance and fracture was assessed using Cox proportional hazards models. RESULTS We identified 175 clinical fractures (osteoporotic fracture: 77, major osteoporotic fracture: 48) in 1686 men during a mean follow-up period of 8.4 years. After adjusting for potential confounding factors including bone mineral density, men who performed poorly on all three physical performance tests had a 3.7-fold higher risk of osteoporotic fracture and a 6.6-fold higher risk of major osteoporotic fracture than men who did not perform poorly on any of the tests. CONCLUSIONS Japanese elderly men who performed poorly on all three physical performance tests had a significantly higher risk of incident osteoporotic fracture independently of bone mineral density. The combined results of several physical performance tests may be useful for predicting incident fractures in elderly men.
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Affiliation(s)
- Yuki Fujita
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Masayuki Iki
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan.
| | - Akiko Yura
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Akihiro Harano
- Department of Orthopedics, Yamato Takada Municipal Hospital, 1-1 Isonokitamachi, Yamato-Takada, Nara 635-8501, Japan
| | - Katsuyasu Kouda
- Department of Hygiene and Public Health, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Junko Tamaki
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Yuho Sato
- Department of Human Life, Jin-ai University, 3-1-1 Ohdecho, Echizen, Fukui 915-8586, Japan
| | - Takahiro Tachiki
- Chukyo Gakuin University Faculty of Nursing, 2216 Tokicho, Mizunami, Gifu 509-6192, Japan
| | - Etsuko Kajita
- Chukyo Gakuin University Faculty of Nursing, 2216 Tokicho, Mizunami, Gifu 509-6192, Japan
| | - Rika Ishizuka
- Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara 634-8521, Japan
| | - Jong-Seong Moon
- Department of Nursing, Kio University, 4-2-2 Umami-naka, Koryo-cho, Nara 635-0832, Japan
| | - Nozomi Okamoto
- Graduate School of Education, Hyogo University of Teacher Education, 942-1 Shimokume, Kato-City, Hyogo 673-1494, Japan
| | - Norio Kurumatani
- Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara 634-8521, Japan
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Larsson BAM, Johansson L, Mellström D, Johansson H, Axelsson KF, Harvey N, Vandenput L, McCloskey E, Liu E, Sundh D, Kanis JA, Lorentzon M. One leg standing time predicts fracture risk in older women independent of clinical risk factors and BMD. Osteoporos Int 2022; 33:185-194. [PMID: 34498096 PMCID: PMC8758616 DOI: 10.1007/s00198-021-06039-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/15/2021] [Indexed: 11/28/2022]
Abstract
In women of ages 75-80 years, a low one leg standing time (OLST) was associated with an increased risk of incident fractures, independently of bone mineral density and clinical risk factors. OLST contributed substantially to fracture probability, indicating that the test should be considered when evaluating fracture risk in older women. INTRODUCTION Physical function and risk of falls are important risk factors for fracture. A few previous studies have suggested that a one leg standing time (OLST) less than 10 s predicts fracture risk, but the impact of OLST, in addition to known clinical risk factors, for fracture probability is unknown. The aim of this study was to determine the independent contribution of OLST to fracture probability in older women. METHODS The Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures (SUPERB) is a prospective population-based study of 3028 women 75-80 years old, recruited from the greater Gothenburg area in Sweden. At baseline, information on risk factors was collected using questionnaires, bone mineral density was measured with dual-energy X-ray absorptiometry (DXA), and OLST was performed. RESULTS During a median follow-up of 3.6 years (IQR 1.5 years), X-ray-verified incident fractures were identified using health records. OLST was available in 2405 women. OLST less than 10 s was associated with an increased risk for incident hip fracture (Hazard Ratio (HR) 3.02, 95% Confidence Interval (CI) [1.49-6.10]), major osteoporotic fracture (HR 95% CI 1.76 [1.34-1.46]), and nonvertebral fracture (HR 95% CI 1.61 [1.26-2.05]) in Cox regression analyses adjusted for age, height, and weight. Depending on BMD, the 4-year fracture probability increased by a factor of 1.3 to 1.5 in a 75-year-old woman with a low OLST (<10 s). CONCLUSION A low OLST has a substantial impact on fracture probability and should be considered when evaluating fracture risk in older women.
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Affiliation(s)
- B A M Larsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - L Johansson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - D Mellström
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - H Johansson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - K F Axelsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Norrmalm Health Centre, Skövde, Sweden
| | - N Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK
| | - L Vandenput
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - D Sundh
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - J A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - M Lorentzon
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia.
- Region Västra Götaland, Department of Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden.
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Montalvão MT, Lucena JMSD, Lima MSND, Ribeiro ALDA, Safons MP, Pinheiro SB, Martins WR. Predictive factors of functional mobility in older women after 12 weeks of resistance training. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.e0210029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To analyze the association between functional mobility and anthropometric and functional characteristics of older women after 12 weeks of resistance training. METHODS: Forty-seven community-dwelling older women underwent 12 weeks of supervised resistance training twice a week. The dependent variable (mobility measured by the Timed Up and Go test) and the independent variables (age, body mass index, fat-free mass of the lower limbs, waist circumference, peak knee torque at 60º/s, peak knee torque at 180º/s, functional reach test, and 30-second chair stand test) were measured before and after the intervention. RESULTS: A multivariate analysis showed that age, body mass index, waist circumference, and the 30-second stand test predicted 30% (R2 = 0.30; p = 0.001; F = 5.53) of the total variance regarding an improvement in mobility after resistance training (p < 0.0001; [95% CI 0.72–1.20]; the effect size was considered large [0.90]) when comparing women before and after the intervention. CONCLUSIONS: Age, body mass index, waist circumference, and the 30-second stand test predicted 30% of the increase in functional mobility.
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Ikuta S, Aihara T, Nakajima T, Kasai M, Yamanaka N. Computed tomography-measured bone mineral density as a surrogate marker of survival after resection of colorectal liver metastases. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:21. [PMID: 33553314 PMCID: PMC7859742 DOI: 10.21037/atm-20-3751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Background Osteopenia/osteoporosis, characterized by low bone mineral density (BMD), is a potential prognostic factor in cancer patients. We conducted a retrospective single-institution study to evaluate the prognostic impact of preoperative low BMD on colorectal liver metastases (CRLM) in patients undergoing liver resection. Methods BMD was assessed in 281 patients undergoing initial liver resection for CRLM by analyzing the preoperative computed tomography (CT) images at the level of the eleventh thoracic vertebra as the region of interest. Survival outcomes were compared between the two groups divided by the median BMD value and prognostic factors after surgery were assessed. Propensity score-based inverse probability weighting (IPW) was applied to adjust for between-group differences in baseline characteristics. Results The low BMD group had significantly more older patients (≥75 years) (P=0.01) and a higher incidence of bilobar metastases (P=0.005) than the normal BMD group. After IPW adjustment, overall survival (OS) was significantly poorer (P=0.02) and recurrence-free survival was slightly poorer (P=0.05) in the low BMD group than in the normal BMD group. IPW-adjusted regression analysis revealed that low BMD was independently associated with an adverse OS (hazard ratio, 1.42; 95% CI, 1.04–1.93; P=0.03), in addition to other factors such as tumor number, extrahepatic disease, preoperative carcinoembryonic antigen level (≥5 ng/mL), and right-sided primary tumor location. Conclusions Preoperative CT-measured low BMD can serve as a surrogate marker of adverse OS in CRLM patients undergoing liver resection. Prevention and early intervention for osteopenia/osteoporosis may be suggested for these patients.
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Affiliation(s)
- Shinichi Ikuta
- Department of Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan
| | - Tsukasa Aihara
- Department of Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan
| | | | - Meidai Kasai
- Department of Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan
| | - Naoki Yamanaka
- Department of Surgery, Meiwa Hospital, Nishinomiya, Hyogo, Japan
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Alex D, Khor HM, Chin AV, Hairi NN, Cumming RG, Othman S, Khoo S, Kamaruzzaman SB, Tan MP. Factors Associated With Falls Among Urban-Dwellers Aged 55 Years and Over in the Malaysian Elders Longitudinal Research (MELoR) Study. Front Public Health 2020; 8:506238. [PMID: 33304870 PMCID: PMC7701238 DOI: 10.3389/fpubh.2020.506238] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Falls are major issues affecting the older population with potentially serious complications, including fractures, head injury, institutionalization, fear of falling and depression. While risk factors for falls have been established across Western Europe and North America, geographical differences in falls risk have not been well researched. We aim to examine the clinical and physical risk factors for falls in a middle-income South East Asian country. Cross-sectional data from the Malaysian Elders Longitudinal Research (MELoR) study involving 1,362 community dwelling individuals aged 55 years and above was utilized. Information on sociodemographic and medical history was obtained by computer-assisted questionnaires completed during home visits and hospital-based detailed health checks. Univariate and multivariate analyses compared non-fallers and fallers in the previous 12 months. Urinary incontinence, hearing impairment, depression, arthritis and cognitive impairment were risk factors for falls in the past 12 months after adjustment for age in our study population. Awareness about the risk factors in a population helps the design of fall prevention strategies that target specific or multiple risk factors.
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Affiliation(s)
- Deepa Alex
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia.,Division of Geriatric Medicine, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Hui M Khor
- Division of Geriatric Medicine, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.,Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ai V Chin
- Division of Geriatric Medicine, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.,Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Noran N Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine, Julius Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Robert G Cumming
- School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Sajaratulnisah Othman
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Selina Khoo
- Centre for Sport and Exercise Sciences, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul B Kamaruzzaman
- Division of Geriatric Medicine, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.,Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Maw P Tan
- Division of Geriatric Medicine, Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia.,Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Kuala Lumpur, Malaysia
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10
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Kirk B, Miller S, Zanker J, Duque G. A clinical guide to the pathophysiology, diagnosis and treatment of osteosarcopenia. Maturitas 2020; 140:27-33. [PMID: 32972632 DOI: 10.1016/j.maturitas.2020.05.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Advances in medicine have paved the way for older persons to live longer, but with more years spent living with disability and dependency. Many older persons are living with comorbidities such as osteoporosis (loss of bone mass) and sarcopenia (loss of muscle mass and function), two diseases that, when concurrent, form osteosarcopenia, a newly identified musculoskeletal syndrome. Osteosarcopenia impedes mobility and diminishes independence and thus quality of life. Evidence suggests the pathology of this syndrome comprises genetic polymorphisms, alterations in mechanotransduction, and localized or systemic crosstalk between growth factors and other proteins (myokines, osteokines, adipokines). As a direct result of an aging society, health outcomes such as falls and fractures will rise as the prevalence of osteosarcopenia increases. Two major risk factors for osteosarcopenia (other than age itself) are physical inactivity and poor nutrition. Addressing these modifiable risk factors can prevent, or at least delay, the onset of osteosarcopenia. Pharmaceutical treatments for osteosarcopenia are currently unavailable, although research trials are underway. This review provides an update from basic and clinical sciences on the biology, epidemiology (prevalence, risk factors and diagnosis) and treatments for osteosarcopenia, and recommends future research priorities to improve health outcomes for those living with or at risk of osteosarcopenia.
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Affiliation(s)
- Ben Kirk
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Sarah Miller
- London North West University Healthcare, United Kingdom
| | - Jesse Zanker
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Gustavo Duque
- Department of Medicine-Western Health, Melbourne Medical School, University of Melbourne, St Albans, Melbourne, VIC, Australia; Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia.
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11
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Montgomery G, McPhee J, Pääsuke M, Sipilä S, Maier AB, Hogrel JY, Degens H. Determinants of Performance in the Timed Up-and-Go and Six-Minute Walk Tests in Young and Old Healthy Adults. J Clin Med 2020; 9:E1561. [PMID: 32455757 PMCID: PMC7290512 DOI: 10.3390/jcm9051561] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to assess associations between performance in the timed up-and-go (TUG) and six-minute walk distance (6MWD) with physiological characteristics in young and old healthy adults. Thereto, we determined TUG, 6MWD, normalised jump power, centre of pressure displacement during 1-leg standing, forced expiratory volume in 1 s, percentage of age-predicted maximal heart rate (HR%) and height in 419 healthy young (men: 23.5 ± 2.8 years, women: 23.2 ± 2.9 years) and old (men: 74.6 ± 3.2 years, women: 74.1 ± 3.2 years) adults. Normalised jump power explained 8% and 19% of TUG in young (p = 0.025) and older men (p < 0.001), respectively. When fat mass percentage and age were added to normalised jump power, 30% of TUG was explained in older men (R2adj = 0.30, p < 0.001 to 0.106). Appendicular lean muscle mass percentage (ALM%) and age were the best determinants of TUG for older women (R2adj = 0.16, p < 0.001 to 0.01). HR% explained 17-39% of 6MWD across all groups (R2adj = 0.17 to 39, p < 0.001). In conclusion, in men, jump power was a key determinant for TUG, while in old women only it was the ALM%. As HR% was the most important determinant of 6MWD, motivational bias needs to be considered in the interpretation of this test.
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Affiliation(s)
- Gallin Montgomery
- Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK;
| | - Jamie McPhee
- Musculoskeletal Science and Sports Medicine, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester M15 6BH, UK;
| | - Mati Pääsuke
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, 51014 Tartu, Estonia;
| | - Sarianna Sipilä
- Gerontology Research Center, Faculty of Sport and Health Sciences, University of Jyvsäkylä, FI-40014 Jyvsäkylä, Finland;
| | - Andrea B Maier
- Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, 1081 BT Amsterdam, The Netherlands;
- Department of Medicine and Aged Care, The Royal Melbourne Hospital, The University of Melbourne, Victoria 3010, Australia
| | - Jean-Yves Hogrel
- Neuromuscular Investigation Center, Institute of Myology, Pitié-Salpêtrière Hospital, 73013 Paris, France;
| | - Hans Degens
- Musculoskeletal Science and Sports Medicine, School of Healthcare Science, Manchester Metropolitan University, Manchester M1 5GD, UK;
- Institute of Sport Science and Innovations, Lithuanian Sports University, LT-44221 Kaunas, Lithuania
- University of Medicine and Pharmacy of Targu Mures, 540142 Targu Mures, Romania
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12
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Kirk B, Phu S, Brennan-Olsen SL, Bani Hassan E, Duque G. Associations between osteoporosis, the severity of sarcopenia and fragility fractures in community-dwelling older adults. Eur Geriatr Med 2020; 11:443-450. [DOI: 10.1007/s41999-020-00301-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/19/2020] [Indexed: 12/18/2022]
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13
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Wong RMY, Ho WT, Tang N, Tso CY, Ng WKR, Chow SKH, Cheung WH. A study protocol for a randomized controlled trial evaluating vibration therapy as an intervention for postural training and fall prevention after distal radius fracture in elderly patients. Trials 2020; 21:95. [PMID: 31948477 PMCID: PMC6966815 DOI: 10.1186/s13063-019-4013-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 12/19/2019] [Indexed: 01/29/2023] Open
Abstract
Background Fractures of the distal radius are one of the most common osteoporotic fractures in elderly men and women. These fractures are a particular health concern amongst the elderly, who are at risk of fragility fractures, and are associated with long-term functional impairment, pain and a variety of complications. This is a sentinel event, as these fractures are associated with a two to four times increased risk of subsequent hip fractures in elderly patients. This is an important concept, as it is well established that these patients have an increased risk of falling. Fall prevention is therefore crucial to decrease further morbidity and mortality. The purpose of this study is to investigate the effect of low-magnitude high-frequency vibration (LMHFV) on postural stability and prevention of falls in elderly patients post distal radius fracture. Methods This is a prospective single-blinded randomized controlled trial. Two hundred patients will be recruited consecutively with consent, and randomized to either LMHFV (n = 100) or a control group (n = 100). The primary outcome is postural stability measured by the static and dynamic ability of patients to maintain centre of balance on the Biodex Balance System SD. Secondary outcomes are the occurrence of fall(s), the health-related quality of life 36-item short form instrument, the Timed Up and Go test for basic mobility skills, compliance and adverse events. Outcome assessments for both groups will be performed at baseline (0 month) and at 6 weeks, 3 months and 6 months time points. Discussion Previous studies have stressed the importance of reducing falls after distal radius fracture has occurred in elderly patients, and an effective intervention is crucial. Numerous studies have proven vibration therapy to be effective in improving balancing ability in normal patients; However, no previous study has applied the device for patients with fractures. Our study will attempt to translate LMHFV to patients with fractures to improve postural stability and prevent recurrent falls. Positive results would provide a large impact on the prevention of secondary fractures and save healthcare costs. Trial registration ClinicalTrials.gov, NCT03380884. Registered on 21 December 2017.
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Affiliation(s)
- Ronald Man Yeung Wong
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
| | - Wing-Tung Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
| | - Ning Tang
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hospital Authority, Sha Tin, Hong Kong, China
| | - Chi Yin Tso
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hospital Authority, Sha Tin, Hong Kong, China
| | - Wai Kit Raymond Ng
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hospital Authority, Sha Tin, Hong Kong, China
| | - Simon Kwoon-Ho Chow
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China
| | - Wing-Hoi Cheung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China.
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14
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Wickstrom RJ, Wang YC, Wickstrom NE, Smith RL, Dunning KK. A new two square agility test for workplace health-reliability, validity and minimal detectable change. J Phys Ther Sci 2019; 31:823-830. [PMID: 31645814 PMCID: PMC6801334 DOI: 10.1589/jpts.31.823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 07/27/2019] [Indexed: 12/28/2022] Open
Abstract
[Purpose] One promising strategy for workplace wellness programs is to emphasize functional mobility screening and coaching to promote suitable physical activity and reduce musculoskeletal risks. This study examined intra-rater reliability, test-retest reliability, concurrent validity, known-groups validity and minimal detectable change for a new Two Square Agility Test (TSAT) designed as a functional mobility measure to promote workplace health. [Participants and Methods] Two hundred forty eight non-disabled participants (ages 18-69) were measured for body size, physical activity and 3 trials of the Two Square Agility Test. 78 participants were tested a week later on the Two Square Agility Test and other functional mobility tests. [Results] Intra-rater reliability was excellent (ICC=0.94) and test-retest reliability was good (ICC=0.87). Two Square Agility Test correlated moderately with Timed Up and Go (r=0.63), Five Times Sit to Stand (r=0.62), and Maximum Step Length (r= -0.54), supporting its concurrent validity. Performances for Two Square Agility Test were better in males, younger age, higher physical activity, and non-obese groups. The minimal detectable change at a 95% confidence level (MDC95) was 1.37 s. [Conclusion] Preliminary results supported reliability and validity of Two Square Agility Test as a functional mobility measure to promote workplace health.
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Affiliation(s)
- Richard J Wickstrom
- WorkAbility Systems: 7665 Monarch Court, Suite 109, West Chester, OH 45069, USA
| | - Ying-Chih Wang
- College of Health Sciences, Department of Occupational Science & Technology, University of Wisconsin-Milwaukee, USA
| | - Nell E Wickstrom
- WorkAbility Systems: 7665 Monarch Court, Suite 109, West Chester, OH 45069, USA
| | - Rose L Smith
- College of Allied Health Sciences, Department of Rehabilitation, Exercise and Nutrition Science, University of Cincinnati, USA
| | - Kari K Dunning
- College of Allied Health Sciences, Department of Rehabilitation, Exercise and Nutrition Science, University of Cincinnati, USA
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15
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Relationship between the changes over time of bone mass and muscle health in children and adults: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:429. [PMID: 31521141 PMCID: PMC6745072 DOI: 10.1186/s12891-019-2752-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background Various cross-sectional studies provide an abundance of evidence that shows a relationship between bone quantity and muscle health. However, one question remains, less-often studied: is their development - or decline – associated? The aim of the research was to conduct a systematic review and meta-analysis to summarize the studies exploring the association between changes in bone mineral density (BMD) and changes in muscle parameters (registration CRD42018093813). Methods We searched for prospective studies, both in children and adults, by consulting electronic databases (Ovid-MEDLINE, Ovid-AMED, Scopus). Each review steps were performed by two independent reviewers. For outcomes reported by less of 3 studies, we synthetized the results narratively. In other cases, a meta-analysis was performed, giving an overall r coefficient and its 95% confidence interval (CI). Results Fifteen papers were included. In connection with the change of BMD, 10 studies concerned the parallel change of lean mass, 4 were about grip strength, and 1 was about physical performance. Children were the population of interest for 5 studies, while the aging population was the focus of the other studies. The correlation between hip BMD and lean mass was significant, with an overall coefficient r = 0.37 (95% CI 0.23–0.49). High heterogeneity was observed between studies but the length of follow-up, sex and study quality did not seem to significantly influence results. The systematic review allowed some other highlights: a significant link between changes in BMD and changes in muscle strength was observed (p-value < 0.05 in the 4 studies), in addition to changes in performance (1 study, r = 0.21, p-value = 0.004). Conclusion Despite the heterogeneity between studies, we highlighted a significant association between the change of BMD and the change of various muscle parameters. Future studies should investigate preventive and therapeutic strategies that are based on a single entity: the ‘muscle-bone unit’.
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16
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Locquet M, Beaudart C, Reginster JY, Bruyère O. Association Between the Decline in Muscle Health and the Decline in Bone Health in Older Individuals from the SarcoPhAge Cohort. Calcif Tissue Int 2019; 104:273-284. [PMID: 30511152 DOI: 10.1007/s00223-018-0503-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/27/2018] [Indexed: 01/29/2023]
Abstract
The longitudinal relationship between bone health and muscle health is scarcely explored. We aimed to explore the relationship between bone decline and muscle decline over 1 year in older individuals. We used data from the SarcoPhAge cohort, which aims to identify the consequences of sarcopenia. In this way, this study also highlights the yearly changes in muscle mass (by dual-energy absorptiometry), muscle weakness (by grip strength), and/or physical performance (by the short physical performance battery test). Measurements of areal bone mineral density (aBMD), enabling the diagnosis of osteoporosis, and bone microarchitecture (by means of the trabecular bone score) were also performed each year. A 1-year clinically relevant decline in bone and muscle health components was evidenced using the Edwards-Nunnally index. Among the 232 participants with complete data (75.5 ± 5.4 years, 57.8% women), we observed an association between a clinically relevant decline in the skeletal muscle mass index (SMI) and a decrease in aBMD (adjusted OR = 2.12 [1.14-2.51] for the spine, 2.42 [1.10-5.34] for the hip and 2.12 [1.04-5.81] for the neck), as well as a significant association between SMI and deterioration of the skeletal microarchitecture (aOR = 3.99 [2.07-7.70]). A clinically relevant decline in muscle strength was associated with a decrease in spine aBMD (aOR = 2.93 [1.21-7.12]) and hip aBMD (aOR = 3.42 [1.37-7.64]) only. The decline in muscle performance was related to the decline in bone microarchitecture only (aOR = 2.52 [1.23-5.17]). Individuals with incident sarcopenia had an approximately fivefold higher risk of concomitantly developing osteoporosis. A dynamic relationship between impaired muscle and bone health was observed, with an obvious association between the concomitant incidences of osteoporosis and sarcopenia.
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Affiliation(s)
- Médéa Locquet
- World Health Organization Collaborating Center for the Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health Sciences, Epidemiology and Health Economics, University of Liège, CHU of Liège, B.23, Avenue Hippocrate, 13, 4000, Liège, Belgium.
| | - Charlotte Beaudart
- World Health Organization Collaborating Center for the Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health Sciences, Epidemiology and Health Economics, University of Liège, CHU of Liège, B.23, Avenue Hippocrate, 13, 4000, Liège, Belgium
| | - Jean-Yves Reginster
- World Health Organization Collaborating Center for the Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health Sciences, Epidemiology and Health Economics, University of Liège, CHU of Liège, B.23, Avenue Hippocrate, 13, 4000, Liège, Belgium
- Chair for Biomarkers of Osteoporosis, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Olivier Bruyère
- World Health Organization Collaborating Center for the Public Health Aspects of Musculoskeletal Health and Aging, Department of Public Health Sciences, Epidemiology and Health Economics, University of Liège, CHU of Liège, B.23, Avenue Hippocrate, 13, 4000, Liège, Belgium
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17
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Dewan N, MacDermid JC, Grewal R, Beattie K. Association of Modifiable Risk Factors with Bone Mineral Density among People with Distal Radius Fracture: A Cross-Sectional Study. Physiother Can 2019; 71:58-68. [PMID: 30787500 DOI: 10.3138/ptc.2017-72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Purpose: This study determined the extent to which modifiable risk factors (balance, muscle strength, and physical activity [PA]) explained variability in bone mineral density (BMD) among people with a recent distal radius fracture (DRF). Method: This cross-sectional study included 190 patients, aged 50-80 years, with a DRF. Participants were assessed for balance, muscle strength, PA, fracture-specific pain, and disability. Areal BMD at the femoral neck (BMD-FN) and total hip (BMD-TH) was assessed. Correlation and multiple linear regression was used to determine the contribution of modifiable risk factors to BMD. Results: Balance, handgrip strength, knee extension strength, and plantar-flexion strength had significant bivariate associations with BMD-FN. There was a weak to moderate correlation (r = 0.25-0.40; p < 0.05) of balance and grip strength with BMD. Grip strength independently (p < 0.05) explained 17% and 12% of the variability in BMD-FN (n = 81) and BMD-TH (n = 82), respectively. Stratified by age, balance (R 2 = 0.10; p = 0.04) and grip strength (R 2 = 0.32; p = 0.003) were independent significant predictors of BMD-FN among women aged 50-64 years and 65-80 years, respectively. Conclusions: Grip strength of the unaffected hand is independently associated with BMD-FN and BMD-TH in people with recent DRF. It may act as a surrogate for general bone health, frailty, or overall muscle strength rather than as a direct target for intervention.
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Affiliation(s)
- Neha Dewan
- School of Rehabilitation Science, Faculty of Health Sciences.,Roth
- McFarlane Clinical Research Laboratory, Hand and Upper Limb Centre, St. Joseph's Health Care
| | - Joy C MacDermid
- School of Rehabilitation Science, Faculty of Health Sciences.,Roth
- McFarlane Clinical Research Laboratory, Hand and Upper Limb Centre, St. Joseph's Health Care.,Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Ruby Grewal
- Roth
- McFarlane Clinical Research Laboratory, Hand and Upper Limb Centre, St. Joseph's Health Care.,Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ont
| | - Karen Beattie
- School of Rehabilitation Science, Faculty of Health Sciences.,Department of Medicine, McMaster University, Hamilton
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18
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Ibrahim N'I, Sharkawi Ahmad M, Zulfarina MS, Zaris SNASM, Nor Azlin ZA, Naina Mohamed I, Mohamed N, Mokhtar SA, Shuid AN. Physical function assessment of older adults with lower body fractures at 3 months post-discharge from hospital. Ther Clin Risk Manag 2019; 15:201-210. [PMID: 30774356 PMCID: PMC6357875 DOI: 10.2147/tcrm.s189748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and purpose Physical function assessment can be performed to assess functional mobility among older adults, especially after a traumatic incident such as lower body fracture (LBF). The objective of this study was to evaluate physical function of older patients with LBF after 3 months of discharge from the hospital. Patients and methods A total of 89 patients were followed up at the discharge phase. Four independent variables were tested: age, sex, type of fracture, and use of a walking aid before fracture. Mobility and strength were assessed with the Timed Up and Go (TUG) test and hand-grip strength (HGS) test, respectively. Results The majority of the patients were ≥65 years old (64%), female (61.8%), of Chinese ethnicity (50.6%), and had a hip fracture (51.7%). The mean time for TUG test was 26.11 seconds, while mean HGS was 19.02 kg. We found significant differences in TUG test scores with respect to all independent variables tested: age (P=0.026), sex (P=0.011), fracture type (P<0.001), and use of a walking aid before fracture (P=0.004). Significant differences were also detected in HGS test scores with respect to all independent variables tested: age (P<0.001), sex (P<0.001), fracture type (P<0.001), and use of a walking aid before fracture (P=0.035). Conclusion Increasing age, female sex, having a hip fracture, and use of a walking aid before fracture predicted reduction in the physical function and strength among older adults with LBF.
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Affiliation(s)
- Nurul 'Izzah Ibrahim
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
| | - Mohd Sharkawi Ahmad
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
| | - Mohamed S Zulfarina
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
| | | | | | - Isa Naina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
| | - Norazlina Mohamed
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
| | - Sabarul Afian Mokhtar
- Department of Orthopedics and Traumatology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Ahmad Nazrun Shuid
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,
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19
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Scerpella JJ, Buehring B, Hetzel SJ, Heiderscheit BC. Increased Leg Bone Mineral Density and Content During the Initial Years of College Sport. J Strength Cond Res 2018; 32:1123-1130. [PMID: 29570599 DOI: 10.1519/jsc.0000000000001929] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Scerpella, JJ, Buehring, B, Hetzel, SJ, and Heiderscheit, BC. Increased leg bone mineral density and content during the initial years of college sport. J Strength Cond Res 32(4): 1123-1130, 2018-Bone mineral density (BMD) and bone mineral content (BMC) data are useful parameters for evaluating how training practices promote bone health. We used dual-energy X-ray absorptiometry (DXA) to longitudinally assess sport-specific growth in leg and total body BMD/BMC over the initial 2 years of collegiate training. Eighty-five Division 1 collegiate basketball, hockey, and soccer athletes (50 males and 35 females; age 19.0 [0.8] years) underwent annual DXA scans. Leg and total body BMD/BMC were compared within and across two 1-year intervals (periods 1 and 2) using repeated-measures analysis of variance, adjusting for age, sex, race, and sport. Leg BMD, leg BMC, and total body BMC all increased over period 1 (0.05 g·cm [p = 0.001], 0.07 kg [p = 0.002], and 0.19 kg [p < 0.001] respectively). Changes in period 2 compared with period 1 were smaller for leg BMD (p = 0.001), leg BMC (p < 0.001), leg fat mass (p = 0.028), and total BMC (p = 0.005). Leg lean mass increased more during period 2 than period 1 (p = 0.018). Sports participation was the only significant predictor of change in leg BMD. Significant increases in both leg BMD and BMC were demonstrated over both 2-year periods, with greater gains during period 1. These gains highlight the importance of attentive training procedures, capitalizing on attendant physical benefits of increased BMD/BMC. Additional research in young adults, evaluating bone mass acquisition, will optimize performance and decrease risk of bone stress injury among collegiate athletes.
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Affiliation(s)
- John J Scerpella
- Badger Athletic Performance, University of Wisconsin, Madison, WI
| | - Bjoern Buehring
- Osteoporosis Clinical Research Program, University of Wisconsin, Madison, WI
| | - Scott J Hetzel
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI
| | - Bryan C Heiderscheit
- Department of Orthopedics and Rehabilitation and Badger Athletic Performance, School of Medicine and Public Health, University of Wisconsin, Madison, WI
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20
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Lo C, Sung FC, Mou CH, Lin TC, Tseng CH, Tzeng YL. Population study evaluating fracture risk among patients with chronic osteomyelitis. PLoS One 2017; 12:e0189743. [PMID: 29267371 PMCID: PMC5739410 DOI: 10.1371/journal.pone.0189743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/30/2017] [Indexed: 11/18/2022] Open
Abstract
Background Studies investigating the fracture risk in patients with chronic osteomyelitis (COM) limited to case reports. This study evaluated the association between COM and subsequent fracture risk using population-based data. Methods A subset claims data of the Taiwan National Health Insurance was used to identify 7,147 patients with COM newly diagnosed in 1999–2005 without fracture history and 28,588 general population controls, frequency matched by sex, age and diagnosis date. The incident fractures was measured by the end of 2013. Results The incidence density of fracture was 1.94-fold greater in the COM cohort than in controls (21.5 vs. 11.1 per 1000 person-years), with the adjusted hazard ratio (HR) of 1.81 (95% CI: 1.67–1.95) for COM patients compared to controls after controlling for sex, age, and comorbidities of diabetes, osteoporosis, depression and end-stage renal disease in Cox proportional hazards regression. The fracture risk increased with age and women were at greater risk than men. The fracture incidence increased substantially in those with osteoporosis, 40.2 per 1000 person-years in COM patients. Site specific analysis showed a higher portion of incident fractures for lower limbs, 52.7% in COM cohort and 46.3% in controls. Conclusion Findings in this 15-year follow-up observation support our hypothesis that patients with COM are at an elevated risk of subsequent fracture. COM patients and the elderly deserve adequate consultation and awareness for fracture prevention.
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Affiliation(s)
- Chyi Lo
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Chieh Lin
- Division of Traumatology, Emergency Department, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chun-Huang Tseng
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Ling Tzeng
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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Physical-Performance Outcomes and Biomechanical Correlates from the 32-Week Yoga Empowers Seniors Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:6921689. [PMID: 27885329 PMCID: PMC5112317 DOI: 10.1155/2016/6921689] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/25/2016] [Indexed: 11/18/2022]
Abstract
Background. Yoga Empowers Seniors Study (YESS) quantified physical demands associated with yoga performance using biomechanical methods. This study evaluated the efficacy of the program on physical function outcomes. Methods. Twenty community-dwelling older adults aged 70.7 ± 3.8 years attended biweekly 60-minute Hatha yoga classes for 32 weeks. Four domains of the physical measurements including (1) functional performance, (2) flexibility, (3) muscle strength, and (4) balance were taken at the baseline, 16-week and 32-week time points. Repeated-measures ANOVA omnibus tests and Tukey's post hoc tests were employed to examine the differences in each outcome variable across the 3 time points. Results. Improved timed chair stands (p < 0.01), 8-foot up and go (p < 0.05), 2-min step test (p < 0.05), and vertical reach (p = 0.05) performance were evident. Isometric knee flexor strength (p < 0.05) and repetitions of the heel rise test (p < 0.001) also increased following the 32-week intervention. Both flexibility and balance performance remained unchanged. Conclusions. Significant improvements in physical function and muscle-specific lower-extremity strength occur with the regular practice of a modified Hatha yoga program designed for seniors. These adaptations corresponded with the previously reported biomechanical demands of the poses.
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Louer CR, Boone SL, Guthrie AK, Motley JR, Calfee RP, Wall LB. Postural Stability in Older Adults with a Distal Radial Fracture. J Bone Joint Surg Am 2016; 98:1176-82. [PMID: 27440565 PMCID: PMC4994855 DOI: 10.2106/jbjs.15.00963] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The physical risk factors leading to distal radial fractures are poorly understood. The goal of this study was to compare postural stability between older adults with and without a prior distal radial fragility fracture. METHODS This case-control evaluation was performed at a single tertiary institution. The fracture cohort comprised 23 patients treated for a low-energy distal radial fracture within 6 to 24 months prior to this study. Twenty-three age and sex-matched control participants, without a prior fragility fracture, were selected from an outpatient clinic population. All participants completed a balance assessment with a computerized balance platform device. Dynamic motion analysis (DMA) scores ranging from 0 to 1,440 points are produced, with lower scores indicating better postural stability. Participants also completed validated questionnaires for general health quality (EuroQol-5D-3L [EQ-5D-3L]) and physical activity (Physical Activity Scale for the Elderly [PASE]) and comprehensive health and demographic information including treatment for compromised balance or osteoporosis. Statistical analysis compared data between cases and controls using either the Student t test or the Mann-Whitney U test. RESULTS There were no significant differences (p > 0.05) in age, sex, body mass index, physical activity score, or EQ-5D-3L general health visual analog scale score between participants with or without prior distal radial fracture. The fracture cohort demonstrated poorer balance, with higher DMA scores at 933 points compared with 790 points for the control cohort (p = 0.008). Nineteen patients (83%) in the fracture cohort reported having dual x-ray absorptiometry (DXA) scans within 5 years prior to this study, but only 2 patients (9%) had ever been referred for balance training with physical therapy. CONCLUSIONS Older adults who sustain low-energy distal radial fractures demonstrate impaired postural stability compared with individuals of a similar age who have not sustained such fractures. Following a distal radial fracture, these patients may benefit from interventions to improve postural stability. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Craig R. Louer
- Department of Orthopaedic Surgery, Washington University
School of Medicine, St. Louis, Missouri
| | - Sean L. Boone
- Department of Orthopaedic Surgery, Washington University
School of Medicine, St. Louis, Missouri
| | - Andre K. Guthrie
- Department of Orthopaedic Surgery, Washington University
School of Medicine, St. Louis, Missouri
| | - John R. Motley
- Sports Therapy and Rehabilitation Center, Barnes-Jewish
West County Hospital, Chesterfield, Missouri
| | - Ryan P. Calfee
- Department of Orthopaedic Surgery, Washington University
School of Medicine, St. Louis, Missouri
| | - Lindley B. Wall
- Department of Orthopaedic Surgery, Washington University
School of Medicine, St. Louis, Missouri
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Mousa SM, Rasheedy D, El-Sorady KE, Mortagy AK. Beyond mobility assessment: Timed up and go test and its relationship to osteoporosis and fracture risk. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jcgg.2015.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lim Y, Kim K, Ko SH, Cho K, Jang EH, Lee SH, Lim DJ, Baek KH, Ha HS, Park MS, Yim HW, Lee WC, Yoon KH, Son HY, Oh KW, Kang MI. Gender- and age-group-specific associations between physical performance and bone mineral density, falls, and osteoporotic fractures in Koreans: the Chungju Metabolic Disease Cohort study. J Bone Miner Metab 2016; 34:336-46. [PMID: 26056017 DOI: 10.1007/s00774-015-0674-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 04/08/2015] [Indexed: 10/23/2022]
Abstract
Several factors increase the risk of fragility fracture, including low bone mineral density, falls, and poor physical performance. The associations among these factors have been investigated; however, most of the subjects of previous studies were either elderly men or elderly women, and the associations were controversial. The aim of this study was to evaluate the associations between physical performance and bone mineral density, and the history of falls and fractures, stratified by gender and age group. We analyzed 5368 subjects who were aged 50 years or older, including 1288 younger men (younger than 70 years), 1615 younger women (younger than 70 years), 1087 older men (70 years or older), and 1378 older women (70 years or older). We used the one-leg standing time (OLST) for assessing static balance and the timed up-and-go test (TUGT) for assessing dynamic balance. The subjects in the worst performance quartile for the OLST were more likely to have osteoporosis than those in the best performance quartile. Additionally, women who had experienced a fracture during the past 2 years were 1.68 times more likely to be in the worst performance quartile for the OLST than women without a previous fracture. Although the TUGT time was not associated with either the incidence of osteoporosis or the fracture history, the odds ratios for falling were 1.51 and 1.28 as the TUGT time increased by one standard deviation in younger men and younger women, respectively. The findings of the present study show that the OLST was associated with the incidence of osteoporosis and previous fracture and that the TUGT time was associated with the incidence of falling.
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Affiliation(s)
- Yejee Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea
| | - Kyunghee Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea
| | - Sun-Hee Ko
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea
| | - Kwanhoon Cho
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea
| | - Eun-Hee Jang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea
| | - Dong Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea
| | - Ki Hyun Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea
| | - Hee-Sung Ha
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
| | - Mi Sun Park
- Clinical Research Coordinating Center, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
| | - Hyeon-Woo Yim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
- Clinical Research Coordinating Center, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
| | - Won-Chul Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, South Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea
| | - Ho Young Son
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea
| | - Ki Won Oh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 29 Saemunan-ro, Jongno-gu, Seoul, 110-746, South Korea
| | - Moo-Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 137-701, South Korea.
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Yu R, Leung J, Woo J. Incremental Predictive Value of Sarcopenia for Incident Fracture in an Elderly Chinese Cohort: Results From the Osteoporotic Fractures in Men (MrOs) Study. J Am Med Dir Assoc 2014; 15:551-8. [DOI: 10.1016/j.jamda.2014.02.005] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 02/14/2014] [Indexed: 12/29/2022]
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Relationship among fear of falling, physical performance, and physical characteristics of the rural elderly. Am J Phys Med Rehabil 2014; 93:379-86. [PMID: 24196975 DOI: 10.1097/phm.0000000000000009] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship between the fear of falling, physical performance, and physical characteristics in an elderly population. DESIGN This study is a cross-sectional study with 883 community dwellers 60 yrs or older from a rural area. They completed surveys and evaluations including demographics, the Korean version of the Falls Efficacy Scale-International, the Short Physical Performance Battery, the timed up and go (TUG) test, grip strength, and bone mineral density. RESULTS The subjects who had experienced a fall showed lower physical performance than those who had not experienced a fall. Regardless of a previous experience of a fall, the score on the Korean version of the Falls Efficacy Scale-International had a positive correlation with TUG time and negative correlations with the score on the Short Physical Performance Battery, grip strength, and bone mineral density. Compared with the group without the fear of falling, the group with the fear of falling showed a lower score on the Short Physical Performance Battery, longer TUG time, weaker grip strength, and lower bone mineral density. The subjects with osteoporosis showed significantly higher scores on the Korean version of the Falls Efficacy Scale-International. CONCLUSIONS The experience of falls had a significant relationship with the fear of falling and physical performance, and greater fear of falling was related to poorer physical performance, independent of the experience of falls. This result implies that more attention should be paid to seniors with the fear of falling and the experience of falls, and screening and consequent intervention for fall prevention should be warranted in this population. For this purpose, the TUG test may be recommended as a screening tool because TUG time reflects the fear of falling and the experience of falls as well as physical performance.
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Furrer R, van Schoor NM, de Haan A, Lips P, de Jongh RT. Gender-specific associations between physical functioning, bone quality, and fracture risk in older people. Calcif Tissue Int 2014; 94:522-30. [PMID: 24458514 DOI: 10.1007/s00223-013-9836-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 12/15/2013] [Indexed: 11/25/2022]
Abstract
The aim of this study was to investigate which parameters of physical functioning are associated with bone quality and fracture risk and whether gender-specific differences exist within these associations. We studied 1,486 participants of the Longitudinal Aging Study Amsterdam. As measures of physical functioning, handgrip strength, physical performance, and level of physical activity were assessed. To assess bone quality, broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at baseline using quantitative ultrasound and bone mineral density (BMD) at baseline and after 3 years by dual-energy X-ray absorptiometry. In addition, fracture incidence over 6 years was assessed. After adjustment for confounders (age, serum 25[OH]D, smoking, and body weight), in men, physical performance was positively related to BUA, SOS, and BMD cross-sectionally and to BMD longitudinally. Using Cox proportional hazards model, in men higher handgrip strength and physical performance were associated with reduced fracture risk after adjustment for confounders (hazard ratio [HR] 0.96, 95 % confidence interval [CI] 0.92-0.99, and HR 0.89, 95 % CI 0.80-0.98, respectively). In women, a moderate level of physical activity was related to reduced fracture risk (HR 0.57, 95 % CI 0.33-0.99). In conclusion, in men, higher handgrip strength and physical performance are related to higher bone quality and reduced fracture risk, whereas in women, a moderate to high level of physical activity is associated with reduced fracture risk. These measurements may contribute to the identification of individuals at high fracture risk. Both the causality of and explanations for gender-specific differences in these relationships remain subject to further studies.
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Affiliation(s)
- Regula Furrer
- Faculty of Human Movement Sciences, MOVE Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands
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MacIntyre NJ, Recknor CP, Grant SL, Recknor JC. Scores on the Safe Functional Motion test predict incident vertebral compression fracture. Osteoporos Int 2014; 25:543-50. [PMID: 23912556 DOI: 10.1007/s00198-013-2449-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED The Safe Functional Motion test (SFM) was developed to document movement strategies used to perform everyday activities that may increase the risk for osteoporotic fracture. After adjusting for variables known to predict vertebral compression fracture (VCF), baseline score on the SFM was a significant independent predictor of incident VCF at 1- and 3-year follow-ups. INTRODUCTION Functional movements may contribute to risk for VCF. We hypothesize that scores on the SFM, a performance-based test of physical function, are associated with incident VCF. METHODS An osteoporosis clinic database was queried for men and women ≥ 50 years with an initial SFM and corresponding data for prevalent VCF, history of injurious falls, femoral neck bone mineral density (fnBMD), osteoporosis medication use, and incident morphometric VCF at 1-year (n = 878) and 3-year follow-ups (n = 503). Multiple logistic regressions, adjusted for gender, age, injurious fall(s), fnBMD, prevalent VCF at baseline, and osteoporosis medication use, were used to determine whether SFM score was associated with incident VCF at follow-up visits. RESULTS Baseline SFM score was a significant independent predictor of incident VCF at 1-year follow-up (adjusted odds ratio (95 % confidence intervals (CI)) = 0.818 (0.707, 0.948); p < 0.008) and 3-year follow-up (adjusted odds ratio (95 % CI) = 0.728 (0.628, 0.844); p < 0.0001). Baseline fnBMD and osteoporosis medication use were significant predictors at 1-year (p = 0.05 and < 0.0001, respectively) and 3-year (p < 0.01 and 0.001, respectively) follow-ups. At 3-year follow-up, gender and prevalent VCF were also significant predictors (p = 0.003 and 0.007, respectively). CONCLUSIONS For every 10-point increase in SFM score, the odds of future VCF decreases by 18 % at 1 year and 27 % at 3 years after adjusting for known covariates. The SFM may aid in the identification of modifiable functional risk factors for VCF.
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Affiliation(s)
- N J MacIntyre
- School of Rehabilitation Science, McMaster University, IAHS-403, 1400 Main St. West, Hamilton, ON, Canada, L8S 1C7,
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Lu H, Yuan G, Yin Z, Dai S, Jia R, Xu J, Song X, Li L, Lv C. Effects of subchronic exposure to lead acetate and cadmium chloride on rat's bone: Ca and Pi contents, bone density, and histopathological evaluation. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:640-647. [PMID: 24551284 PMCID: PMC3925908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 12/28/2013] [Indexed: 06/03/2023]
Abstract
This study aims to investigate the effects of low-dose subchronic exposure to lead acetate (Pb(NO₃)₂) and cadmium chloride (CdCl₂·2.5H₂O) on bone in rats. The rats were assigned randomly to a control group and three experimental groups that were given the mixture of Pb(NO₃)₂ and CdCl₂·2.5H₂O by gastric gavage at doses of 0 mg/kg body weight (b.w.) (Group I, to serve as a control), 29.96 mg/kg b.w. (Group II, 29.25+0.71), 89.88 mg/kg b.w. (Group III, 87.74+2.14), and 269.65 mg/kg b.w. (Group IV, 263.23+6.42) for at least 90 consecutive days. Calcium (Ca) and phosphorus (Pi) contents in the bone were determined. Bone mineral density (BMD) was measured at the tibia and femur region by dual-energy X-ray absorbsiometry. The histopathology of bone was evaluated by light microscope, scanning electron microscope, and transmission electron microscope. The BMD of rats in the experimental group was significantly lower and the contents of Ca and Pi were decreased than those in the control group. The histopathological evaluation showed that co-induction of Pb and Cd results in bone microstructure damage, especially to trabecular bone, marrow cavity, collagen fiber, and osteoblast. In general, results indicate that combining Pb with Cd induces bone damage and increases the risk of osteoporosis.
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Affiliation(s)
- Hongke Lu
- College of Veterinary Medicine, Sichuan Agricultural UniversityYa’an 625014, China
| | - Guiping Yuan
- Analytical & Testing Center, Sichuan UniversityChengdu 610064, China
| | - Zhongqiong Yin
- College of Veterinary Medicine, Sichuan Agricultural UniversityYa’an 625014, China
| | - Shujun Dai
- College of Veterinary Medicine, Sichuan Agricultural UniversityYa’an 625014, China
| | - Renyong Jia
- College of Veterinary Medicine, Sichuan Agricultural UniversityYa’an 625014, China
| | - Jiao Xu
- College of Veterinary Medicine, Sichuan Agricultural UniversityYa’an 625014, China
| | - Xu Song
- College of Veterinary Medicine, Sichuan Agricultural UniversityYa’an 625014, China
| | - Li Li
- College of Veterinary Medicine, Sichuan Agricultural UniversityYa’an 625014, China
| | - Cheng Lv
- College of Veterinary Medicine, Sichuan Agricultural UniversityYa’an 625014, China
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Recknor CP, Grant SL, Recknor JC, Macintyre NJ. Scores on the safe functional motion test are associated with prevalent fractures and fall history. Physiother Can 2014; 65:75-83. [PMID: 24381386 DOI: 10.3138/ptc.2011-25bh] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The Safe Functional Motion test (SFM) was developed to measure observed body mechanics and functional motion associated with spine load, balance, strength, and flexibility during everyday tasks to profile modifiable risks for osteoporotic fracture. This cross-sectional study evaluated the associations between SFM score and history of vertebral compression fracture (VCF), hip fracture, and injurious falls, all established predictors of future risk. METHOD An osteoporosis clinic database was queried for adults with an initial SFM score and corresponding data for prevalent VCF and/or hip fracture, femoral neck bone mineral density (fnBMD), and history of injurious fall (n=847). Multiple logistic regressions, adjusted for age, gender, and fnBMD (and injurious falls in the prevalent fracture analyses), were used to determine whether associations exist between SFM score and prevalent VCF, prevalent hip fracture, and history of injurious fall. RESULTS SFM score was associated with prevalent VCF (odds ratio [OR]=0.89; 95% CI, 0.79-0.99; p=0.036), prevalent hip fracture (OR=0.77; 95% CI, 0.65-0.92; p=0.004), and history of injurious fall (OR=0.80; 95% CI, 0.70-0.93; p=0.003) after adjusting for other important covariates. CONCLUSIONS Adults with higher SFM scores ("safer motion" during performance of everyday tasks) were less likely to have a history of fracture or injurious fall. Further study is warranted to evaluate the predictive value of this tool.
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Affiliation(s)
- Chris P Recknor
- United Osteoporosis Centers, Limestone Parkway, Gainesville, Ga., USA
| | - Stephanie L Grant
- United Osteoporosis Centers, Limestone Parkway, Gainesville, Ga., USA
| | - Julie C Recknor
- United Osteoporosis Centers, Limestone Parkway, Gainesville, Ga., USA
| | - Norma J Macintyre
- School of Rehabilitation Science, McMaster University, Hamilton, Ont
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Birnie K, Ben-Shlomo Y, Gunnell D, Ebrahim S, Bayer A, Gallacher J, Holly JMP, Martin RM. Childhood milk consumption is associated with better physical performance in old age. Age Ageing 2012; 41:776-84. [PMID: 22542496 DOI: 10.1093/ageing/afs052] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND studies have shown that milk and dairy consumption in adulthood have beneficial effects on health. METHODS we examined the impact of childhood and adult diet on physical performance at age 63-86 years. The Boyd Orr cohort (n = 405) is a 65-year prospective study of children who took part in a 1930's survey; the Caerphilly Prospective Study (CaPS; n = 1,195) provides data from mid-life to old age. We hypothesised that higher intakes of childhood and adult milk, calcium, protein, fat and energy would be associated with a better performance. RESULTS in fully adjusted models, a standard deviation (SD) increase in natural log-transformed childhood milk intake was associated with 5% faster walking times from the get-up and go test in Boyd Orr (95% CI: 1 to 9) and 25% lower odds of poor balance (OR: 0.75; 0.55 to 1.02). Childhood calcium intake was positively associated with walking times (4% faster per SD; 0 to 8) and a higher protein intake was associated with lower odds of poor balance (OR: 0.71; 0.54 to 0.92). In adulthood, protein intake was positively associated with walking times (2% faster per SD; 1 to 3; Boyd Orr and CaPS pooled data). CONCLUSION this is the first study to show positive associations of childhood milk intake with physical performance in old age.
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Affiliation(s)
- Kate Birnie
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
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Abdulameer SA, Syed Sulaiman SA, Hassali MAA, Subramaniam K, Sahib MN. Is there a link between osteoporosis and type 1 diabetes? Findings from a systematic review of the literature. Diabetol Int 2012. [DOI: 10.1007/s13340-012-0083-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Gouveia ÉR, Maia JA, Beunen GP, Blimkie CJR, Rodrigues AL, Freitas DL. Functional fitness and bone mineral density in the elderly. Arch Osteoporos 2012; 7:75-85. [PMID: 23225284 DOI: 10.1007/s11657-012-0083-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 02/14/2012] [Indexed: 02/03/2023]
Abstract
UNLABELLED Bone quality has been associated with genetic factors and several environmental influences. This study suggests that although functional fitness should be considered in clinical assessments of bone health, body composition appears to have a higher relevance in the explanation of bone health/strength in older people. PURPOSE This study aims to describe the association between functional fitness (FF), other constitutive factors, and bone health/strength in a large community-dwelling sample of elderly active Portuguese. METHODS This cross-sectional study included 401 males and 401 females aged 60-79 years old. Bone mineral density (BMD) of the total body, lumbar spine (LS), and hip region was determined by dual-energy X-ray absorptiometry (DXA). In addition, femur strength index (FSI) was determined. FF was assessed using the Senior Fitness Test. Demographic information and a health history were obtained by telephone interview through questionnaire. RESULTS Aerobic endurance and body strength were positively related with hip BMD region in males (0.10 < r < 0.16; p < 0.01-0.05) and females (0.13 < r < 0.28; p < 0.01). No significant correlation was found between any FF test and LS BMD, except for upper-body strength in females. After controlling for other constitutive predictors (sex, age, height, body mass (BM), total fat mass (TFM), and total lean tissue mass (TLTM)), FF had a minor contribution only in prediction of BMD at multisites and FSI. The total explained variance for all determinants was moderate (R² = 0.35 for femoral neck (FN) BMD, R² = 0.27 for LS BMD, R² = 0.49 total body BMD, and R² = 0.22 for FSI). CONCLUSIONS Sex, age, height, BM, TLTM, and TFM entered as the most significant contributors for BMD and FSI. Although FF parameters are typically considered in clinical assessments of bone health/strength in older people, body composition appears to have a higher relevance in the explanation of BMD and strength.
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Affiliation(s)
- Élvio R Gouveia
- Department of Physical Education and Sports, University of Madeira, Campus Universitário da Penteada, 9000-390 Funchal, Portugal.
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Jamal SA, West SL, Miller PD. Fracture risk assessment in patients with chronic kidney disease. Osteoporos Int 2012; 23:1191-8. [PMID: 21901475 DOI: 10.1007/s00198-011-1781-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
Abstract
Fractures are common in patients with chronic kidney disease (CKD) and associated with substantially high morbidity and mortality. Bone mass measurements are commonly used to assess fracture risk in the general population, but the utility of these measurements in patients with CKD, and specifically among those on hemodialysis, is unclear. This review will outline the epidemiology and etiology of fractures in patients with CKD with a particular emphasis on men and women on hemodialysis. As well, we will summarize the published data, which describes the association between risk factors for fracture (including bone mass measurements, biochemical markers of mineral metabolism, and muscle strength) and fractures in patients with CKD. Patients with CKD suffer from fractures due to impairments in bone quantity, bone quality, and abnormalities of neuromuscular function. There is a paucity of evidence on the associations between bone quality, bone turnover markers, neuromuscular function, and fractures in patients with CKD. Furthermore, the complex etiology of fractures combined with the technical limitations of bone mineral density testing, both by dual energy X-ray absorptiometry (DXA) and by peripheral quantitative tomography (pQCT), limits the clinical utility of bone mass measurements for fracture prediction in CKD; this is particularly true among patients with stages 4 and 5 CKD. Further prospective studies to identify noninvasive measures of bone strength that can be used for fracture risk assessment are needed.
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Affiliation(s)
- S A Jamal
- Department of Medicine, University of Toronto, Toronto, ON, Canada.
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Rouzi AA, Al-Sibiani SA, Al-Senani NS, Radaddi RM, Ardawi MSM. Independent predictors of all osteoporosis-related fractures among healthy Saudi postmenopausal women: the CEOR Study. Bone 2012; 50:713-22. [PMID: 22178778 DOI: 10.1016/j.bone.2011.11.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 11/23/2011] [Accepted: 11/25/2011] [Indexed: 11/23/2022]
Abstract
This study was designed to identify independent predictors of all osteoporosis-related fractures (ORFs) among healthy Saudi postmenopausal women. We prospectively followed a cohort of 707 healthy postmenopausal women (mean age, 61.3±7.2 years) for 5.2±1.3 years. Data were collected on demographic characteristics, medical history, personal and family history of fractures, lifestyle factors, daily calcium intake, vitamin D supplementation, and physical activity score. Anthropometric parameters, total fractures (30.01 per 1000 women/year), special physical performance tests, bone turnover markers, hormone levels, and bone mineral density (BMD) measurements were performed. The final model consisted of seven independent predictors of ORFs: [lowest quartile (Q(1)) vs highest quartile (Q(4))] physical activity score (Q(1) vs Q(4): ≤12.61 vs ≥15.38); relative risk estimate [RR], 2.87; (95% confidence interval [CI]: 1.88-4.38); age≥60 years vs age<60 years (RR=2.43; 95% CI: 1.49-3.95); hand grip strength (Q(1) vs Q(4): ≤13.88 vs ≥17.28 kg) (RR=1.88; 95% CI: 1.15-3.05); BMD total hip (Q(1) vs Q(4): ≤0.784 vs 0.973 g/cm(2)) (RR=1.86; 95% CI: 1.26-2.75); dietary calcium intake (Q(1) vs Q(4): ≤391 vs ≥648 mg/day) (RR=1.66; 95% CI: 1.08-2.53); serum 25(OH)D (Q(1) vs Q(4): ≤17.9 vs ≥45.1 nmol/L) (RR=1.63; 95% CI: 1.06-2.51); and past year history of falls (RR=1.61; 95% CI: 1.06-2.48). Compared with having none (41.9% of women), having three or more clinical risk factors (4.8% of women) increased fracture risk by more than 4-fold, independent of BMD. Having three or more risk factors and being in the lowest tertile of T-score of [total hip/lumbar spine (L1-L4)] was associated with a 14.2-fold greater risk than having no risk factors and being in the highest T-score tertile. Several clinical risk factors were independently associated with all ORFs in healthy Saudi postmenopausal women. The combination of multiple clinical risk factors and low BMD is a very powerful indicator of fracture risk.
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Affiliation(s)
- Abdulrahim A Rouzi
- Center of Excellence for Osteoporosis Research, King Abdulaziz University, Jeddah, Saudi Arabia.
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Macintyre NJ. Clinician's Commentary on Wilhelm et al.(1.). Physiother Can 2012; 64:395-6. [PMID: 23997395 PMCID: PMC3484911 DOI: 10.3138/ptc.2011-31-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Norma J Macintyre
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario;
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Shin M, Paek D, Yoon C. The relationship between the bone mineral density and urinary cadmium concentration of residents in an industrial complex. ENVIRONMENTAL RESEARCH 2011; 111:101-109. [PMID: 21167481 DOI: 10.1016/j.envres.2010.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2010] [Revised: 11/16/2010] [Accepted: 11/24/2010] [Indexed: 05/30/2023]
Abstract
BACKGROUND An association between cadmium exposure and bone mineral density (BMD) has been demonstrated in elderly women, but has not been well studied in youths and men. Some studies report either no or a weak association between cadmium exposure and bone damage. OBJECTIVES This study was designed to investigate the relationship between the urinary cadmium (U-Cd) levels and BMD of females and males of all ages. METHODS A total of 804 residents near an industrial complex were surveyed in 2007. U-Cd and BMD on the heel (non-dominant calcaneus) were analyzed with AAS-GTA and Dual-Energy X-ray absorptiometry, respectively. Demographic characteristics were collected by structured questionnaires. Osteoporosis and osteopenia were defined by BMD cut-off values and T-scores set by the WHO; T score>-1, normal; -2.5<T score <-1, osteopenia; and T score <-2.5, osteoporosis. Logistic and multiple linear regressions were applied to estimate the association between U-Cd levels and BMD. RESULTS The U-Cd levels in females (0.64 μg/g creatinine) were higher than those in males (0.48 μg/g creatinine) (p<0.001). With the logistic regression model, osteopenia was associated with high U-Cd levels (≥ 1.0 μg/g creatinine) in females (OR=2.92; 95% CI, 1.51-5.64) and in males (OR=3.37; 95% CI, 1.09-10.38). With the multiple linear regression model, the BMD of the adult group was negatively associated with U-Cd (<0.05), gender (female, p<0.001) and age (p<0.001). The BMD of participants who were ≤ 19 years of age was negatively associated with gender (female, p<0.01), whereas it was positively associated with age and BMI (p<0.001). BMD was not associated with exercise, smoking habits, alcohol consumption, job or parental education. CONCLUSION Results suggested that U-Cd might be associated with osteopenia as well as osteoporosis in both male and female adults. Age and female gender were negatively associated with BMD in the adult group, whereas age was positively associated with BMD in the youth group. Cadmium exposure may be a potential risk factor for lower-BMD and osteopenia symptoms as well as for osteoporosis symptoms.
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Affiliation(s)
- Minah Shin
- Institute of Health and Environment, Department of Environmental Health, School of Public Health, Seoul National University, Gwanak-599, Gwanak-gu, Seoul 151-742, Republic of Korea
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Bernad Pineda M, González Fernández CM, Fernández Prada M, Fernández Campillo J, Maeso Martín R, Garcés Puentes MV. Reumatología y osteoporosis (RETOSS): osteoporosis posmenopáusica en la consulta de reumatología. ACTA ACUST UNITED AC 2011; 7:13-9. [DOI: 10.1016/j.reuma.2010.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Revised: 02/24/2010] [Accepted: 03/07/2010] [Indexed: 12/21/2022]
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