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Does metabolic syndrome increase the risk of fracture? A systematic review and meta-analysis. Arch Osteoporos 2022; 17:118. [PMID: 36042109 DOI: 10.1007/s11657-022-01149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 07/18/2022] [Indexed: 02/03/2023]
Abstract
UNLABELLED Metabolic syndrome is of increasing concern globally. The aspects of this disease and its interaction with other morbidities should be discussed in detail. By investigating the effects of metabolic syndrome on the bone fracture rate, we have shown a protective role for metabolic syndrome in the male population. PURPOSE There is controversy on the effects of metabolic syndrome on bone health and fracture risk. This systematic review and meta-analysis reappraises the literature on the subject and quantitatively evaluates the fracture risk in individuals with metabolic syndrome. METHODS PubMed, Embase, Web of Science, and Scopus were searched for all relevant articles. Studies were selected if they included the rate of any type of fracture in individuals with metabolic syndrome. Non-English studies, review articles, case reports, and editorials were excluded. The titles and abstracts were screened to identify relevant studies and the data was extracted from these. The data were analyzed to determine the estimated effect at a 95% confidence interval. Publication bias was assessed using the Egger's test, and funnel plots were drawn. The heterogeneity of the results was determined according to I2 statistics. RESULTS Of the 3141 articles from the initial search, 20 studies were selected for review and included 13 cross-sectional and seven cohort studies. A meta-analysis of all studies showed no association between metabolic syndrome and fractures across the entire population (HR = 0.954; p = 0.410). However, separate analysis of the cohort studies showed a decreased risk over the entire population (HR = 0.793; p = 0.000) and in males (HR = 0.671; p = 0.000), but not in females (HR = 1.029; p = 0.743). CONCLUSION This systematic review and meta-analysis showed that the current literature suggests that metabolic syndrome is a protective factor for bone fractures in males but has no net effect on fractures among females.
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Hoang DV, Akter S, Inoue Y, Kuwahara K, Fukunaga A, Islam Z, Nakagawa T, Honda T, Yamamoto S, Okazaki H, Miyamoto T, Ogasawara T, Sasaki N, Uehara A, Yamamoto M, Kochi T, Eguchi M, Shirasaka T, Shimizu M, Nagahama S, Hori A, Imai T, Nishihara A, Tomita K, Nishiura C, Konishi M, Kabe I, Yamamoto K, Mizoue T, Dohi S. Metabolic syndrome and the increased risk of medically-certified long-term sickness absence: a prospective analysis among Japanese workers. J Epidemiol 2021. [PMID: 34690243 PMCID: PMC10165215 DOI: 10.2188/jea.je20210185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) has been associated with various chronic diseases which may lead to long-term sickness absence (LTSA), but there is lacking information on the direct association between MetS and LTSA. The present study aimed to investigate the all-cause and cause-specific associations between MetS and the risk of medically-certified LTSA among Japanese workers. METHOD We recruited 67,403 workers (57,276 men and 10,127 women), aged 20-59 years, of 13 companies in Japan, during their health check-ups in 2011 (11 companies) and 2014 (2 companies), and followed them up for LTSA events (≥ 30 consecutive days) until March 31, 2020. MetS was defined according to the Joint Interim Statement. A Cox proportional hazards regression model was used to estimate hazard ratio (HR) and its 95% confidence interval (CI) for LTSA associated with MetS and its components. RESULTS During 408,324 person-years of follow-up, 2,915 workers experienced LTSA. The adjusted HR for all-cause LTSA was 1.54 (95% CI, 1.41-1.68) among those with vs without MetS. In cause-specific analysis, HRs associated with MetS significantly increased for LTSA due to overall physical disorders (1.76), cardiovascular diseases (3.16), diseases of the musculoskeletal system and connective tissue (2.01), cancers (1.24), obesity-related cancers (1.35), mental, behavioral and neurodevelopmental disorders (1.28), reaction to severe stress and adjustment disorders (1.46) and external causes (1.46). The number of MetS components were also significantly associated with increased LTSA risk. CONCLUSION MetS was associated with an increase in the risk of LTSA due to various diseases among Japanese workers.
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Affiliation(s)
- Dong V Hoang
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
| | - Shamima Akter
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
| | - Yosuke Inoue
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
| | - Keisuke Kuwahara
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine.,Graduate School of Public Health, Teikyo University
| | - Ami Fukunaga
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
| | - Zobida Islam
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
| | | | - Toru Honda
- Hitachi Health Care Center, Hitachi, Ltd
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ai Hori
- Department of Global Public Health, Faculty of Medicine, University of Tsukuba
| | | | | | | | | | - Maki Konishi
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
| | | | - Kenya Yamamoto
- Division of Chemical Information, National Institute of Occupational Safety and Health
| | - Tetsuya Mizoue
- Department of Epidemiology and Prevention, National Center for Global Health and Medicine
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Lasschuit JWJ, Center JR, Greenfield JR, Tonks KTT. Comparison of calcaneal quantitative ultrasound and bone densitometry parameters as fracture risk predictors in type 2 diabetes mellitus. Diabet Med 2020; 37:1902-1909. [PMID: 31724226 DOI: 10.1111/dme.14183] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2019] [Indexed: 01/06/2023]
Abstract
AIM To investigate the utility of calcaneal quantitative ultrasound compared with bone densitometry (DXA) in predicting incident low-trauma fracture in type 2 diabetes. METHODS This retrospective cohort study included a subset of participants in the Dubbo Osteoporosis Epidemiology Study who had concurrent calcaneal quantitative ultrasound and DXA measurement, comprising 809 people without type 2 diabetes and 96 with type 2 diabetes. Fracture data had been collected prospectively. Cox proportional hazard models and receiver operating curves (ROC) were used to compare calcaneal quantitative ultrasound and DXA parameters as predictors for any low-trauma fracture. RESULTS The median age of participants was 71 years (IQR 68-76, 50% men) for those without type 2 diabetes and 70 years (IQR 68-76, 55% men) for those with type 2 diabetes. There was no difference in low-trauma fracture incidence between groups when stratified by sex. In those without type 2 diabetes, the hazard ratio for fracture per 1 sd decrease in broadband ultrasound attenuation and femoral neck bone mineral density (BMD) was 1.47 [95% confidence interval (CI) 1.26-1.71] and 1.39 (95% CI 1.17-1.64), respectively. The corresponding figures in type 2 diabetes were 1.81 (95% CI 1.03-3.19) for broadband ultrasound attenuation and 2.55 (95% CI 1.28-5.08) for femoral neck BMD. CONCLUSION Broadband ultrasound attenuation is comparable with femoral neck BMD as a predictor for low trauma incident fracture in type 2 diabetes. Calcaneal quantitative ultrasound offers several advantages over DXA and should be considered in further studies of bone health screening or in clinical practice where DXA is unavailable.
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Affiliation(s)
- J W J Lasschuit
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW, Australia
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - J R Center
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW, Australia
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - J R Greenfield
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW, Australia
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - K T T Tonks
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, NSW, Australia
- Diabetes and Metabolism Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
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Chin KY, Wong SK, Ekeuku SO, Pang KL. Relationship Between Metabolic Syndrome and Bone Health - An Evaluation of Epidemiological Studies and Mechanisms Involved. Diabetes Metab Syndr Obes 2020; 13:3667-3690. [PMID: 33116718 PMCID: PMC7569044 DOI: 10.2147/dmso.s275560] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome (MetS) and osteoporosis are two medical problems plaguing the ageing populations worldwide. Though seemingly distinctive to each other, metabolic derangements are shown to influence bone health. This review summarises the relationship between MetS and bone health derived from epidemiological studies and explains the mechanistic basis of this relationship. The discourse focuses on the link between MetS and bone mineral density, quantitative sonometric indices, geometry and fracture risk in humans. The interesting sex-specific trend in the relationship, probably due to factors related to body composition and hormonal status, is discussed. Mechanistically, each component of MetS affects the bone distinctly, forming a complex interacting network influencing the skeleton. Lastly, the effects of MetS management, such as pharmacotherapies, exercise and bariatric surgery, on bone, are presented. This review aims to highlight the significant relationship between MetS and bone, and proper management of MetS with the skeletal system in mind could prevent cardiovascular and bone complications.
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Affiliation(s)
- Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Correspondence: Kok-Yong Chin Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, MalaysiaTel +60 3-9145 9573 Email
| | - Sok Kuan Wong
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sophia Ogechi Ekeuku
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kok-Lun Pang
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Tükel HC, Delilbaşı E. Effects of metabolic syndrome on jawbones and bone metabolic markers in sucrose-fed rats. Odontology 2019; 107:457-464. [DOI: 10.1007/s10266-019-00422-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/12/2019] [Indexed: 12/20/2022]
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Felice JI, Schurman L, McCarthy AD, Sedlinsky C, Aguirre JI, Cortizo AM. Effects of fructose-induced metabolic syndrome on rat skeletal cells and tissue, and their responses to metformin treatment. Diabetes Res Clin Pract 2017; 126:202-213. [PMID: 28259010 DOI: 10.1016/j.diabres.2017.02.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/06/2016] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
Abstract
AIMS Deleterious effects of metabolic syndrome (MS) on bone are still controversial. In this study we evaluated the effects of a fructose-induced MS, and/or an oral treatment with metformin on the osteogenic potential of bone marrow mesenchymal stromal cells (MSC), as well as on bone formation and architecture. METHODS 32 male 8week-old Wistar rats were assigned to four groups: control (C), control plus oral metformin (CM), rats receiving 10% fructose in drinking water (FRD), and FRD plus metformin (FRDM). Samples were collected to measure blood parameters, and to perform pQCT analysis and static and dynamic histomorphometry. MSC were isolated to determine their osteogenic potential. RESULTS Metformin improved blood parameters in FRDM rats. pQCT and static and dynamic histomorphometry showed no significant differences in trabecular and cortical bone parameters among groups. FRD reduced TRAP expression and osteocyte density in trabecular bone and metformin only normalized osteocyte density. FRD decreased the osteogenic potential of MSC and metformin administration could revert some of these parameters. CONCLUSIONS FRD-induced MS shows reduction in MSC osteogenic potential, in osteocyte density and in TRAP activity. Oral metformin treatment was able to prevent trabecular osteocyte loss and the reduction in extracellular mineralization induced by FRD-induced MS.
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Affiliation(s)
- Juan Ignacio Felice
- Laboratorio de Investigaciones en Osteopatías y Metabolismo Mineral (LIOMM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Argentina
| | - León Schurman
- Laboratorio de Investigaciones en Osteopatías y Metabolismo Mineral (LIOMM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Argentina
| | - Antonio Desmond McCarthy
- Laboratorio de Investigaciones en Osteopatías y Metabolismo Mineral (LIOMM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Argentina
| | - Claudia Sedlinsky
- Laboratorio de Investigaciones en Osteopatías y Metabolismo Mineral (LIOMM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Argentina
| | - José Ignacio Aguirre
- Department of Physiological Sciences, University of Florida, Gainesville, FL, USA
| | - Ana María Cortizo
- Laboratorio de Investigaciones en Osteopatías y Metabolismo Mineral (LIOMM), Facultad de Ciencias Exactas, Universidad Nacional de La Plata, Argentina.
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Qin L, Yang Z, Zhang W, Gu H, Li X, Zhu L, Lu S, Xing Y, Zhang H, Niu Y, Ning G, Su Q. Metabolic syndrome and osteoporotic fracture: a population-based study in China. BMC Endocr Disord 2016; 16:27. [PMID: 27233999 PMCID: PMC4882795 DOI: 10.1186/s12902-016-0106-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/15/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Associations between metabolic syndrome (MetS) and osteoporotic fracture have been reported. However, the epidemiological studies are not conclusive. The objective of the study was to determine whether metabolic syndrome associates with osteoporotic fracture. METHODS This was a cross-sectional study of 9930 Chinese adults aged 40 year or older in the Chongming District, Shanghai, China. A questionnaire, anthropometric measurements and laboratory tests were conducted. MetS was defined according to the updated National Cholesterol Education Program Adult Treatment Panel III criteria for Asian-Americans. A history of fractures was collected with an interviewer-assisted questionnaire. Osteoporotic fractures were defined as fractures that occurred due to low-trauma in 2 years prior to the study. RESULTS Among women, the prevalence of osteoporotic fractures was significantly higher in those with MetS (3.5 vs. 2.6 %, P =0.028). However, the difference was not found in men (2.6 vs. 2.4 %, P =0.737). The presence of Mets was significantly associated with increased odds of osteoporotic fracture among women (odds ratio 1.22; 95 % confidence interval 1.12-1.54; P = 0.039) after controlling for potential confounders. The significant associations were not detected in men. CONCLUSIONS The presence of MetS was significantly associated with a recent history of osteoporotic fracture in middle-aged and elderly Chinese women.
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Affiliation(s)
- Li Qin
- Department of Endocrinology, Xinhua hospital Chongming branch, School of medicine, Shanghai Jiaotong University, 25 Nanmen Road, Shanghai, China
- Department of Endocrinology, Xinhua hospital, School of medicine, Shanghai Jiaotong University, Shanghai, China
| | - Zhen Yang
- Department of Endocrinology, Xinhua hospital Chongming branch, School of medicine, Shanghai Jiaotong University, 25 Nanmen Road, Shanghai, China.
- Department of Endocrinology, Xinhua hospital, School of medicine, Shanghai Jiaotong University, Shanghai, China.
| | - Weiwei Zhang
- Department of Endocrinology, Xinhua hospital, School of medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hongxia Gu
- Department of Endocrinology, Xinhua hospital Chongming branch, School of medicine, Shanghai Jiaotong University, 25 Nanmen Road, Shanghai, China
| | - Xiaoyong Li
- Department of Endocrinology, Xinhua hospital, School of medicine, Shanghai Jiaotong University, Shanghai, China
| | - Lingfei Zhu
- Department of Endocrinology, Xinhua hospital, School of medicine, Shanghai Jiaotong University, Shanghai, China
| | - Shuai Lu
- Department of Endocrinology, Xinhua hospital Chongming branch, School of medicine, Shanghai Jiaotong University, 25 Nanmen Road, Shanghai, China
| | - Yin Xing
- Department of Endocrinology, Xinhua hospital Chongming branch, School of medicine, Shanghai Jiaotong University, 25 Nanmen Road, Shanghai, China
| | - Hongmei Zhang
- Department of Endocrinology, Xinhua hospital, School of medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yixin Niu
- Department of Endocrinology, Xinhua hospital, School of medicine, Shanghai Jiaotong University, Shanghai, China
| | - Guang Ning
- Department of Endocrinology, Ruijin hospital, School of medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qing Su
- Department of Endocrinology, Xinhua hospital Chongming branch, School of medicine, Shanghai Jiaotong University, 25 Nanmen Road, Shanghai, China.
- Department of Endocrinology, Xinhua hospital, School of medicine, Shanghai Jiaotong University, Shanghai, China.
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Li R, Li W, Lun Z, Zhang H, Sun Z, Kanu JS, Qiu S, Cheng Y, Liu Y. Prevalence of metabolic syndrome in Mainland China: a meta-analysis of published studies. BMC Public Health 2016; 16:296. [PMID: 27039079 PMCID: PMC4818385 DOI: 10.1186/s12889-016-2870-y] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/16/2016] [Indexed: 02/07/2023] Open
Abstract
Background Metabolic syndrome (MS) comprises a set of conditions that are risk factors for cardiovascular diseases and diabetes. Numerous epidemiological studies on MS have been conducted, but there has not been a systematic analysis of the prevalence of MS in the Chinese population. Therefore, the aim of this study was to estimate the pooled prevalence of MS among subjects in Mainland China. Methods We performed a systematic review by searching both English and Chinese literature databases. Random or fixed effects models were used to summarize the prevalence of MS according to statistical tests for heterogeneity. Subgroup, sensitivity, and meta-regression analyses were performed to address heterogeneity. Publication bias was evaluated using Egger’s test. Results Thirty-five papers were included in the meta-analysis, with a total population of 226,653 Chinese subjects. Among subjects aged 15 years and older, the pooled prevalence was 24.5 % (95 % CI: 22.0–26.9 %). By sex, the prevalences were 19.2 % (95 % CI: 16.9–21.6 %) in males and 27.0 % (95 % CI: 23.5–30.5 %) in females. The pooled prevalence of MS increased with age (15–39 years: 13.9 %; 40–59 years: 26.4 %; and ≥60 years: 32.4 %). Individuals living in urban areas (24.9 %, 95 % CI: 18.5–31.3 %) were more likely to suffer from MS than those living in rural areas (19.2 %, 95 % CI: 14.8–23.7 %). Hypertension was the most prevalent component of MS in males (52.8 %), while the most prevalent component of MS for females was central obesity (46.1 %). Conclusions Our systematic review suggested a high prevalence of MS among subjects in Mainland China, indicating that MS is a serious public health problem. Therefore, more attention should be paid to the prevention and control of MS. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-2870-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ri Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Wenchen Li
- Department of Neurotrauma, First Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Zhijun Lun
- Department of Library, First Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Huiping Zhang
- Department of Psychiatry, VA Medical Center, Yale University School of Medicine, West Haven, USA
| | - Zhi Sun
- Clinical Laboratory of China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Joseph Sam Kanu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Shuang Qiu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Yi Cheng
- Department of Cardiovascular Center, First Hospital of Jilin University, Changchun City, Jilin Province, China
| | - Yawen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun City, Jilin Province, China.
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