Bone mineral density reference values in Singaporean adults and comparisons for osteoporosis establishment - The Yishun Study

Comparison of the prevalence of osteoporosis in people with spinal cord injury according to bone mineral density reference values for the diagnosis of osteoporosis: a retrospective, cross-sectional study

BACKGROUND

Spinal cord injury (SCI) is a complex cause of rapid low bone mass that easily predisposes the affected individuals to osteoporosis-induced fractures. Several studies have investigated osteoporosis pathophysiology in SCI; however, those associated with its diagnosis in SCI are limited. Additionally, errors in osteoporosis diagnosis and its prevalence vary based on the bone mineral density (BMD) reference values (BMDRV), and no studies have reported BMDRV application for osteoporosis diagnosis in individuals with SCI. Therefore, this study aimed to compare the prevalence of osteoporosis among Korean adults aged ≥ 50 years with SCI according to BMDRV for diagnosing osteoporosis.

METHODS

Overall, 855 patients with SCI who underwent BMD tests of the lumbar spine, femoral neck, and total hip at the National Rehabilitation Center (NRC) in Korea between 2010 and 2020 were included in this retrospective cross-sectional study. Osteoporosis was diagnosed in patients with SCI by comparing the differences in prevalence, diagnostic consistency, and risk factors according to the region-based BMDRV of the dual-energy x-ray absorptiometry (DXA) manufacturer and international BMDRV based on the Third National Health and Nutrition Examination Survey (NHANES III) data of females aged 20-29 years.

RESULTS

The prevalence of osteoporosis according to the T-score provided by a single reference population of the NHANES III (TNHA) (PONHA) (males: 26.69%; females: 69.35%) was significantly higher in females and males than that according to the T-scores provided by the DXA manufacturer (TDXA) (PODXA) (males: 15.32%; females: 43.15%). The lumbar spine and femoral neck were major osteoporosis diagnosis sites for the PODXA and PONHA, respectively. Risk factors for osteoporosis differed based on the probability of osteoporosis (also known as the OZ ratio) according to the BMD criteria; however, the risk factors were similar according to old age, female sex, low body mass index (BMI), and long SCI period. No significant relationship was noted between the different SCI-related clinical factors (p > 0.05).

CONCLUSIONS

The osteoporosis diagnostic site and prevalence in SCI differed according to the regional-based TDXA and international standards of the TNHA. Therefore, further studies on BMDRV are warranted to establish accurate diagnostic criteria for osteoporosis prevention in patients with SCI.

Racial/Ethnic Differences in Bone Mineral Density for Osteoporosis

PURPOSE OF REVIEW

We primarily aim to review differences in bone mineral density (BMD) for osteoporosis among different racial/ethnic groups and to highlight the magnitude of racial/ethnic differences in obesity and diabetes. We also explore the factors contributing to the BMD differences among various subgroups. In addition, we investigate the existing disparities in research, educational initiatives, screening practices, and treatment options for osteoporosis and discuss these findings' clinical and public health implications.

RECENT FINDINGS

Racial/ethnic differences in BMD for osteoporosis exist in the USA and other countries. There are disparities regarding osteoporosis screening and treatment. Understanding the factors contributing to these differences can help develop targeted interventions and policies to reduce their impact. Clinicians should consider the racial/ethnic differences in BMD when making treatment decisions and providing preventive care. Future research could contribute to developing effective strategies for preventing osteoporosis among different racial/ethnic groups. This review offered a comprehensive examination of differences in BMD across various racial and ethnic groups, elucidating the influence of genetic, lifestyle, and cultural factors on these differences. This review also highlighted the disparities in osteoporosis screening, treatment options, research on medical effectiveness, and educational outreach tailored to each subgroup. Recognizing the importance of addressing these inequalities, we present this review to advocate for targeted interventions to reduce disparities in osteoporosis and improve bone health for all populations.

Prevalence of osteoporosis and incidence of related fractures in developed economies in the Asia Pacific region: a systematic review

Robust data on osteoporosis in the Asia Pacific region could improve healthcare decision-making. Osteoporosis affects 10-30% of women aged 40 + , and up to 10% of men in 7 developed economies in Asia Pacific. Fractures affect 500-1000 adults aged 50 + per 100,000 person-years. Policymakers and clinicians must address this problem.

PURPOSE

Osteoporosis and associated fractures result in considerable morbidity, loss of productivity, early mortality, and increased healthcare expenses. Many countries in the Asia Pacific (AP) region, especially middle- and higher-income economies, are faced with aging and increasingly sedentary populations. It is critical to consolidate and analyze the available information on the prevalence and incidence of the disease in these countries.

METHODS

We systematically reviewed articles and gray literature for Australia, China, Hong Kong, Japan, Singapore, South Korea, and Taiwan. We searched PubMed, ScienceDirect, JSTOR, Cochrane, Google Scholar, and other databases for data published 2009-2018. We included articles with prevalence or incidence estimates for adults with osteoporosis or related fractures.

RESULTS

All locations had data available, but of widely varying quantity and quality. Most estimates for osteoporosis prevalence ranged from 10 to 30% for women ages 40 and older, and up to 10% for men. Osteoporotic fracture incidence typically ranged between 500 and 1000 per 100,000 person-years among adults aged 50 and older. Both outcomes typically increased with age and were more common among women.

CONCLUSION

Osteoporosis and associated fractures affect significant portions of the adult population in developed economies in the AP region. Governments and healthcare systems must consider how best to prevent and diagnose osteoporosis, and manage affected individuals, to reduce healthcare costs and mortality associated with fractures.

DXAGE 2.0 - adult age at death estimation using bone loss in the proximal femur and the second metacarpal

The accurate age at death assessment of unidentified adult skeletal individuals is a critical research task in forensic anthropology, being a key feature for the determination of biological profiles of individual skeletal remains. We have previously shown that the age-related decrease of bone mineral density (BMD) in the proximal femur could be used to assess age at death in women (Navega et al., J Forensic Sci 63:497-503, 2018). The present study aims to generate models for age estimation in both sexes through bone densitometry of the femur and radiogrammetry of the second metacarpal. The training sample comprised 224 adults (120 females, 104 males) from the "Coimbra Identified Skeletal Collection," and different models were generated through least squares regression and general regression neural networks (GRNN). The models were operationalized in a user-friendly online interface at https://osteomics.com/DXAGE2/ . The mean absolute difference between the known and estimated age at death ranges from 9.39 to 13.18 years among women and from 10.33 to 15.76 among men with the least squares regression models. For the GRNN models, the mean absolute difference between documented and projected age ranges from 8.44 to 12.58 years in women and from 10.56 to 16.18 years in men. DXAGE 2.0 enables age estimation in incomplete and/or fragmentary skeletal remains, using alternative skeletal regions, with reliable results.

Reference values for bone density and bone mineral content from 5 to 80 years old in a province of Chile

Background

The assessment of bone health throughout the life cycle is essential to determine fracture risk. The objectives of the work were (a) compare bone mineral density and content with international references from the United States, (b) determine maximum bone mass, (c) propose references for bone health measurements from ages 5 to 80 years old.

Methods

Research was carried out on 5,416 subjects. Weight and height were measured. Body Mass Index (BMI) was calculated. The total body was scanned using dual energy X-ray absorptiometry (DXA). Information was extracted from the bone health measures (bone mineral density (BMD) and bone mineral content (BMC)) for both sexes, according to pediatric and adult software.

Results and Discussion

Differences were identified between the mean values of Chilean and American men for BMD (~0.03 to 0.11 g/cm²) and BMC (~0.15 to 0.46 g). Chilean females showed average values for BMD similar to the US references (~-0.01 to 0.02 g/cm²). At the same time, they were relatively higher for BMC (~0.07 to 0.33 g). The cubic polynomial regression model reflected a relationship between BMD and BMC with chronological age in both sexes. For males, R² was higher (R² = 0.72 and 0.75) than for females (R² = 0.59 and 0.66). The estimate of maximum bone mass (MBM) for males emerged at 30 years old (1.45 ± 0.18 g/cm² of BMD and 3.57 ± 0.60 g of BMC) and for females at age 28 (1.22 ± 0.13 g/cm² of BMD and 2.57 ± 0.44 g of BMC). The LMS technique was used to generate smoothed percentiles for BMD and BMC by age and sex. Results showed that maximum bone mass occurred in females at age 28 and in males at 30. Reference values obtained from this research may be used to evaluate bone health, diagnose bone fragility and osteoporosis in individuals and regional population groups.

The Prevalence of Osteoporosis in Patients Older than 50 Years with Distal Radius Fractures in an Institutional Registry of 2,572 Patients in Singapore

Background: The distal radius is one of the common sites for fragility fractures. A fracture of the distal radius in the elderly is often associated with low bone mineral density (BMD). It is an early predictor of osteoporosis and increased risk of subsequent fragility fractures of the hip and the spine with greater morbidity. Osteoporosis is becoming an increasing cause for concern in the elderly population. The aim of this study is to determine the prevalence of osteoporosis in patients aged 50 years and above with distal radius fractures in our local population. Methods: This is a retrospective study of all patients aged 50 years and above who were treated for a distal radius fracture at our institution over a 4-year period. Data regarding gender, mechanism of injury (low or high energy), and outcome of BMD scans were collected. The data were analyzed to look at the prevalence of osteoporosis and osteopenia and the relation amongst BMD, gender, and the mechanism of injury. Results: About 2,572 patients aged 50 years and above were treated at our institution over a 4-year period from 2013 to 2016. The average age of the patients was 67.7 years old and 1,938 (75.3%) were women. A total of 1,034 patients had BMD scans and of these 56.0% had osteoporosis and 37.4% had osteopenia. There was no correlation between the prevalence of osteoporosis and gender or the mechanism of injury. Conclusions: The prevalence of osteoporosis in patients aged 50 and above with distal radius fractures is a significant cause for concern in Singapore. Routine assessment for osteoporosis is recommended for all patients above 50 years old with distal radius fractures. Level of Evidence: Level III (Therapeutic).

Bone mineral density following liver transplantation: a 10-year trend analysis

We evaluated the prevalence of osteoporosis and annual changes in bone mineral density (BMD) over 10 years post-liver transplantation. BMD in the lumbar spine improved significantly post-transplantation, reaching a 12% increase at year 10. In contrast, BMD in the femoral neck and hip deteriorated and did not return to baseline levels.

INTRODUCTION

This study (1) evaluated the prevalence of osteoporosis, and the annual changes in bone mineral density (BMD) over 10 years, and (2) identified the risk factors for worsened BMD in stable liver transplant recipients (LTRs).

METHODS

LTRs who underwent liver transplantation (LT) at Singapore General Hospital between February 2006 and Mar 2019 were included. Demographic, clinical data, and BMD in the lumbar spine (LS), femoral neck (FN), and total hip (TH) were collected retrospectively from the medical records.

RESULTS

Eighty-three patients (mean age: 55 ± 8 years) with a median follow-up of 80 months were included. The prevalence of osteoporosis increased significantly from 18.1% pre-LT to 34.3% post-LT (p = 0.021), and the incidence of osteoporosis was 18.2%. Worsened BMD (normal to osteopenia/osteopenia to osteoporosis) was found in 27.2% of LTRs. No significant risk factors were associated with worsened BMD, but females had a trend towards a higher odd (adjusted odds ratio: 3.54, 95%CI (0.61-20.5), p = 0.159). The LS BMD increased within 6-month post-LT and continued to improve throughout the entire follow-up period. In contrast, BMD in the FN and TH deteriorated and did not return to baseline levels post-LT.

CONCLUSION

Prevalence of osteoporosis increased significantly post-LT. Over a 10-year follow-up, 27.2% of LTRs had worsened BMD status, and a possible risk factor may be female gender. While the LS BMD improved with time, the BMD in the FN and TH persisted below baseline throughout the follow-up period. Future studies should explore long-term therapies to improve BMD in the FN and TH post-LT.

Racial and Ethnic Disparities in Bone Health and Outcomes in the United States

Osteoporosis is a bone disease classified by deterioration of bone microarchitecture and decreased bone strength, thereby increasing subsequent risk of fracture. In the United States, approximately 54 million adults aged 50 years and older have osteoporosis or are at risk due to low bone mass. Osteoporosis has long been viewed as a chronic health condition affecting primarily non-Hispanic white (NHW) women; however, emerging evidence indicates racial and ethnic disparities in bone outcomes and osteoporosis management. The primary objective of this review is to describe disparities in bone mineral density (BMD), prevalence of osteoporosis and fracture, as well as in screening and treatment of osteoporosis among non-Hispanic black (NHB), Hispanic, and Asian adults compared with NHW adults living on the US mainland. The following areas were reviewed: BMD, osteoporosis prevalence, fracture prevalence and incidence, postfracture outcomes, DXA screening, and osteoporosis treatments. Although there are limited studies on bone and fracture outcomes within Asian and Hispanic populations, findings suggest that there are differences in bone outcomes across NHW, NHB, Asian, and Hispanic populations. Further, NHB, Asian, and Hispanic populations may experience suboptimal osteoporosis management and postfracture care, although additional population-based studies are needed. There is also evidence that variation in BMD and osteoporosis exists within major racial and ethnic groups, highlighting the need for research in individual groups by origin or background. Although there is a clear need to prioritize future quantitative and qualitative research in these populations, initial strategies for addressing bone health disparities are discussed. © 2021 American Society for Bone and Mineral Research (ASBMR).

Late Effects of Allogeneic Hematopoietic Stem Cell Transplantation in an Asian Patient Population

Background

Long-term survivors of allogeneic hematopoietic stem cell transplantation (alloHSCT) are at a substantial risk of developing medical late effects. We aimed to determine the incidence of metabolic syndrome (MS), cardiovascular (CV) events, bone density loss, and fractures in a cohort of patients who underwent alloHSCT for hematologic disorders. The potential risk factors for MS, CV events, bone density loss, and fractures, as well as the sufficiency of existing monitoring measures in our institution, were also evaluated.

Methods

A single-center, retrospective study was conducted. We included patients who underwent alloHSCT at the Singapore General Hospital between January 2011 and December 2016, were at least 21 years old, and had a minimum follow-up period of 6 months. Patients with MS-related data comprised the CV study population, whereas patients with bone loss-related data comprised the skeletal study population. Associations between risk factors and the development of MS or bone loss were assessed using a univariate analysis followed by multivariate logistic regression. All analyses were performed using SPSS version 23.

Results

A total of 91 patients were included in the CV study population, of which 13 (14.3%) had preexisting MS, 17 (18.7%) developed MS, and 5 (5.5%) developed CV events after alloHSCT. Thirty-one patients were included in the skeletal study population, of which 2 (6.5%) had preexisting bone loss, 23 (71.0%) developed osteopenia or osteoporosis, and 2 (6.5%) had a fracture. After adjusting for preexisting MS, pretransplant abdominal obesity (p=0.002), elevated triglyceride (p<0.001), and fasting hyperglycemia (p<0.001) significantly predicted MS on multivariate analyses. Only female sex predicted the risk of bone loss after alloHSCT on multivariate analyses after adjusting for preexisting osteopenia (p=0.02). Of the 174 patients who underwent alloHSCT during the study period, 83 (47.7%) and 143 (82.2%) patients had no MS-related data and bone loss-related data, respectively.

Conclusion

Long-term alloHSCT survivors are at an increased risk of MS, CV complications, and bone loss. This underscores the importance of close monitoring and timely interventions to reduce long-term morbidity and mortality.

Coexistence of osteoporosis, sarcopenia and obesity in community-dwelling adults - The Yishun Study

OBJECTIVES

To 1) report prevalence of 'osteosarcopenia' (OS) and osteosarcopenic obesity (OSO) entities using evidence-based diagnostic techniques and definitions, 2) examine if OSO offers additional predictive value of functional decline over its components, and 3) identify associated factors in a multi-racial Southeast Asian population.

METHODS

We performed a cross-sectional study of a representative sample of 542 community-dwelling adults (21-90 years old), and assessed anthropometry, cognition, functional performance, and self-report sociodemographic, health and lifestyle questionnaires. Low muscle mass, and the Asian Working Group for Sarcopenia (AWGS) 2019 criteria, were used to assess sarcopenia. Obesity was defined using percentage body fat and fat mass index. Osteopenia/osteoporosis was determined using lumbar spinal bone mineral density. Associated factors were examined using logistic regression, and OSO's value investigated using linear regressions with functional performance.

RESULTS

OS and OSO prevalence were 1.8% and 0% (21-59 years), 12.9% and 2.8% (≥ 60 years), 17.3% and 4.1% (≥ 65 years), and 25.5% and 7.0% (≥75 years), respectively. OSO entity as defined was not a significant predictor (P > 0.05) and did not improve explanations for functional decline over sarcopenia or sarcopenic obesity. Age, sex, race and body mass index (BMI) were associated with OS, while age, sex, race and alcoholism were associated with OSO.

CONCLUSIONS

Our results do not support OSO as a distinct entity in relation to functional decline. Aside from biological age, sex, and race, amenable lifestyle factors such as BMI and alcohol intake are important variables that can influence the co-existence of osteopenia/osteoporosis, sarcopenia and obesity.