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Adida S, Taori S, Wong VR, Tang A, Sefcik RK, Zhang X, Gerszten PC. Analysis of injected cement volume and clinical outcomes following balloon-assisted kyphoplasty in a series of 368 patients. Clin Neurol Neurosurg 2024; 243:108367. [PMID: 38851118 DOI: 10.1016/j.clineuro.2024.108367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Balloon-assisted kyphoplasty (BAK) is a modified vertebroplasty technique developed to treat vertebral compression fractures (VCFs) secondary to osteoporosis. This study investigates the association between injected cement volume and the development of subsequent VCFs after BAK. METHODS A retrospective analysis of 368 patients who underwent BAK at a single institution was performed from 2001 to 2021. Inclusion was defined by at least 2 years of follow-up. Clinical characteristics and outcomes following BAK, including subsequent fractures at adjacent and remote levels, were identified. Patients that underwent a thoracic BAK were stratified by injected cement volume: below or equal to the median (≤ 6.0 mL, 265 vertebrae) or above the median (> 6.0 mL, 144 vertebrae). Patients that underwent a lumbar BAK were similarly stratified: below or equal to the median (≤ 8.0 mL, 233 vertebrae) or above the median (>8.0 mL, 160 vertebrae). RESULTS A total of 802 vertebrae were treated. The average volume of cement was recorded in the thoracic (6.2 ± 1.9 mL) and lumbar (7.8 ± 1.8 mL) vertebrae. In the thoracic spine, vertebrae that were injected with > 6.0 mL of cement underwent a greater change in local kyphotic angle (P = 0.0001) and were more likely to develop adjacent-level VCFs (P = 0.032) after kyphoplasty. Univariate analysis did not elucidate any additional risk factors. There were no statistical differences in clinical outcomes between the three groups of lumbar vertebrae. CONCLUSIONS Larger volumes of injected cement were associated with a greater change in local kyphosis and subsequent adjacent-level fractures after BAK in the thoracic spine. This association was not found in the lumbar spine. Close attention to injected cement volumes must be made in the thoracic spine and patients who undergo significant kyphotic correction should be carefully observed postoperatively.
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Affiliation(s)
- Samuel Adida
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Suchet Taori
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213, USA; Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Victoria R Wong
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213, USA
| | - Anthony Tang
- University of Pittsburgh School of Medicine, 200 Lothrop Street, Suite B-400, Pittsburgh, PA 15213, USA
| | - Roberta K Sefcik
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Xiaoran Zhang
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Xin Z, Xu H, Zhang X, Samelson EJ, Kiel DP, Liu CT. Association of bone fracture with 30-year body mass index (BMI) trajectories: findings from the Framingham Heart Study : Bone fracture and 30-year BMI trajectories. Osteoporos Int 2024; 35:1205-1212. [PMID: 38587675 DOI: 10.1007/s00198-024-07068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
A knowledge gap exists in associating later life's osteoporotic fracture and middle adulthood's BMI trajectories. We observed an association showing those transitioning from overweight to normal weight face a higher fracture risk in late adulthood, emphasizing the potential benefits of maintaining a stable BMI to reduce late-life fractures. PURPOSE Numerous studies on the relationship between obesity and fractures have relied on body mass index (BMI) at a single time point, yielding inconclusive results. This study investigated the association of BMI trajectories over middle adulthood with fracture risk in late adulthood. METHODS This prospective cohort study analyzed 1772 qualified participants from the Framingham Original Cohort Study, with 292 (16.5%) incident fractures during an average of 17.1-year follow-up. We constructed BMI trajectories of age 35-64 years based on latent class mixed modeling and explored their association with the risk of fracture after 65 years using the Cox regression. RESULTS The result showed that compared to the BMI trajectory Group 4 (normal to slightly overweight; see "Methods" for detailed description), Group 1 (overweight declined to normal weight) had a higher all-fracture risk after age 65 (hazard ratio [HR], 2.22, 95% CI, 1.13-4.39). The secondary analysis focusing on lower extremity fractures (pelvis, hip, leg, and foot) showed a similar association pattern. CONCLUSIONS This study suggested that people whose BMI slightly increased from normal weight to low-level overweight during 30 years of middle adulthood confer a significantly lower risk of fracture in later life than those whose BMI declined from overweight to normal weight. This result implies the potentially beneficial effects of avoiding weight loss to normal weight during middle adulthood for overweight persons, with reduced fracture risk in late life.
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Affiliation(s)
- Zihao Xin
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Third Floor, Boston, MA, 02118, USA
| | - Hanfei Xu
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Third Floor, Boston, MA, 02118, USA
| | - Xiaoyu Zhang
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Third Floor, Boston, MA, 02118, USA
| | - Elizabeth J Samelson
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Third Floor, Boston, MA, 02118, USA.
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Li HL, Shen Y, Tan LH, Fu SB, Guan CH, Zhen DH, Lv HH, Wu XY, Tang XL. Association between BMI and osteoporotic fractures at different sites in Chinese women: a case-control retrospective study in Changsha. BMC Musculoskelet Disord 2024; 25:187. [PMID: 38424521 PMCID: PMC10903060 DOI: 10.1186/s12891-024-07271-x] [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: 10/24/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Osteoporotic fractures are a growing problem in an aging society. The association between body mass index (BMI) and osteoporotic fractures varies by fracture site and ethnicity. Limited knowledge exists regarding this association in native Chinese, particularly utilizing local databases as reference sources. OBJECTIVE To investigate the association between BMI and osteoporotic fractures at different sites in Chinese women. METHODS Three thousand ninety-eight female patients with radiographic fractures and 3098 age- and sex-matched healthy controls without fractures were included in the study. Both of them underwent assessment using dual-energy X-ray absorptiometry (DXA), with BMD measurements calculated using our own BMD reference database. Participants were classified into underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24 ≤ BMI < 28 kg/m2) and obese (BMI ≥ 28 kg/m2) according to the Chinese BMI classification standard. RESULTS There were 2296 (74.1%) vertebral fractures, 374 (12.1%) femoral neck fractures, and 428 (13.8%) other types of fractures in the case group. Bone mineral density (BMD) was almost lower in the fracture groups compared to the control groups (p = 0.048 to < 0.001). Compared with normal weight, underweight had a protective effect on total [odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.49 -0.75; P< 0.001], and lumbar fractures (OR = 0.52; 95% CI, 0.41 - 0.67; P < 0.001), while obesity was associated with an increased risk for total (OR = 2.26; 95% CI, 1.85 - 2.76; P < 0.001), lumbar (OR = 2.17; 95% CI, 1.72 - 2.73; P < 0.001), and femoral neck fractures (OR = 4.08; 95% CI, 2.18 - 7.63; P < 0.001). Non-linear associations were observed between BMI and fractures: A J-curve for total, lumbar, and femoral neck fractures, and no statistical change for other types of fractures. Underweight was found to be a risk factor for other types of fracturess after adjusting for BMD (OR = 2.29; 95% CI, 1.09 - 4.80; P < 0.001). Osteoporosis and osteopenia were identified as risk factors for almost all sites of fracture when compared to normal bone mass. CONCLUSIONS Underweight has a protective effect on total and lumbar spine fractures in Chinese women, while obesity poses a risk factor for total, lumbar, and femoral neck fractures. The effect of BMI on fractures may be mainly mediated by BMD.
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Affiliation(s)
- Hong-Li Li
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
- Department of Metabolism and Endocrinology, and Hunan Provincial Key Laboratory for Metabolic Bone Diseases, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China
| | - Yi Shen
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China
| | - Li-Hua Tan
- Department of Radiology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China
| | - Song-Bo Fu
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Cong-Hui Guan
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Dong-Hu Zhen
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Hai-Hong Lv
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Xi-Yu Wu
- Department of Metabolism and Endocrinology, and Hunan Provincial Key Laboratory for Metabolic Bone Diseases, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China.
| | - Xu-Lei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China.
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Liu HF, Meng DF, Yu P, De JC, Li HY. Obesity and risk of fracture in postmenopausal women: a meta-analysis of cohort studies. Ann Med 2023; 55:2203515. [PMID: 37190975 DOI: 10.1080/07853890.2023.2203515] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Obesity is associated with an increased risk of fracture in adults, but is unclear in postmenopausal women. We aim to determine the association of obesity with the risk of fracture in postmenopausal women. METHODS PubMed, EMBASE, Cochrane Library and Web of Science were searched up to 11 April 2022 for cohort studies. And the included studies regarding the relationship between obesity with all cause of fracture in postmenopausal women were included in our meta-analysis. Data were screened and extracted independently by two reviewers. The relative risks (RR) were estimated using a random-effects model. Between-study heterogeneity was assessed using Cochran's Q and I2 statistics. RESULTS Eight cohort studies comprising 671,532 postmenopausal women and 40,172 fractures were included. Overall, the pooling analysis shows that obesity in postmenopausal women is associated with an increased risk of all-cause fracture (relative ratio (RR) = 1.18; 95% confidence interval (CI):1.09-1.28, I2 = 86.3%, p = .000). Sub-analyses for each site of fracture indicate that obesity was associated with an increased risk of vertebral fracture in postmenopausal women (RR = 1.154, 95% CI: 1.020-1.305, I2 = 94.5%, p = .023), but reduced the risk of pelvic fracture (RR = 0.575, 95% CI:0.470-0.702, I2 = 0.0%, p = .000). There is no statistically significant difference in the risk of hip and humerus fractures associated with obesity in postmenopausal women. CONCLUSION Obesity is associated with an increased risk of all-cause and vertebral fractures in postmenopausal women, but is a protective factor for pelvic fractures. Our findings suggest that postmenopausal women who regulate their weight might lower their risk of fractures.Registration: (PROSPERO: CRD42022324973)KEY MESSAGESObesity is associated with an increased risk of all-cause and vertebral fractures in postmenopausal women.Obesity maybe a protective factor for pelvic fractures in postmenopausal women.Postmenopausal women should regulate their weight to prevent fractures.
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Affiliation(s)
- Hong-Fei Liu
- College of Orthopaedics and Traumatology, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Dong-Fang Meng
- Orthopaedic Department, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Peng Yu
- College of Orthopaedics and Traumatology, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Ji-Cao De
- Clinical Medicine, Gannan Tibetan Autonomous Prefecture Tibetan Medical Hospital, Gannan, Gansu, China
| | - Hui-Ying Li
- Orthopaedic Department, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, Henan, China
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Liang H, Jiajue R, Qi W, Jiang Y, Cui L, Pang Q, Chi Y, Liu W, Wang Q, Wang W, Pei Y, Wang X, Huang W, Zheng X, Ning Z, Wang O, Li M, Xing X, Yu W, Xu L, Xia W. Influence of Obesity and Changes in Weight or BMI on Incident Fractures in Postmenopausal Women: From Peking Vertebral Fracture Study. Calcif Tissue Int 2023; 113:483-495. [PMID: 37704776 DOI: 10.1007/s00223-023-01129-5] [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: 06/24/2023] [Accepted: 08/17/2023] [Indexed: 09/15/2023]
Abstract
This study aims to investigate the influence of overweight/obesity and change in weight or body mass index (BMI) on incident fractures among Chinese postmenopausal women. According to BMI, 754 postmenopausal women were categorized into normal weight (NW), overweight (OW), and obesity (OB) groups, respectively. We used data from the baseline and the second survey for statistical analysis, including anthropometric data, clinical fractures, and morphometric vertebral fractures (MVFs) assessed by X-rays. The prevalence of previous MVFs was 32.7% and 21.8% in the OB and NW groups, respectively (p < 0.05). All incident fractures and incident MVFs accounted for 10.7 and 6.3% among all participants within five years. Overweight/obesity and increase in weight or BMI during the follow-up had no associations with all incident fractures, incident MVFs, and incident clinical non-VFs among all participants. However, after multivariate adjustment, the increased BMI at baseline was the risk factor of incident MVFs in the OW group (odds ratio, OR 2.06, 95% confidence interval, 95% CI 1.16-3.66, p = 0.014), and increase in weight (OR 0.89, 95% CI 0.79-0.99, p = 0.036) or BMI (OR 0.77, 95% CI 0.59-0.99, p = 0.045) during the follow-up were the protective factors of all incident fractures in the NW group. Overweight/obesity and change in weight or BMI do not correlate with fracture risk in postmenopausal women, but an increase in weight is the protective factor against incident fractures in normal-weight participants. Overweight postmenopausal women with a higher BMI should pay attention to the risk of MVFs.
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Affiliation(s)
- Hanting Liang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Ruizhi Jiajue
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Wenting Qi
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Lijia Cui
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Qianqian Pang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Yue Chi
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Wei Liu
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Qiuping Wang
- Department of Endocrinology, Beijing Liangxiang Hospital, Beijing, 102401, China
| | - Wenbo Wang
- Department Endocrinology, Peking University Shougang Hospital, Beijing, 100144, China
| | - Yu Pei
- Department of Geriatric Endocrinology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiran Wang
- Department of Cadre Unit, General Hospital of the Second Artillery Force, Beijing, 100088, China
| | - Wei Huang
- Department of Endocrinology, Beijing Haidian Hospital, Beijing, 100080, China
| | - Xin Zheng
- Department of Endocrinology, China Rehabilitation Research Center, Beijing, 100068, China
| | - Zhiwei Ning
- Department of Endocrinology, Beijing Chaoyang Hospital, Beijing, 100020, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xiaoping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Ling Xu
- Department of Gynaecology and Obstetrics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, 100730, China
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shuaifuyuan No. 1, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
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Kim JG, Hong JY, Park J, Park SM, Han K, Kim HJ, Yeom JS. Risk of fracture according to temporal changes of low body weight changes in adults over 40 years: a nationwide population-based cohort study. BMC Public Health 2023; 23:948. [PMID: 37231395 PMCID: PMC10210452 DOI: 10.1186/s12889-023-15940-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 05/19/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Low body weight is associated with an increased risk of fractures. However, the effect of temporal changes in the low body weight status on the risk of fracture remains unknown. This study aimed to evaluate the relationships between temporal changes in low body weight status and the risk of fractures in adults over the age of 40 years. METHODS This study included data on adults over 40 years old who underwent two biannual consecutive general health examinations between January 1, 2007 and December 31, 2009 extracted from the National Health Insurance Database, a large nationwide population database. Fracture cases in this cohort were monitored from the time of the last health examination to the end of the designated follow-up period (from January 1, 2010 to December 31, 2018) or the participant's death. Fractures were defined as any fracture resulting in hospitalization or outpatient treatment claim after the date of general health screening. The study population was then separated into four groups based on the temporal changes in low body weight status as follows: low body weight to low body weight (L-to-L), low body weight to non-low body weight (L-to-N), non-low body weight to low body weight (N-to-L), and non-low body weight to non-low body weight (N-to-N). The hazard ratios (HRs) for new fractures, depending on weight changes over time, were calculated using Cox proportional hazard analysis. RESULTS Adults in the L-to-L, N-to-L, and L-to-N groups had a substantially increased risk of fractures after multivariate adjustment (HR, 1.165; 95% confidence interval [CI], 1.113-1.218; HR, 1.193; 95% CI, 1.131-1.259; and HR, 1.114; 95% CI, 1.050-1.183, respectively). Although the adjusted HR was greater in participants who changed into having a low body weight, followed by those with consistently low body weight, those with low body weight remained to have an elevated risk of fracture independent of weight fluctuation. Elderly men (aged over 65 years), high blood pressure, and chronic kidney disease were significantly associated with an increase in fractures (p < 0.05). CONCLUSION Individuals aged over 40 years with low body weight, even after regaining normal weight, had an increased risk of fracture. Moreover, having a low body weight after having a normal body weight increased the risk of fractures the most, followed by those with consistently low body weight.
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Affiliation(s)
- Jung Guel Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Jae-Young Hong
- Department of Orthopedics, Korea University Hospital, Ansan, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea
| | - Jiwon Park
- Department of Orthopedics, Korea University Hospital, Ansan, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea
| | - Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea.
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-Ro, Dongjak-Gu, Seoul, 06978, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-Ro 173 Beon-Gil, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13620, Republic of Korea
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7
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Park SM, Park J, Han S, Jang HD, Hong JY, Han K, Kim HJ, Yeom JS. Underweight and risk of fractures in adults over 40 years using the nationwide claims database. Sci Rep 2023; 13:8013. [PMID: 37198201 PMCID: PMC10192329 DOI: 10.1038/s41598-023-34828-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
We aimed to investigate how underweight affects the incidence of fractures, as well as the influence of cumulative, longitudinal periods of low body mass index (BMI) and changes in body weight on fracture development. Data on adults aged 40-year and over who had three health screenings between January 1, 2007, and December 31, 2009 were used to determine the incidence of new fractures. The hazard ratios (HRs) for new fractures depending on BMI, total cumulative number of underweight, and weight change over time were calculated using Cox proportional hazard analysis. In this study, 15,955 (2.8%) of the 561,779 adults were diagnosed with fractures more than once over three health examinations. The fully adjusted HR for fractures in underweight individuals was 1.173 (95% Confidence interval [CI] 1.093-1.259). Underweight individuals diagnosed only once, twice, or three times had an adjusted HR of 1.227 (95%CI 1.130-1.332), 1.174 (95%CI 1.045-1.319), and 1.255 (95%CI 1.143-1.379), respectively. Although the adjusted HR was higher in adults who consistently had underweight (HR; 1.250 [95%CI 1.146-1.363]), those with underweight had an increased risk of fractures regardless of weight change (HR; 1.171 [95%CI 1.045-1.312], and 1.203[95%CI 1.075-1.346]). Underweight is a risk factor for fractures in adults over the age of 40 years, even if they returned to normal weight.
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Affiliation(s)
- Sang-Min Park
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jiwon Park
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea
| | - Sangsoo Han
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, 170 Jomaru-Ro, Bucheon, 14584, Republic of Korea
| | - Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, 170 Jomaru-Ro, Bucheon, 14584, Republic of Korea
| | - Jae-Young Hong
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan, 123, Jeokgeum-Ro, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 15355, Republic of Korea.
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-Ro, Dongjak-Gu, Seoul, 06978, Republic of Korea
| | - Ho-Joong Kim
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin S Yeom
- Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea
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Huang D, Wang J, Zeng Y, Li Q, Wang Y. Identifying microbial signatures for patients with postmenopausal osteoporosis using gut microbiota analyses and feature selection approaches. Front Microbiol 2023; 14:1113174. [PMID: 37077242 PMCID: PMC10106639 DOI: 10.3389/fmicb.2023.1113174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/15/2023] [Indexed: 04/05/2023] Open
Abstract
Osteoporosis (OP) is a metabolic bone disorder characterized by low bone mass and deterioration of micro-architectural bone tissue. The most common type of OP is postmenopausal osteoporosis (PMOP), with fragility fractures becoming a global burden for women. Recently, the gut microbiota has been connected to bone metabolism. The aim of this study was to characterize the gut microbiota signatures in PMOP patients and controls. Fecal samples from 21 PMOP patients and 37 controls were collected and analyzed using amplicon sequencing of the V3-V4 regions of the 16S rRNA gene. The bone mineral density (BMD) measurement and laboratory biochemical test were performed on all participants. Two feature selection algorithms, maximal information coefficient (MIC) and XGBoost, were employed to identify the PMOP-related microbial features. Results showed that the composition of gut microbiota changed in PMOP patients, and microbial abundances were more correlated with total hip BMD/T-score than lumbar spine BMD/T-score. Using the MIC and XGBoost methods, we identified a set of PMOP-related microbes; a logistic regression model revealed that two microbial markers (Fusobacteria and Lactobacillaceae) had significant abilities in disease classification between the PMOP and control groups. Taken together, the findings of this study provide new insights into the etiology of OP/PMOP, as well as modulating gut microbiota as a therapeutic target in the diseases. We also highlight the application of feature selection approaches in biological data mining and data analysis, which may improve the research in medical and life sciences.
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Affiliation(s)
- Dageng Huang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Jihan Wang
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an, China
| | - Yuhong Zeng
- Department of Osteoporosis, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Qingmei Li
- Department of Osteoporosis, Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Qingmei Li,
| | - Yangyang Wang
- School of Electronics and Information, Northwestern Polytechnical University, Xi’an, China
- Yangyang Wang,
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Cumulative Burden of Being Underweight Increases the Risk of Hip Fracture: A Nationwide Population-Based Cohort Study. Healthcare (Basel) 2022; 10:healthcare10122568. [PMID: 36554091 PMCID: PMC9778138 DOI: 10.3390/healthcare10122568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
(1) Background: Being underweight is a known risk factor for hip fractures. However, it is unclear whether the cumulative underweight burden affects the incidence of hip fractures. Therefore, we explored the effect of the cumulative underweight burden on the development of hip fractures; (2) Methods: In a cohort of adults aged 40 years and older, 561,779 participants who were not underweight and had no hip fractures from 2007 to 2009 were identified. The risk of hip fracture from the time of the last examination to December 2018 according to the cumulative burden of being underweight (based on 0 to 3 examinations) was prospectively analyzed; (3) Results: During follow-up (mean 8.3 ± 0.8 years), the prevalence of newly diagnosed hip fractures was 0.2%, 0.4%, 0.5%, and 0.9% among those with 0, 1, 2, and 3 cumulative underweight, respectively. The adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of groups meeting the diagnostic criteria for underweight 1, 2, and 3 compared to 0 were 2.3 (1.6−3.3), 2.9 (1.8−4.5), and 4.5 (3.4−6.1), respectively (p for trend < 0.01); (4) Conclusions: The risk of hip fracture increased as the burden of underweight accumulated.
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da Cruz GF, Lunz TM, Rocha de Jesus T, Costa MB, Vidigal CV, Albergaria BH, Marques-Rocha JL, Guandalini VR. Low appendicular skeletal muscle mass index is associated with the anthropometric variables of post-menopausal women. BMC Geriatr 2022; 22:639. [PMID: 35922763 PMCID: PMC9346057 DOI: 10.1186/s12877-022-03313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/18/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Skeletal muscle mass is a central component of body composition and its decline is enhanced during aging. We verified the association between the appendicular skeletal muscle mass index (ASMI) with the anthropometric variables, biochemical variables, and lifestyle of postmenopausal women. METHODS Cross-sectional observational study conducted with postmenopausal women. Sociodemographic, clinical, lifestyle, physical activity level, biochemical, and anthropometric markers were collected. Body composition was assessed by dual-energy densitometry. Multivariate logistic regression analysis was applied. RESULTS One hundred fourteen women aged in average 66.0 ± 5.8 years were evaluated. There was a significant association between ASMI and age (p = 0.004), body mass (p < 0.001), body mass index (BMI) (p < 0.001), adductor pollicis muscle thickness (APMT) (p < 0.001), plasma calcium levels (p = 0.003), calf circumference (CC), and waist circumference (WC) (p < 0.001 for both). Adjusted regression analyses revealed the influence of BMI, CC, and APMT in the 1st tertile of ASMI (p < 0.05), BMI and CC in the 2rd tertile of ASMI. CONCLUSIONS ASMI was associated with BMI and muscle mass reserve indicators such as CC and DAPMT. In clinical practice, this indicates that simple, low-cost measures with good applicability can be used to predict and track the risk of depletion of skeletal muscle mass and consequent sarcopenia.
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Affiliation(s)
- Geise Ferreira da Cruz
- Department of Integrated Health Education, Federal University of Espirito Santo, Vitoria, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
| | - Tatiana Mion Lunz
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
| | - Tatielle Rocha de Jesus
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
| | - Mariana Braga Costa
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
| | - Camila Vilarinho Vidigal
- Department of Integrated Health Education, Federal University of Espirito Santo, Vitoria, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
| | - Ben-Hur Albergaria
- Department of Social Medicine, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
| | - José Luiz Marques-Rocha
- Department of Integrated Health Education, Federal University of Espirito Santo, Vitoria, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, 29040-090, Brazil
| | - Valdete Regina Guandalini
- Department of Integrated Health Education, Federal University of Espirito Santo, Vitoria, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, 29040-090, Brazil.
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, 29040-090, Brazil.
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Khinda R, Valecha S, Kumar N, Walia JPS, Singh K, Sethi S, Singh A, Singh M, Singh P, Mastana S. Prevalence and Predictors of Osteoporosis and Osteopenia in Postmenopausal Women of Punjab, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052999. [PMID: 35270692 PMCID: PMC8910053 DOI: 10.3390/ijerph19052999] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 01/02/2023]
Abstract
The prevalence and predictors of osteoporosis and osteopenia remain to be examined in the postmenopausal women of Punjab, India. The present cross-sectional study screened 1628 postmenopausal women during September 2019 to March 2020. Osteoporosis and osteopenia were confirmed on the basis of T-scores using dual energy X-ray absorptiometry (DXA) at the hip (femoral neck) and lumbar spine regions (L1−L4 vertebrae). The prevalence of osteoporosis and osteopenia was observed to be 30.50% and 44.20%, respectively, in postmenopausal women of Punjab. In univariable and multivariable regression analysis, variables independently influencing the risk of osteoporosis and osteopenia were: higher systolic blood pressure (95%CI: 1.22−3.11 & 1.08−2.49), triglyceride levels (95%CI: 1.21−3.10 & 1.42−2.51), poor sleep quality (95%CI: 1.91−2.47 & 1.76−3.47) and C-reactive protein levels (95%CI: 2.18−3.56 & 1.03−2.18). Years since menopause >10 years was observed to be an independent predictor for the risk of osteopenia but not for osteoporosis. Higher body mass index (>30 kg·m−2) was observed to be a significant protective factor against the risk of osteoporosis (95%CI: 0.26−0.68) and osteopenia (95%CI: 0.19−0.52). The higher prevalence rates of osteoporosis and osteopenia in postmenopausal women of Punjab are alarming, which solicits awareness and earlier testing of those women who are approaching menopause.
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Affiliation(s)
- Rubanpal Khinda
- Department of Human Genetics, Punjabi University, Patiala 147002, Punjab, India; (R.K.); (S.V.); (N.K.); (M.S.)
| | - Srishti Valecha
- Department of Human Genetics, Punjabi University, Patiala 147002, Punjab, India; (R.K.); (S.V.); (N.K.); (M.S.)
| | - Nitin Kumar
- Department of Human Genetics, Punjabi University, Patiala 147002, Punjab, India; (R.K.); (S.V.); (N.K.); (M.S.)
| | - J. P. S. Walia
- Department of Orthopedics, Aggarsain Charitable Hospital, Patiala 147002, Punjab, India;
| | - Kuldeep Singh
- Department of Orthopedics, Government Medical College and Hospital, Patiala 147002, Punjab, India;
| | - Sudhir Sethi
- Department of Orthopedics, Mata Kaushalya Hospital, Patiala 147002, Punjab, India;
| | - Avtar Singh
- Department of Orthopedics, Amandeep Hospital, Amritsar 143001, Punjab, India;
| | - Monica Singh
- Department of Human Genetics, Punjabi University, Patiala 147002, Punjab, India; (R.K.); (S.V.); (N.K.); (M.S.)
| | - Puneetpal Singh
- Department of Human Genetics, Punjabi University, Patiala 147002, Punjab, India; (R.K.); (S.V.); (N.K.); (M.S.)
- Correspondence: (P.S.); (S.M.)
| | - Sarabjit Mastana
- Human Genomics Lab, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough LE11 3TU, UK
- Correspondence: (P.S.); (S.M.)
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da Cruz GF, Lunz TM, de Jesus TR, Costa MB, Vidigal CV, Albergaria BH, Marques-Rocha JL, Guandalini VR. Influence of the appendicular skeletal muscle mass index on the bone mineral density of postmenopausal women. BMC Musculoskelet Disord 2021; 22:861. [PMID: 34627216 PMCID: PMC8501937 DOI: 10.1186/s12891-021-04748-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 09/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The appendicular skeletal muscle mass index (ASMI) is an important risk indicator for osteoporosis because of the anatomical proximity and metabolic connection between muscle and bone mass. The present study investigated the relationship between ASMI and the bone mineral density (BMD) categories of postmenopausal women. METHODS In this cross-sectional study with a probabilistic sample, sociodemographic, lifestyle, menopause time, anthropometric, and physical activity variables were collected. ASMI and BMD were assessed by dual-energy X-ray absorptiometry (DXA). Participants were grouped according to BMD values into normal density, osteopenia, and osteoporosis. Multivariate logistic regression models were applied to verify the influence of ASMI on BMD. Data were analyzed using the SPSS statistical software, version 22. The significance level for all tests was set at 5%. RESULTS Of the 114 women analyzed, most were between 60 and 69.9 years of age (62.3%), on menopause for ≤19.0 (51.8%), self-declared brown race/color (49.1%), had < 4 years of education (41.2%), never smoked (69.0%) or drank alcohol (62.8%). Of these, 52.6% were classified as sufficiently active and 52.2% had regular sun exposure. Women with osteoporosis were older (p = 0.035), on menopause for a longer time (p = 0.011), underweight (p = 0.004), had adequate waist circumference (p = 0.017), and low ASMI values (p = 0.002). There was an association between the 1st tertile of ASMI and osteoporosis. However, after adjustments for age, race/color, and body mass index, the strength of association between BMD and ASMI was not maintained. CONCLUSIONS ASMI was not associated with the BMD of the postmenopausal women evaluated. Total body and muscle mass, in addition to bone mass, should be monitored during menopause treatment. Longitudinal studies must be conducted to elucidate the mechanisms and gaps in this relationship.
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Affiliation(s)
- Geise Ferreira da Cruz
- Postgraduate Program in Nutrition and Health, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, CEP: 29040-090, Brazil
| | - Tatiana Mion Lunz
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, CEP: 29040-090, Brazil
| | - Tatielle Rocha de Jesus
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, CEP: 29040-090, Brazil
| | - Mariana Braga Costa
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, CEP: 29040-090, Brazil
| | - Camila Vilarinho Vidigal
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, CEP: 29040-090, Brazil
| | - Ben-Hur Albergaria
- Department of Social Medicine, Federal University of Espirito Santo, Marechal Campos avenue, 1468 - Maruípe, Vitória, Espírito Santo, CEP: 29040-090, Brazil
| | - Jose Luiz Marques-Rocha
- Postgraduate Program in Nutrition and Health, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, CEP: 29040-090, Brazil
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, CEP: 29040-090, Brazil
| | - Valdete Regina Guandalini
- Postgraduate Program in Nutrition and Health, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, CEP: 29040-090, Brazil.
- Department of Integrated Education, Federal University of Espirito Santo, Marechal Campos, avenue, 1468 - Maruípe, Vitória, Espírito Santo, CEP: 29040-090, Brazil.
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