Influence of obesity on vertebral fracture prevalence and vitamin D status in postmenopausal women

Cardiovascular risk factors in Moroccan women: systematic review and meta-analysis

BACKGROUND

Cardiovascular diseases (CVD) are the major cause of disability and premature death. This is due to the ascending trend of consuming an unhealthy diet and obesity which increases the risk of hypertension and type 2 diabetes mellitus. The main aim of this review was to fill the knowledge gap by providing an up-to-date overview of the prevalence of CVD risk factors among women and to estimate the pooled prevalence among adolescent and pregnant women in Morocco.

METHODS

The review included original cross-sectional studies reporting the prevalence of CVD risk factors in Moroccan women aged ≥ 15 years, published between January 2008 and December 2022. The databases searched included MEDLINE, Scopus, Web of Science, Google Scholar and national government publications (PROSPERO ID: CRD42023426809).

RESULTS

Initially, 1471 articles were identified, and 76 studies were included. The most commonly reported CVD risk factor was obesity (reported in 56 studies), the prevalence of obesity varies according to the age groups of women with the rate being particularly high in urban women aged ≥ 35 years (ranging of 14-44.9%). Followed by diabetes (ranging from 7.2 to 12.6%) with a high rate in menopausal women. Hypertension prevalence ranged from 29.8 to 39.29%. Among adolescents, the overall prevalence of obesity was 3.15% (95% CI: 2.6%, 3.7%) and the prevalence of physical inactivity was 56.5% (95% CI: 36.9 - 76%). Among pregnant women, the overall prevalence of obesity was 26.8% (95% CI: 15.5 - 38.2%). Gestational diabetes and hypertension were 15.2% (95% CI: 6.3 - 24.1%) and 7.07% (95% CI: 2.5 - 11.6%), respectively.

CONCLUSION

This review highlights the significant burden of CVD risk factors among Moroccan women, with a high prevalences of diabetes, obesity, hypertension. The prevalences of these risk factors varies with age, being notably higher in older age groups. These findings underscore the need for targeted public health interventions to address these risk factors. Future research should focus on longitudinal studies and standardized assessment tools to enhance the robustness of prevalence estimates and inform effective prevention strategies.

Association of overweight and obesity with vertebral fractures: a systematic review and meta-analysis

INTRODUCTION

Over the past decade, there has been increasing interest in exploring the relationship between overweight, obesity and vertebral fractures. Nonetheless, available data from studies on the relationship between overweight, obesity and vertebral fractures remains controversial.

EVIDENCE ACQUISITION

A systematic search was performed in the PubMed and Cochrane Library databases. We selected relevant literature by using these keywords: fracture, vertebral fracture, vertebral compression fracture, overweight, obese, obesity. The retrieval mainly collected publicly published observational studies on the correlation between overweight, obesity and vertebral fractures, excluding the literature that did not meet the inclusion criteria. Meta-analysis for the data extracted from all the included literatures was performed by STATA 12.0 (StataCorp LLC, College Station, TX, USA) to summarize test performance with forest plots and assess the heterogeneity.

EVIDENCE SYNTHESIS

Ten studies, including 1,024,181 subjects satisfied the predefined eligibility criteria. The results showed that the overweight (25.0≤ Body Mass Index [BMI] ≤29.9 kg/m2) and obesity (BMI≥30.0kg/m2) were associated with a decreased risk of vertebral fractures, respectively. The pooled RR is 0.86 (95% CI: 0.79, 0.95) and 0.81(95% CI:0.74-0.90) with no evidence of statistical heterogeneity. However, the relationship between overweight/obesity (BMI≥25 kg/m2) and vertebral fractures is not statistically significant.

CONCLUSIONS

This study showed that overweight and obesity might decrease the risk of vertebral fractures, respectively. However, we did not observe a significant association between overweight/obesity (BMI≥25 kg/m2) and vertebral fractures.

Influence of Obesity and Changes in Weight or BMI on Incident Fractures in Postmenopausal Women: From Peking Vertebral Fracture Study

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.

The pathophysiology of osteoporosis in obesity and type 2 diabetes in aging women and men: The mechanisms and roles of increased bone marrow adiposity

Osteoporosis is defined as a systemic skeletal disease characterized by decreased bone mass and micro-architectural deterioration leading to increased fracture risk. Osteoporosis incidence increases with age in both post-menopausal women and aging men. Among other important contributing factors to bone fragility observed in osteoporosis, that also affect the elderly population, are metabolic disturbances observed in obesity and Type 2 Diabetes (T2D). These metabolic complications are associated with impaired bone homeostasis and a higher fracture risk. Expansion of the Bone Marrow Adipose Tissue (BMAT), at the expense of decreased bone formation, is thought to be one of the key pathogenic mechanisms underlying osteoporosis and bone fragility in obesity and T2D. Our review provides a summary of mechanisms behind increased Bone Marrow Adiposity (BMA) during aging and highlights the pre-clinical and clinical studies connecting obesity and T2D, to BMA and bone fragility in aging osteoporotic women and men.

Osteoporotic hip and vertebral fractures in the Arab region: a systematic review

Asia is projected to account for the largest proportion of the rising burden of osteoporotic fractures worldwide. Data from the Middle East is scarce. We performed a systematic review on the epidemiology of vertebral and hip osteoporotic fractures in 22 Arab League countries, using Scopus, PubMed, and Embase. We identified 67 relevant publications, 28 on hip and 39 on vertebral fractures. The mean age of patients was 70-74 years, female to male ratio 1.2:2.1. Age-standardized incidence rates, to the UN 2010 population, were 236 to 290/100,000 for women from Kuwait and Lebanon, lower in Morocco. Risk factors for hip fractures included lower BMD or BMI, taller stature, anxiolytics, and sleeping pills. Most patients were not tested nor treated. Mortality derived from retrospective studies ranged between 10 and 20% at 1 year, and between 25 and 30% at 2-3 years. Among 39 studies on vertebral fractures, 18 described prevalence of morphometric fractures. Excluding grade 1 fractures, 13.3-20.2% of women, mean age 58-74 years, had prevalent vertebral fractures, as did 10-14% of men, mean age 62-74 years. Risk factors included age, gender, smoking, multiparity, years since menopause, low BMD, bone markers, high sclerostin, low IgF1, hypovitaminosis D, abdominal aortic calcification score, and VDR polymorphisms. Vertebral fracture incidence in women from Saudi Arabia, mean age 61, was 6.2% at 5 years, including grade 1 fractures. Prospective population-based fracture registries, prevalence studies, predictive models, fracture outcomes, and fracture liaison services from Arab countries are still lacking today. They are the pillars to closing the care gap of this morbid disease.

The association between overweight/obesity and vertebral fractures in older adults: a meta-analysis of observational studies

A meta-analysis of observational studies was conducted to assess the relationship between overweight/obesity and vertebral fractures in older adults. We found that overweight was related to a decreased risk of vertebral fractures in female and non-Asian populations, while obesity failed to be associated with vertebral fracture risks based on the present data.

INTRODUCTION

Recent investigations suggest that the influence of overweight/obesity on fracture risks is site-specific, while conflicting data were reported related to vertebral fracture. This meta-analysis was performed to qualitatively assess the relationship between overweight/obesity and the risk of vertebral fracture.

METHODS

MEDLINE, Web of Science, Embase, and Cochrane were searched for relevant observational articles assessing the vertebral fracture risk of the overweight or obese population compared to normal population. Two independent reviewers conducted data extraction and quality assessment. Relative risks (RR) and 95% confidence intervals (CI) were pooled using a random effect model.

RESULTS

Eleven studies including 1,078,094 participants were extracted from 1645 records. Pooled RR showed that decreased risk of vertebral fractures was observed in the overweight older adults (RR: 1.16; 95% CI: 1.07-1.26; I²: 51.8%), but not in the obese populations (RR: 0.98; 95% CI: 0.82-1.17; I²: 92.1%). In the subgroup analysis, we found a significant inverse association between overweight and risk of vertebral fracture in women (RR: 0.92; 95% CI: 0.85-1.00; I²: 0.0%), non-Asian areas (RR: 0.89; 95% CI: 0.80-0.99; I²: 40.7%), sample size > 2000 (RR: 0.87; 95% CI: 0.80-0.94; I²: 4.9%), and quality score > 7 (RR: 0.87; 95% CI: 0.79-0.95; I²: 21.9%). Furthermore, pooled studies of sample size > 2000 (RR: 0.66; 95% CI: 0.76, 0.89; I²: 52.1%) and quality score > 7 (RR: 0.75; 95% CI: 0.62, 0.91; I²: 68.1%) showed that the people with obesity had a significantly lower prevalence of vertebral fracture.

CONCLUSIONS

Overweight aged adults tend to have a lower vertebral fracture risk. When gender and ethnicity were taken into consideration, the inverse relationship between overweight and vertebral fracture risk were only observed in female and non-Asian populations. Besides, there is insufficient data to conclude the relationship between obesity and the risk of vertebral fractures, and thus, further studies are needed.

Association between fractures and traditional risk factors for osteoporosis and low bone mineral density in patients with obesity

Objective

To evaluate the reasons for request of bone mineral density (BMD) evaluation and correlate the BMD results with previous fractures, risk factors for osteoporosis, and clinical characteristics in patients with obesity.

Methods

Cross-sectional, retrospective, single-site study including adult patients with body mass index (BMI) ≥ 30 kg/m² and BMD evaluation between January 2015 and May 2016 selected from a BMD database. Data on demographic characteristics, lifestyle habits, comorbidities, medications, risk factors, previous fractures, and indications for BMD evaluation were collected from the participants' medical records.

Results

The study included 619 patients (89.9% women, mean BMI 34.79 ± 4.05 kg/m²). In all, 382 (61.7%), 166 (26.8%), and 71 (11.5%) patients had class 1, 2, and 3 obesity, respectively. The most frequent (29.9%) reason for BMD evaluation was for osteoporosis monitoring. In all, 69.4% of the patients had low BMD. Multivariate analysis showed that age, calcium supplementation, and previous osteoporosis or osteopenia were associated with low BMD, while age, vitamin D supplementation, use of proton pump inhibitors (PPIs), and low BMD were associated with previous fractures (p < 0.05 for all).

Conclusion

Among patients with obesity identified from a tertiary hospital database, those with low bone mass and risk factors traditionally associated with fractures had an increased history of fractures. Patients with greater BMI had better bone mass and fewer fractures. These findings indicate that the association between reduced weight, risk factors for osteoporosis, and fractures remained despite the presence of obesity in our population.

Consensus evidence-based clinical practice guidelines for the diagnosis and treat-to-target management of osteoporosis in Africa: an initiative by the African Society of Bone Health and Metabolic Bone Diseases

The objective of this consensus statement is to inform the clinical practice communities, research centres and policymakers across Africa of the results of the recommendations for osteoporosis prevention, diagnosis and management. The developed guideline provides state-of-the-art information and presents the conclusions and recommendations of the consensus panel regarding these issues.

PURPOSE

To reach an African expert consensus on a treat-to-target strategy, based on current evidence for best practice, for the management of osteoporosis and prevention of fractures.

METHOD

A 3-round Delphi process was conducted with 17 osteoporosis experts from different African countries. All rounds were conducted online. In round 1, experts reviewed a list of 21 key clinical questions. In rounds 2 and 3, they rated the statements stratified under each domain for its fit (on a scale of 1-9). After each round, statements were retired, modified or added in view of the experts' suggestions and the percent agreement was calculated. Statements receiving rates of 7-9 by more than 75% of experts' votes were considered as achieving consensus.

RESULTS

The developed guidelines adopted a fracture risk-centric approach. Results of round 1 revealed that of the 21 proposed domains, 10 were accepted whereas 11 were amended. In round 2, 32 statements were presented: 2 statements were retired for similarity, 9 statements reached consensus, whereas modifications were suggested for 21 statements. After the 3rd round of rating, the experts came to consensus on the 32 statements. Frequency of high-rate recommendation ranged from 83.33 to 100%. The response rate of the experts was 100%. An algorithm for the osteoporosis management osteoporosis was suggested.

CONCLUSION

This study is an important step in setting up a standardised osteoporosis service across the continent. Building a single model that can be applied in standard practice across Africa will enable the clinicians to face the key challenges of managing osteoporosis; furthermore, it highlights the unmet needs for the policymakers responsible for providing bone health care together with and positive outcomes of patients' care.

Relationship Between Obesity and Risk of Major Osteoporotic Fracture in Postmenopausal Women: Taking Frailty Into Consideration

The role of obesity in fracture risk remains uncertain and inconclusive in postmenopausal women. Our study aimed to assess the relationship between obesity and risk of major osteoporotic fracture (MOF; ie, a clinical fracture of upper arm or shoulder, hip, spine, or wrist) in postmenopausal women, after taking frailty into consideration. We used the data from the Global Longitudinal Study of Osteoporosis in Women (GLOW) 5-year Hamilton cohort for this study. Frailty was measured by a frailty index (FI) of deficit accumulation at baseline. We incorporated an interaction term (obesity × FI) in the Cox proportional hazards regression model. We included 3985 women (mean age 69.4 years) for analyses, among which 29% were obese (n = 1118). There were 200 (5.02%) MOF events documented during follow-up: 48 (4.29%) in obese women and 152 (5.65%) in the nonobese group. Significant relationships between obesity, frailty, and MOF risk were found: hazard ratio (HR) = 0.72 (95% confidence interval [CI] 0.67-0.78) for those with an FI of zero regarding MOF risk among obese women, and HR = 1.34 (95% CI 1.11-1.62) per SD increase in the FI among nonobese women. The interaction term was also significant: HR = 1.16 (95% CI 1.02-1.34) per SD increase in the FI among obese women. Increased HRs were found with higher FIs regarding the relationship between obesity and MOF risk, indicating increasing frailty attenuated the protective effect of obesity. For example, although the HR for obesity and MOF risk among those who were not frail (FI = 0) was 0.72 (95% CI 0.67-0.78), among those who were very frail (FI = 0.70), the HR was 0.91 (95% CI 0.85-0.98). To conclude, after taking frailty into consideration, obesity was significantly associated with decreased risk of MOF in postmenopausal women among those who were not frail; however, increasing frailty attenuated this protective effect of obesity. Evaluating frailty status may aid in understanding of the complex relationship between obesity and fracture risk. © 2020 American Society for Bone and Mineral Research (ASBMR).

Soft tissue variations influence HR-pQCT density measurements in a spatially dependent manner

OBJECTIVE

Significant weight loss following treatments for obesity undermines bone metabolism and increases bone turnover and fracture incidence. High resolution peripheral quantitative computed tomography (HR-pQCT) is widely used in skeletal heath assessment research to provide noninvasive bone parameter measurement (e.g. volumetric bone mineral density (vBMD)) with minimal radiation exposure. However, variation in body composition among study groups or longitudinal variations within individuals undergoing significant weight change will generate artifacts and errors in HR-pQCT data. The purpose of this study is to determine the influence of these artifacts on the measurement of vBMD.

METHODS

We designed a custom-made hydroxyapatite (HA)-polymer phantom surrounded by layers of reusable gel pack and hydrogenated fat to mimic the distal tibia and the surrounding lean and fat tissue. Four different thicknesses of fat were used to mimic the soft tissue of increasingly overweight individuals. We then evaluated how a change in soft tissue thickness influenced image quality and vBMD quantification within total, trabecular, and cortical bone compartments. Based on these data, we applied a data correction to previously acquired clinical data in a cohort of gastric bypass patients.

RESULTS

In the phantom measurements, total, trabecular, and cortical vBMD increased as soft tissue thickness decreased. The impact of soft tissue thickness on vBMD varied by anatomic quadrant. When applying the soft tissue data correction to a set of clinical data, we found that soft tissue reduction following bariatric surgery can lead to a clinically significant underestimation of bone loss in longitudinal data, and that the effect is most severe in the cortical compartment.

CONCLUSION

HR-pQCT-based vBMD measurement accuracy is influenced by soft tissue thickness and is spatially inhomogeneous. Our results suggest that variations in soft tissue thickness must be considered in HR-pQCT studies, particularly in studies enrolling cohorts with differing body composition or in studies of longitudinal weight change.

Osteoporosis in Africa-where are we now

Africa is experiencing an exponential increase in the number of older persons. The number of persons surviving with human immunodeficiency virus is simultaneously increasing due to improved availability of anti-retroviral therapy. The burden of non-communicable diseases, in particular, osteoporosis and its consequent fragility fractures, is also predicted to increase. Osteoporosis, however, remains a neglected disease and there are no age-standardized reference data available to accurately screen and diagnose individuals with osteoporosis. Epidemiological studies reporting the incidence of hip fracture or vertebral fractures are limited from Africa, especially Sub-Saharan Africa. The studies are usually limited as they are based on a retrospective data and small study numbers and often from a single study site. However, compared with early initial studies, the more recent studies show that osteoporosis and fractures are increasing across the continent. The overall incidence rates for osteoporosis and fractures still vary greatly between different regions in Africa and ethnic groups. Predisposing factors are similar with those in developed countries, but awareness of osteoporosis is sorely lacking. There is a lack of awareness among the population as well as health authorities, making it extremely difficult to quantify the burden of disease. There is great potential for research into the need and availability of preventive strategies. The FRAX® tool needs to be developed for African populations and may circumvent the shortage of bone densitometry.

Characteristics of patients with low-trauma vertebral fractures in the United Arab Emirates: a descriptive multi-center analysis

Vertebral fracture is the most common type of osteoporotic fracture. However, the prevalence of osteoporosis and osteoporotic vertebral fractures were not explored previously in the United Arab Emirates (UAE). This study aims to describe for the first time the demographic and morphological characteristics of patients with fragility vertebral fractures in the UAE through a retrospective review of the medical records of patients with low-trauma vertebral fractures who visited two tertiary centers during 2011-2016. The sex, age at the time of fracture, nationality, body mass index (BMI), and anatomical fracture location were recorded for each patient. Overall, 143 subjects were diagnosed with low-trauma vertebral fractures in the Emirate of Abu Dhabi during 2011-2016. Of these, 98 were women (68.5%) and 45 were men (31.5%). The overall mean patient age at diagnosis was 62.5 years, and almost half were younger than 65 years. Approximately 60% of the patients were UAE nationals. Fifty-one patients (36.7%) were obese (mean BMI: 35.3 kg/m²), and women with vertebral fractures had a significantly higher mean BMI compared with men (p = 0.041). Nearly 40% of men had a normal BMI, compared with 20% of women. Most fractures were compression fractures (77.6%) in the thoracolumbar transition region. In conclusion, patients with fragility vertebral fractures were predominantly female and tended to be overweight or obese, although male patients tended to have a lower BMI than female patients.

Identification of prevalent vertebral fractures using Vertebral Fracture Assessment (VFA) in asymptomatic postmenopausal women: A systematic review and meta-analysis

BACKGROUND

Vertebral fracture (VF) is the most common osteoporotic fracture in postmenopausal women, although most VFs are subclinical. Prevalent VFs are a significant predictor of subsequent fracture and therefore, identification of VF improves the identification of those with high fracture risk. The aim of present study was to systematically review the literature that assessed the prevalence of VF in asymptomatic postmenopausal women, using Vertebral Fracture Assessment (VFA) by dual-energy X-ray absorptiometry.

METHOD

Medline, Web of Science and Cochrane databases were searched between Jan 1st, 2000 and Jan 31st, 2018, for publications in English that reported the prevalence of VFA-detected VF in asymptomatic postmenopausal women. We also searched for reports, conference papers and grey literature. Reviewers screened studies for eligibility and extracted data for included studies. Random effects meta-analyses were performed to calculate the prevalence of VF. The presence of publication bias was assessed using funnel plots by precision and Egger's Test of the Intercept.

RESULTS

A total of 1777 articles were identified, 94 studies were fully reviewed and 28 studies (n = 25,418) met the inclusion criteria and were analyzed. More than two thirds of the studies were cross-sectional and the sample size varied widely across the studies (from 63 to 5156). The mean age ranged from 59.5 to 86.2 years old. The prevalence of osteoporosis and osteopenia varied between 6-57.0% and 25.1-58.9%, respectively. However, among women who had prevalent VFs, up to 43% had osteopenia and as many as 32% had normal bone density. The weighted pooled prevalence of VFA-detected VF in asymptomatic women was 28% (95% CI: 23%-32%).

CONCLUSION

VFA is able to identify prevalent VF in asymptomatic postmenopausal women. The use of VFA identified an average of 28% of asymptomatic women with VFs, many of whom did not have a diagnosis of osteoporosis. Implementation of VFA as a routine screening tool may detect high risk women. Detection of VF might lead to pharmacological treatment in individuals who may not otherwise be treated.

Mediterranean Diet and Osteoarticular Diseases

Background:

Besides the well-known positive effect on the reduction of the risk of cardiovascular diseases, in the latest decades growing evidence has accumulated on the beneficial effects of MD on various aspects of health outcomes. Nevertheless, data concerning the existence of a direct positive effect of MD, irrespective of its beneficial effect on body weight, in osteo-articular diseases, are still controversial. In osteo-articular diseases, a pro-inflammatory environment is highlighted, with an increased systemic levels of pro-inflammatory cytokines.

Objective:

Our objective is to investigate the effects of adherence to the Mediterranean diet and osteo-articular diseases.

Conclusion:

Many foods included in MD, have anti-inflammatory properties, due to the presence of nutrients, such as polyunsaturated (PUFA) and monounsaturated (MUFA) fats. The two types of polyunsaturated fatty acids, omega-3 and omega-6, have opposing effects on the inflammatory process. Omega-6 stimulates the production of pro-inflammatory cytokines, while omega-3 fatty acids exert anti-inflammatory effects, including significant reductions in the release of pro-inflammatory cytokines. Some studies have shown that the dietary pattern of MD consumption has an important role in the prevention and development of inflammatory arthritis. Nevertheless, the possible influence of MD on chronic osteo-articular diseases is very limited, this review updates the main experimental and clinical evidences concerning the potential beneficial effects of the Mediterranean Diet on the most diffuse osteo-articular chronic and degenerative joint disease.

A modification and validation of quantitative morphometry classification system for osteoporotic vertebral compressive fractures in mainland Chinese

This study described a modified quantitative morphometry (mQM) system adapted to specific reference values for Mainland Chinese population. The mQM system is validated using the Genant Semiquantative system and is sensitive for detecting vertebral height changes and predicting cement leakage after percutaneous kyphoplasty (PKP) in patients with osteoporotic vertebral compressive fracture (OVCF).

INTRODUCTION

OVCF is a manifestation of osteoporosis. To improve clinical management of osteoporosis, the quantitative morphometry (QM) system has been widely used for the early diagnosis and precise classification of OVCF in developed countries. Here, we present an mQM system and validated its use in detecting OVCF in Mainland Chinese.

METHODS

Using our mQM system, the pre- and post-operative values of vertebral heights were measured and evaluated in 309 Mainland Chinese who received percutaneous kyphoplasty (PKP) as OVCF treatment. Measurements and classification of fractures from the mQM system were validated by comparing to values obtained by the Genant semiquantative (SQ) method. Moreover, we evaluated the sensitivity of the mQM system by its ability to detect restoration of vertebral heights and predict cement leakage after PKP.

RESULTS

The five classification of fractures, No deformity (ND), anterior wedge (AW), posterior wedge (PW), biconcavity (BC), and compression (CP), evaluated by the mQM method shared similar distribution characteristics compared to those obtained by the SQ method. In addition, mQM evaluation showed that the vertebra height of all fracture types showed significant restoration after PKP. The incidence of cement leakage was most common in CP (37.5%), followed by AW (31.6%), BC (26.5%), ND (23.7%), and PW (0.0%).

CONCLUSIONS

Our mQM system is suitable for classification of fractures, detection of vertebral height restoration, and correlation of cement leakage after PKP in Mainland Chinese population.

Complex interplay among adiposity, insulin resistance and bone health

Obesity and osteoporosis are common public health problems. Paradoxically, while obesity is associated with higher bone density, type 2 diabetic obese individuals have an increased fracture risk. Although obesity and insulin resistance co-exist, some obese individuals remain insulin-sensitive. We suggest that the apparent paradox relating obesity, bone density and fracture risk in type 2 diabetes may be at least partly influenced by differences in bone strength and quality between insulin-resistant and insulin-sensitive obese individuals. In this review, we focus on the complex interplay between, adiposity, insulin resistance and osteoporotic fracture risk and suggest that this is an important area of study that has implications for individually tailored and targeted treatment to prevent osteoporotic fracture in obese type 2 diabetic individuals.

Vitamin D status and abdominal aortic calcification in postmenopausal women

Vitamin D has an important role in bone metabolism and may be involved in the process of vascular calcification. The objective of this study was to evaluate the effect of vitamin D status on the presence of abdominal aortic calcification (AAC). We enrolled, in a cross-sectional study, 429 postmenopausal women [mean age, weight, and BMI of 59.5 ± 8.3 (50-83) years, 75.8 ± 13.3 (35-165) kg, and 29.9 ± 5.2 (14.6-50.8) kg/m², respectively]. Lateral vertebral fracture assessment (VFA) images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy densitometer. Vertebral fractures (VFs) were defined using the Genant semiquantitative (SQ) approach. We used the Kauppila score to assess AAC extension. Clinical risk factors of osteoporosis were collected, and 25-hydroxy vitamin D was measured using electrochemiluminescence (Roche). Prevalence of osteoporosis and hypovitaminosis D (<20 ng/ml) was 21.0% and 78.1%, respectively. VFs grade 2/3 were identified in 76 patients (17.7%). Two thirds of the evaluable participants did not have any detectable AAC. The prevalence of significant atherosclerotic burden, defined as a radiographic 24-point AAC score of 5 or higher, was 7.9%. The group of women with extended AAC were older and had a statistically significant higher menopause duration and more prevalent grade 2/3 VFs. Compared to women with normal values of vitamin D, women with vitamin D insufficiency (<20 ng/ml) and deficiency (<10 ng/ml) had a lower BMD and more prevalent VFs. No difference was noted with regard to AAC among the three groups. Multiple stepwise conditional logistic regression analysis showed that the presence of AAC was associated significantly with age and the presence of VFs. Extended aortic calcifications are independently associated with prevalent VFA-identified VFs but not with serum vitamin D levels in postmenopausal women. VFA imaging using DXA may detect at the same time prevalent VFs and AAC, an important cardiovascular disease risk factor.

Reduced kidney function is associated with BMD, bone loss and markers of mineral homeostasis in older women: a 10-year longitudinal study

Kidney function decreases with age; however, the long-term influence on bone density (BMD) in older women already at risk of osteoporosis is unknown. We followed kidney function and bone loss for 10 years. Declining kidney function was adversely associated with bone loss and mineral homeostasis in old women, though it attenuated with advanced aging.

INTRODUCTION

Existing studies do not fully address the relationship between kidney function and bone metabolism with advanced aging in Caucasian women. This study describes the association between kidney function, BMD, bone loss and bone metabolism in older women and provides a review of the available literature for context.

METHODS

We studied participants from the OPRA cohort with follow-up after 5 and 10 years. Using plasma cystatin C (cysC), estimated glomerular function rate (eGFR) was evaluated at age 75 (n = 981), 80 (n = 685) and 85 (n = 365). Women were stratified into "normal" function (CKD stages 1-2), "intermediate" (stage 3a) and "poor" (stages 3b-5), and outcome measures-BMD, bone loss and markers of mineral homeostasis-were compared.

RESULTS

Femoral neck (FN) BMD positively associated with kidney function at 75 years old ([Formula: see text] = 0.001, p = 0.028) and 80 years old ([Formula: see text] = 0.001, p = 0.001), although with small effect size. Prevalence of osteoporosis (FN T-score ≤ - 2.5) did not differ with kidney function. Measured at age 75, women with poor kidney function had higher annual percentage bone loss over 5 years compared to those with normal function (2.3%, 95% CI 1.8-2.8 versus 1.3%, 95% CI 1.1-1.5, p = 0.007), although not when measured from age 80 or 85. Additionally, markers of mineral homeostasis (PTH, phosphate, vitamin D, calcium), CRP and osteocalcin differed by kidney function.

CONCLUSIONS

In old women, kidney function is associated with BMD, bone loss and altered mineral homeostasis; probably, a relationship attenuated in the very elderly.

Low-dose vitamin D supplementation and incident frailty in older people: An eight year longitudinal study

Hypovitaminosis D is associated with frailty, but if vitamin D supplementation may prevent the onset of frailty is poorly known. Therefore, we aimed to investigate whether vitamin D supplementation is associated with a lower risk of frailty. In this longitudinal study, 4,421 individuals at high risk or having knee osteoarthritis free from frailty at baseline (mean age: 61.3, females=58.0%) were followed for 8 years. Details regarding vitamin D supplementation were captured by asking whether the participant took vitamin D during the previous year, at least once per month. Frailty was defined using the Study of Osteoporotic Fracture (SOF) index as the presence of at least two of the following criteria: (i) weight loss≥5% between baseline and any subsequent follow-up visit; (ii) inability to do five chair stands; (iii) low energy level according to the SOF definition. Multivariable Cox's regression analyses, calculating hazard ratios (HRs) with 95% confidence intervals (CIs), were undertaken. At baseline 69.7% took vitamin D supplements in the previous year, with a mean dose of 384±157 IU per day. During the 8-year follow-up, no difference in the incidence of frailty was evident by vitamin D supplementation status at baseline, even after adjusting for 13 baseline confounders (HR=0.95; 95% CI: 0.72-1.25). Similar results were obtained using the propensity score (HR=0.95; 95% CI: 0.71-1.25) or age- and sex-matched controls (HR=1.00; 95% CI: 0.75-1.33). In conclusion, low-dose vitamin D supplementation was not associated with any decreased risk of frailty during eight years of follow-up in a large cohort of North American people. Future large-scale trials with high doses of oral vitamin D and longer follow-up are needed to confirm/refute our findings.

Serum 25-hydroxyvitamin D and bone turnover markers in Palestinian postmenopausal osteoporosis and normal women

This study evaluated the association of vitamin D and bone markers with the development osteoporosis in Palestinian postmenopausal women. Even though vitamin D deficiency was very high for the recruited subjects, it was not associated with osteoporosis except for bones of the hip. Age and obesity were the strongest determining factors of the disease.

PURPOSE

The purpose of this study was to investigate the association of bone mineral density (BMD) with serum vitamin D levels, parathyroid hormone (PTH), calcium, obesity, and bone turnover markers in Palestinian postmenopausal women.

METHODS

Three hundred eighty-two postmenopausal women (≥45 years) were recruited from various women clinics for BMD assessment (131 women had osteoporosis and 251 were normal and served as controls). Blood samples were obtained for serum calcium, PTH, 25(OH)D, bone formation (N-terminal propeptide (PINP)), and bone resorption (serum C-terminal telopeptide of type I collagen (CTX1)) markers.

RESULTS

Women with osteoporosis had statistically significant lower mean weight, height, body mass index (BMI), and serum calcium (p < 0.05) compared to controls. No significant differences were detected between the mean values of bone turnover markers (CTX and PINP), 25(OH)D, and PTH of the two groups. Women with vitamin D deficiency (severe and insufficiency) represented 85.9% of the study subjects. Multiple and logistic regression showed that age and BMI significantly affected BMD and vitamin D had a significant association with BMD only at the lumbar spine. BMI was positively correlated with BMD and PTH but negatively correlated with vitamin D. Logistic regression showed that the odds ratio (OR) for having osteoporosis decreased with increasing BMI (overweight OR = 0.11, p = 0.053; obese OR = 0.05, p = 0.007).

CONCLUSIONS

There was no direct correlation between BMD and PTH, bone turnover markers, and vitamin D except at the lumbar spine. A negative correlation between BMD and age and a positive correlation with BMI were observed. The protective effect of obesity on osteoporosis was complicated by the effect of obesity on vitamin D and PTH.

Lateral Skull Base Attenuation in Superior Semicircular Canal Dehiscence and Spontaneous Cerebrospinal Fluid Otorrhea

Objectives

(1) To quantitatively assess the lateral skull base thickness in patients with superior semicircular canal dehiscense (SSCD) using a standardized and validated radiographic measure and to compare it with that of a population with spontaneous cerebrospinal fluid otorrhea (CSFO). (2) To analyze demographic and clinical factors associated with skull base thickness in the SSCD group.

Study Design

Case series with chart review.

Setting

Tertiary neurotologic referral center.

Subjects and Methods

Based on computed tomography imaging of the tegmen, mean skull base thickness was calculated for 16 patients with radiographic and clinical SSCD. Similar measures were performed in 4 comparison groups consisting of adults with spontaneous CSFO (n = 33), as well as 3 control groups recruited from our adult cochlear implant database: 30 obese controls (body mass index [BMI] >30 kg/m2), 11 overweight controls (BMI, 25-30 kg/m2), and 20 normal weight controls (BMI <25 kg/m2).

Results

The SSCD group had a significantly lower mean BMI (28.6 kg/m2) than the spontaneous CSFO group (37.7 kg/m2; P = .0007). The mean skull base thickness of SSCD patients was 17% thinner than that of the CSFO group, 31% thinner vs obese controls, 49% thinner vs overweight controls, and 45% thinner vs normal weight controls. These differences were all statistically significant ( P < .05).

Conclusion

Patients with SSCD have a marked thinning of the lateral skull base, more so than patients with spontaneous CSF otorrhea and control groups with different BMIs. Skull base attenuation in SSCD patients did not correlate with BMI.