1
|
Moberg L, Jehpsson L, Nilsson PM, Rosengren B. Birth weight and birth length affect future fracture risk differently in men and women. Osteoporos Int 2024:10.1007/s00198-024-07172-8. [PMID: 38967677 DOI: 10.1007/s00198-024-07172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 06/21/2024] [Indexed: 07/06/2024]
Abstract
We wanted to determine if there are any associations between birth factors and adult fracture risk. For women only, shorter birth length was associated with lower relative fracture risk. For women and men, individuals who were long at birth as well as tall in adulthood had a substantially higher relative fracture risk. PURPOSE We aimed to examine associations between birth anthropometry and adult fracture risk and to investigate if developmental mismatch is associated with fracture risk. METHODS We included 4635 participants (476 women and 4159 men; born 1921-1950) with hospital and national registry-based data on birth anthropometry and adult fractures (≥ 50 years). We tested associations by Cox proportional hazards regressions and present hazard ratios (HR) with 95% confidence intervals. RESULTS In total, 1215 (26%) suffered ≥ 1 fracture during a mean observation period of 26 years. In women, unadjusted analyses indicated that both higher birth weight (HR 1.42 per kg (1.10-1.84)) and birth length (1.10 per cm (1.05-1.17)) were associated to higher adult fracture risk. After adjustment (year of birth and gestational age), statistical significance remained only for birth length, HR 1.10 per cm (1.04-1.17). For men, no associations were apparent. We found no associations between developmental mismatch (lower birth weight followed by higher adult weight) and adult fracture risk. However, for both sexes, being born tall and staying tall into adulthood was associated with a markedly higher (55-105%) relative fracture risk (HR women 2.09 (1.18-3.68), men 1.55 (1.19-2.03)) compared to being born short and remaining short in adulthood. CONCLUSION In this study, being born shorter and lighter was associated with a lower risk for fractures ≥ 50 years in women. However, analyses indicated that tall adults who were also long at birth may be at markedly higher risk of fractures; this warrants further examinations.
Collapse
Affiliation(s)
- Louise Moberg
- Department of Obstetrics and Gynecology, Skåne University Hospital, Klinikgatan 12, S-221 85, Lund, Sweden.
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Lars Jehpsson
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Peter M Nilsson
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Björn Rosengren
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| |
Collapse
|
2
|
Obërtinca R, Meyer T, Aus der Fünten K. Epidemiology of football-related injuries in young male football players. An additional analysis of data from a cluster-randomised controlled trial. SCI MED FOOTBALL 2024:1-11. [PMID: 38922821 DOI: 10.1080/24733938.2024.2369545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
Football carries a high risk of injury for youth players. The aim of this study was to investigate the epidemiology of football-related injuries in young male players. The data stems from a previously conducted cluster-randomised controlled trial that investigated the efficacy of 'FUNBALL', a new injury prevention programme. This study contains the data of the 503 players of the control arm. The players belonged to 22 football teams of the Under-(U)15, U17 and U19 age groups. The time-loss injuries were recorded during the season 2021-2022 according to the Football Consensus Statement. An analysis on the injury incidence (IR, calculated per 1000 hours of exposure), location, severity, category, and type was performed. Incidence rate ratios (IRRs) were used to compare the variables between the specific age groups. 187 injuries (96 in training and 91 in matches) occurred during 52 938 hours of exposure. The overall IR was 3.53 injuries/1000 h (95% confidence intervals (CI) 3.06 to 4.07). The training IR was 2.16 injuries/1000 h (95% CI 1.17 to 2.64). The match IR was 10.50 injuries/1000 h (95% CI 8.55 to 12.89). In the U19s, the overall IRR was higher compared to the U17s (IRR 1.57, CI 1.12 to 2.19; p = 0.008) and compared to the U15s (IRR 1.82, 95% CI 1.25 to 2.62; p = 0.001). The thigh was the most commonly affected body region (IR 0.92/1000 h, 95% CI 0.69 to 1.22). Muscle injuries were the most common injury type (IR 1.05/1000 h, 95% CI 0.81 to 1.37). Injury burden was 74 lost days/1000 h. The findings of this study indicate a lower injury incidence in youth players than in adult ones. We observed a higher injury incidence towards the older age groups.
Collapse
Affiliation(s)
- Rilind Obërtinca
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
- Department of Physiotherapy, University of Gjakova "Fehmi Agani", Gjakova, Kosovo
| | - Tim Meyer
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| | - Karen Aus der Fünten
- Institute of Sports and Preventive Medicine, Saarland University, Saarbrücken, Germany
| |
Collapse
|
3
|
Tsinopoulou VR, Kotanidou EP, Athanasiadis N, Bacopoulou F, Stefanaki C, Fidani L, Galli-Tsinopoulou A, Christoforidis A. Earlier Menarche in Greek Girls Born by Caesarean Section: A Case-Control Study. J Clin Med 2024; 13:3452. [PMID: 38929980 PMCID: PMC11204395 DOI: 10.3390/jcm13123452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Objectives: The purpose of this study was to report on the menarcheal age in girls of Greek origin and assess its potential associations with their demographic and perinatal data, as well as their maternal menarcheal age. Methods: In this case-control study, adolescent girls were recruited between September 2021 and September 2022 from two Pediatric Endocrinology Units, Aristotle University of Thessaloniki, Greece. Eligible participants included Greek girls up to the age of 18 years, with menarche and the absence of chronic disease or chronic medication use. Participants were divided into two groups, the early menarche group and the control group (menarche before or after 11 years of age, respectively). Data included participants' maternal menarcheal age, their chronological age, place of residence, anthropometric data (at recruitment) and perinatal data (birth order, gestational age, type of delivery, birth weight/length). Results: A total of 100 girls aged 7-17 years (mean age ± SD 12.51 ± 2.59 years) were included in this study. The mean ± SD menarcheal age of the total sample was 11.47 ± 1.55 years (median 11.20 years; range 7.50-16.25 years); 43% had early menarche (median menarcheal age 10.50 years; range 7.50-10.91 years), and 57% had menarche after age 11 (median menarcheal age 12.08 years; range 11.00-16.25 years). The caesarean section rate was significantly (p < 0.001) higher in girls with early menarche (83.7%) than controls, whereas other variables did not differ significantly between groups. Conclusions: This Greek sample demonstrated a relatively young age at menarche with a significant proportion of girls with early menarche; in the latter group, the rate of caesarian sections was significantly higher than controls.
Collapse
Affiliation(s)
- Vasiliki Rengina Tsinopoulou
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University General Hospital AHEPA, 54636 Thessaloniki, Greece
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Ippokratio General Hospital, 54636 Thessaloniki, Greece
| | - Eleni P. Kotanidou
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University General Hospital AHEPA, 54636 Thessaloniki, Greece
| | - Nikolaos Athanasiadis
- 3rd Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Ippokratio General Hospital, 54636 Thessaloniki, Greece
| | - Flora Bacopoulou
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Charikleia Stefanaki
- Center for Adolescent Medicine and UNESCO Chair in Adolescent Health Care, First Department of Pediatrics, Medical School, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, 11527 Athens, Greece
| | - Liana Fidani
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University General Hospital AHEPA, 54636 Thessaloniki, Greece
- Laboratory of Genetics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
| | - Assimina Galli-Tsinopoulou
- 2nd Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University General Hospital AHEPA, 54636 Thessaloniki, Greece
| | - Athanasios Christoforidis
- 1st Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Ippokratio General Hospital, 54636 Thessaloniki, Greece
| |
Collapse
|
4
|
Laue HE, Lanphear BP, Calafat AM, Cecil KM, Chen A, Xu Y, Kalkwarf HJ, Madan JC, Karagas MR, Yolton K, Fleisch AF, Braun JM. Time-varying associations of gestational and childhood triclosan with pubertal and adrenarchal outcomes in early adolescence. Environ Epidemiol 2024; 8:e305. [PMID: 38617430 PMCID: PMC11008648 DOI: 10.1097/ee9.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/07/2024] [Indexed: 04/16/2024] Open
Abstract
Background Triclosan is an endocrine-disrupting chemical, but associations with pubertal outcomes remain unclear. We examined associations of gestational and childhood triclosan with adolescent hormone concentrations and pubertal stage. Methods We quantified urinary triclosan concentrations twice during pregnancy and seven times between birth and 12 years in participants recruited from Cincinnati, OH (2003-2006). We averaged concentrations across pregnancy and childhood and separately considered individual exposure periods in multiple informant models. At 12 years, we measured serum hormone concentrations (males [n = 72] and females [n = 84]-dehydroepiandrosterone-sulfate, luteinizing hormone, follicle-stimulating hormone; males-testosterone; females-estradiol). Also at age 12 years, participants self-reported physical development and menarchal timing. We estimated associations (95% confidence interval) of triclosan with hormone concentrations, more advanced physical development, and age at menarche. Results For females, each doubling of childhood triclosan was associated with 16% lower estradiol concentrations (-29%, 0%), with stronger associations for measures closer to adolescence. We found suggestive evidence that higher triclosan at any age was associated with ~10% (for gestational triclosan: -18%, -2%) lower follicle-stimulating hormone concentrations among males and early postnatal (1-3 years) triclosan was associated with 63% (5%, 96%) lower odds of advanced pubic hair development in females. In multiple informant models, each doubling of gestational triclosan concentrations was associated with 5% (0%, 9%) earlier age at menarche, equivalent to 5.5 months. Conclusion Gestational and childhood triclosan concentrations were related to some pubertal outcomes including hormone concentrations and age at menarche. Our findings highlight the relevance of elucidating potential sex-specific and time-dependent actions of triclosan.
Collapse
Affiliation(s)
- Hannah E. Laue
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Bruce P. Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Antonia M. Calafat
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kim M. Cecil
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, Cincinnati, Ohio
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Yingying Xu
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, Cincinnati, Ohio
| | - Heidi J. Kalkwarf
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, Cincinnati, Ohio
| | - Juliette C. Madan
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
- Departments of Pediatrics and Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Margaret R. Karagas
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine Cincinnati, Cincinnati, Ohio
| | - Abby F. Fleisch
- Center for Interdisciplinary and Population Health Research, Maine Institute for Research, Portland, Maine
- Pediatric Endocrinology and Diabetes, Maine Medical Center, Portland, Maine
| | - Joseph M. Braun
- Department of Epidemiology, Brown University, Providence, Rhode Island
| |
Collapse
|
5
|
Bezerra A, Boppre G, Freitas L, Battista F, Duregon F, Faggian S, Busetto L, Ermolao A, Fonseca H. Body Composition Changes in Adolescents Who Underwent Bariatric Surgery: A Systematic Review and Meta-analysis. Curr Obes Rep 2024; 13:107-120. [PMID: 38172484 PMCID: PMC10933211 DOI: 10.1007/s13679-023-00549-6] [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] [Accepted: 09/05/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE OF REVIEW The purpose of this review and meta-analysis is to characterize the changes in body composition of children and adolescents who underwent bariatric surgery and identify possible negative effects of performing this procedure during pediatric ages. RECENT FINDINGS Bariatric surgery in children and adolescents is an emerging strategy to promote higher and faster body weight and fat mass losses. However, possible negative effects usually observed in surgical patients' muscle-skeletal system raise a major concern perform this intervention during growth. Despite these possible issues, most experimental studies and reviews analyze bariatric surgery's effectiveness only by assessing anthropometric outcomes such as body weight and BMI, disregarding the short- and long-term impact of bariatric surgery on all body composition outcomes. Bariatric surgery is effective to reduce fat mass in adolescents, as well as body weight, waist circumference, and BMI. Significant reduction in lean mass and fat-free mass is also observed. Bone mass seems not to be impaired. All outcomes reduction were observed only in the first 12 months after surgery. Sensitivity analysis suggests possible sex and type of surgery-related differences, favoring a higher fat mass, body weight, and BMI losses in boys and in patients who underwent RYGB.
Collapse
Affiliation(s)
- Andréa Bezerra
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Giorjines Boppre
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Human Motricity Research Center, University Adventista, Chillean, Chile
| | - Laura Freitas
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Francesca Battista
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy.
| | - Federica Duregon
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Sara Faggian
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
| | - Luca Busetto
- Department of Medicine, University of Padova, Padova, Italy
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, Padova, Italy
- Clinical Network of Sports and Exercise Medicine of the Veneto Region, Padova, Italy
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| |
Collapse
|
6
|
van der Loos MATC, Vlot MC, Klink DT, Hannema SE, den Heijer M, Wiepjes CM. Bone Mineral Density in Transgender Adolescents Treated With Puberty Suppression and Subsequent Gender-Affirming Hormones. JAMA Pediatr 2023; 177:1332-1341. [PMID: 37902760 PMCID: PMC10616766 DOI: 10.1001/jamapediatrics.2023.4588] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/30/2023] [Indexed: 10/31/2023]
Abstract
Importance Bone mineral density (BMD) z scores in transgender adolescents decrease during puberty suppression with a gonadotropin-releasing hormone (GnRH) agonist. Previous research found that after short-term use of gender-affirming hormones (GAH), pretreatment z scores were not restored. Long-term follow-up studies are lacking. Objective To assess BMD after long-term GAH treatment in transgender adults who used puberty suppression in adolescence. Design, Setting, and Participants This single-center cohort study with follow-up duration of 15 years selected participants from a database containing all people visiting a gender identity clinic at an academic hospital in the Netherlands between 1972 and December 31, 2018. Recruitment occurred from March 1, 2020, to August 31, 2021. A total of 75 participants diagnosed with gender dysphoria who had used puberty suppression before age 18 years prior to receiving at least 9 years of long-term GAH were included. Exposures Puberty suppression with a GnRH agonist followed by GAH treatment. Main Outcomes and Measures Lumbar spine, total hip, and femoral neck BMD and z scores before the start of puberty suppression, at start of GAH, and at short- and long-term follow-up. Results Among 75 participants, 25 were assigned male at birth, and 50 were assigned female at birth. At long-term follow-up, the median (IQR) age was 28.2 (27.0-30.8) years in participants assigned male at birth and 28.2 (26.6-30.6) years in participants assigned female at birth. The median (IQR) duration of GAH treatment was 11.6 (10.1-14.7) years among those assigned male at birth and 11.9 (10.2-13.8) years among those assigned female at birth. The z scores decreased during puberty suppression. In individuals assigned male at birth, the mean (SD) z score after long-term GAH use was -1.34 (1.16; change from start of GnRH agonist: -0.87; 95% CI, -1.15 to -0.59) at the lumbar spine, -0.66 (0.75; change from start of GnRH agonist: -0.12; 95% CI, -0.31 to 0.07) at the total hip, and -0.54 (0.84; change from start of GnRH agonist: 0.01; 95% CI, -0.20 to 0.22) at the femoral neck. In individuals assigned female at birth, after long-term GAH use, the mean (SD) z score was 0.20 (1.05; change from start of GnRH agonist: 0.09; 95% CI, -0.09 to 0.27) at the lumbar spine, 0.07 (0.91; change from start of GnRH agonist: 0.10; 95% CI, -0.06 to 0.26) at the total hip, and -0.19 (0.94; change from start of GnRH agonist: -0.20; 95% CI, -0.26 to 0.06) at the femoral neck. Conclusions and Relevance In this cohort study, after long-term use of GAH, z scores in individuals treated with puberty suppression caught up with pretreatment levels, except for the lumbar spine in participants assigned male at birth, which might have been due to low estradiol concentrations. These findings suggest that treatment with GnRH agonists followed by long-term GAH is safe with regard to bone health in transgender persons receiving testosterone, but bone health in transgender persons receiving estrogen requires extra attention and further study. Estrogen treatment should be optimized and lifestyle counseling provided to maximize bone development in individuals assigned male at birth.
Collapse
Affiliation(s)
- Maria Anna Theodora Catharina van der Loos
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center (UMC) at Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC at Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mariska Caroline Vlot
- Department of Internal Medicine, Hospital St Jansdal, Harderwijk/Lelystad, the Netherlands
| | - Daniel Tatting Klink
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Sabine Elisabeth Hannema
- Center of Expertise on Gender Dysphoria, Amsterdam UMC at Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Pediatrics, Amsterdam UMC at Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Martin den Heijer
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center (UMC) at Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC at Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Chantal Maria Wiepjes
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center (UMC) at Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC at Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
7
|
Gao H, Zhao Y, Zhao L, Wang Z, Yan K, Gao B, Zhang L. The Role of Oxidative Stress in Multiple Exercise-Regulated Bone Homeostasis. Aging Dis 2023; 14:1555-1582. [PMID: 37196112 PMCID: PMC10529750 DOI: 10.14336/ad.2023.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/23/2023] [Indexed: 05/19/2023] Open
Abstract
Bone is a tissue that is active throughout the lifespan, and its physiological activities, such as growth, development, absorption, and formation, are always ongoing. All types of stimulation that occur in sports play an important role in regulating the physiological activities of bone. Here, we track the latest research progress locally and abroad, summarize the recent, relevant research results, and systematically summarize the effects of different types of exercise on bone mass, bone strength and bone metabolism. We found that different types of exercise have different effects on bone health due to their unique technical characteristics. Oxidative stress is an important mechanism mediating the exercise regulation of bone homeostasis. Excessive high-intensity exercise does not benefit bone health but induces a high level of oxidative stress in the body, which has a negative impact on bone tissue. Regular moderate exercise can improve the body's antioxidant defense ability, inhibit an excessive oxidative stress response, promote the positive balance of bone metabolism, delay age-related bone loss and deterioration of bone microstructures and have a prevention and treatment effect on osteoporosis caused by many factors. Based on the above findings, we provide evidence for the role of exercise in the prevention and treatment of bone diseases. This study provides a systematic basis for clinicians and professionals to reasonably formulate exercise prescriptions and provides exercise guidance for patients and the general public. This study also provides a reference for follow-up research.
Collapse
Affiliation(s)
- Haoyang Gao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yilong Zhao
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Linlin Zhao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zhikun Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Kai Yan
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Bo Gao
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Lingli Zhang
- College of Athletic Performance, Shanghai University of Sport, Shanghai, China
| |
Collapse
|
8
|
Barrett ES, Rivera-Núñez Z. Invited Perspective: PFAS and Pubertal Timing in Girls-A Maturing Literature. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:91304. [PMID: 37751324 PMCID: PMC10521913 DOI: 10.1289/ehp12658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/14/2023] [Accepted: 08/14/2023] [Indexed: 09/28/2023]
Affiliation(s)
- Emily S. Barrett
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey, USA
| | - Zorimar Rivera-Núñez
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Environmental and Occupational Health Sciences Institute, Rutgers University, Piscataway, New Jersey, USA
| |
Collapse
|
9
|
Hidayat K, Zhang LL, Rizzoli R, Guo YX, Zhou Y, Shi YJ, Su HW, Liu B, Qin LQ. The Effects of Dairy Product Supplementation on Bone Health Indices in Children Aged 3 to 18 Years: A Meta-Analysis of Randomized Controlled Trials. Adv Nutr 2023; 14:1187-1196. [PMID: 37414219 PMCID: PMC10509403 DOI: 10.1016/j.advnut.2023.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/29/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023] Open
Abstract
Childhood and adolescence are critical periods for optimizing skeletal growth. Dairy products are valuable sources of bone-beneficial nutrients, particularly calcium and protein. A random-effects meta-analysis of published randomized controlled trials was performed to quantitatively assess the effects of dairy supplementation on bone health indices in children and adolescents. The PubMed and Web of Science databases were searched. Dairy supplementation increased whole-body bone mineral content (BMC) (+25.37 g) and areal bone mineral density (aBMD) (+0.016 g/cm2), total hip BMC (+0.49 g) and aBMD (+0.013 g/cm2), femoral neck BMC (+0.06 g) and aBMD (+0.030 g/cm2), lumbar spine BMC (+0.85 g) and aBMD (+0.019 g/cm2), and height (0.21 cm). When expressed as a percentage difference, whole-body BMC was increased by 3.0%, total hip BMC by 3.3%, femoral neck BMC by 4.0%, lumbar spine BMC by 4.1%, whole-body aBMD by 1.8%, total hip aBMD by 1.2%, femoral neck aBMD by 1.5%, and lumbar spine aBMD by 2.6%. Dairy supplementation increased serum insulin-like growth factor I concentrations (19.89 nmol/L) and reduced concentrations of urinary deoxypyridinoline (-1.78 nmol/mmol creatinine) and serum parathyroid hormone (-10.46 pg/mL) but did not significantly affect the serum concentrations of osteocalcin, bone alkaline phosphatase, and C-terminal telopeptide of type 1 collagen. Serum 25-hydroxyvitamin D concentrations (+4.98 ng/mL) increased with vitamin D-fortified dairy supplementation. The positive effects on bone mineral mass parameters and height were generally consistent across subgroups defined by sex, geographical region, baseline calcium intake, calcium from the supplementation, trial duration, and Tanner stages. In summary, dairy supplementation during growth leads to a small but significant increase in bone mineral mass parameters, and these findings are generally supported by the changes in several biochemical parameters related to bone health.
Collapse
Affiliation(s)
- Khemayanto Hidayat
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China.
| | - Li-Li Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - René Rizzoli
- Division of Bone Diseases, Department of Internal Medicine, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Ya-Xin Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Yan Zhou
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China
| | - Yu-Jie Shi
- Branch Company, Inner Mongolia Yili Industrial Group Co, Ltd, Hohhot, China
| | - Hong-Wen Su
- Branch Company, Inner Mongolia Yili Industrial Group Co, Ltd, Hohhot, China
| | - Biao Liu
- Branch Company, Inner Mongolia Yili Industrial Group Co, Ltd, Hohhot, China.
| | - Li-Qiang Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, China.
| |
Collapse
|
10
|
Barbosa CCL, da Costa JC, Romanzini CLP, Batista MB, Blasquez-Shigaki G, Fernandes RA, Martinho DV, Oliveira T, Ribeiro LP, Coelho-E-Silva MJ, Ronque ERV. Interrelationship between muscle fitness in childhood and bone mineral density in adulthood: mediation analysis of muscle fitness in adulthood. BMC Public Health 2023; 23:648. [PMID: 37016376 PMCID: PMC10074897 DOI: 10.1186/s12889-023-15545-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/28/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND This study was aimed to examine the relationship between muscular fitness indicators in childhood and areal bone mineral density (aBMD) in adulthood and to verify whether the relationship is mediated by performance on muscular fitness indicators in adulthood. METHODS A sample of 138 healthy adults (69 males; 22.3 years) were followed after a previous assessment at the age of 7-10 years. Stature, body mass and muscular fitness indicators (handgrip strength, standing long jump and sit-ups tests) were assessed in childhood and adulthood. Additionally, total body, upper limbs, lower limbs, right femoral neck and lumbar spine aBMD was assessed in adulthood using dual X-ray absorptiometry. Analysis included descriptive statistics; t-test or Mann-Whitney U-test for comparison between males and females, multiple linear regression for the prediction aBMD from muscular fitness indicators in childhood, mediation analysis of the respective muscular fitness indicators in adulthood and the relationship between muscular fitness indicators in childhood and aBMD. RESULTS Males were stronger compared to females regarding muscular fitness indicators in childhood and adulthood, and presented higher mean values for aBMD in adulthood, except for lumbar spine (p < 0.05). Regression analysis revealed that some muscular fitness indicators in childhood showed significant positive relationship with bone health indicators in adulthood, such as: handgrip strength and total body aBMD (β = 0.005; R2 = 0.35; p = 0.040) and upper limbs aBMD (β = 0.005; R2 = 0.55; p = 0.019); and sit-ups test was a significant predictors of lumbar spine BMD (β = 0.003; R2 = 0.06; p = 0.039). Mediation analysis pointed out the following: adulthood handgrip strength mediated relationships between childhood handgrip strength and total aBMD (indirect effect (IE) = 0.0025; 95%CI = 0.0005-0.0048), and upper limbs aBMD (IE = 0.0040; 95%CI = 0.0017-0.0069). CONCLUSIONS Muscular fitness indicators in childhood showed significant relationship with bone health indicators in adulthood and the sit-ups test in childhood had direct effect on lumbar spine aBMD in adulthood. Adulthood handgrip strength mediated the relationship between childhood handgrip strength and total body and upper limb aBMD, pointing out that muscular fitness in childhood may be a aBMD determinant in adulthood, especially when higher muscle fitness performance is maintained in adulthood.
Collapse
Affiliation(s)
- Cynthia Correa Lopes Barbosa
- Laboratory of Physical Activity and Health, Center of Physical Education and Sports, Londrina State University - UEL, Highway Celso Garcia Cid, Km 380, University Campus, P.O. box 6001, 86051-990, Londrina, Paraná, Brazil
- Department of Humanities, Federal Technological University of Paraná - UTFPR, Apucarana, Paraná, Brazil
| | - Julio Cesar da Costa
- Laboratory of Physical Activity and Health, Center of Physical Education and Sports, Londrina State University - UEL, Highway Celso Garcia Cid, Km 380, University Campus, P.O. box 6001, 86051-990, Londrina, Paraná, Brazil.
| | - Catiana Leila Possamai Romanzini
- Laboratory of Physical Activity and Health, Center of Physical Education and Sports, Londrina State University - UEL, Highway Celso Garcia Cid, Km 380, University Campus, P.O. box 6001, 86051-990, Londrina, Paraná, Brazil
| | - Mariana Biagi Batista
- Laboratory of Physical Activity and Health, Center of Physical Education and Sports, Londrina State University - UEL, Highway Celso Garcia Cid, Km 380, University Campus, P.O. box 6001, 86051-990, Londrina, Paraná, Brazil
- Federal University of Mato Grosso do Sul - UFMS, Mato Grosso do Sul, Campo Grande, Brazil
| | - Gabriela Blasquez-Shigaki
- Laboratory of Physical Activity and Health, Center of Physical Education and Sports, Londrina State University - UEL, Highway Celso Garcia Cid, Km 380, University Campus, P.O. box 6001, 86051-990, Londrina, Paraná, Brazil
| | - Rômulo Araújo Fernandes
- Department of Physical Education, Exercise Research Laboratory (LIVE), Faculdade de Ciências e Tecnologia, State São Paulo University - UNESP, Presidente Prudente, São Paulo, Brazil
| | - Diogo V Martinho
- Faculty of Sports Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Tomás Oliveira
- Faculty of Sports Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
| | - Luís P Ribeiro
- Faculty of Sports Sciences and Physical Education, University of Coimbra, Coimbra, Portugal
- University of Algarve, Faro, Portugal
| | | | - Enio Ricardo Vaz Ronque
- Laboratory of Physical Activity and Health, Center of Physical Education and Sports, Londrina State University - UEL, Highway Celso Garcia Cid, Km 380, University Campus, P.O. box 6001, 86051-990, Londrina, Paraná, Brazil
| |
Collapse
|
11
|
Yang M, Yin H, Zhen D, Ding Y, Wang Y, Sun L, He F, Tang X. Exposure to famine in every stage of life and the risk of osteoporosis and fractures later in life: A cross-sectional study. Bone 2023; 168:116644. [PMID: 36566820 DOI: 10.1016/j.bone.2022.116644] [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: 06/28/2022] [Revised: 11/24/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Data on the association between early-life famine exposure and osteoporosis and fractures remain limited and inconclusive. The aim of this study was to investigate the correlation between famine exposure and osteoporosis and fractures. METHODS We performed a cross-sectional analysis using the first follow-up survey data from the China Cardiometabolic Disease and Cancer Cohort Study from 2014 to 2016. We classified 4807 Lanzhou participants into seven groups based on their birthday (non-exposed or exposed in the fetal stage, early childhood, mid-childhood, late childhood, adolescence, or early adulthood). And we combined the non-exposed and early-adulthood exposed groups as a control group, which was called "age balanced group". This age-balanced group was used as the control group to further evaluate the risk of osteoporosis and fracture. We used multiple logistic regression to estimate the association between famine exposure and the risk of osteoporosis (T-score ≤ -1.8 by QUS) and self-reported fracture. RESULTS In women, compared to the age-balanced group, the odds ratios (95 % CI) for the risk of osteoporosis were 1.400(1.034, 1.897), 1.630(1.268, 2.095), 1.707(1.314, 2.218), 2.150(1.732.2.668) and 2.885(2.286,3.641) in the fetal stage, early childhood, mid-childhood, late childhood and adolescence famine-exposed cohorts. In men, no association between famine and osteoporosis was noted with exposed cohort compared with the age-balanced control cohort (p > 0.05). Interestingly, the association between famine exposure and fractures was slightly different from the above results: in women, the odds ratios (95 % CI) for fractures in mid-childhood famine exposure was 1.461(1.082,1.973), in late childhood famine exposure was 1.333(1.035,1.718) and in adolescence famine exposure was 1.607(1.239,2.085). However, compared to the age-balanced control cohort, men exposed to famine in early childhood (OR: 1.801, 95 % CI: 1.010,3.211) had a higher risk of fracture. CONCLUSION Famine exposure in different life stage has adverse effects on bone health. Famine exposure in not only the period from gestation to infancy, but also childhood and adolescence was associated with an increased risk of osteoporosis, especially in women. Exposure to famine in childhood- (mid and late) and adolescence- life period is associated with fracture in women. But, in men early-childhood famine exposure was only associated with fracture.
Collapse
Affiliation(s)
- Mengdi Yang
- First School of Clinical Medicine, Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China
| | - Hongtao Yin
- Department of Endocrinology, The First Hospital of Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China
| | - Donghu Zhen
- Department of Endocrinology, The First Hospital of Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China.
| | - Yulu Ding
- First School of Clinical Medicine, Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China
| | - Yujie Wang
- First School of Clinical Medicine, Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China
| | - Linnan Sun
- First School of Clinical Medicine, Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China
| | - Fengying He
- First School of Clinical Medicine, Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China
| | - Xulei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, Donggang West Road, Lanzhou 730000, Gansu, People's Republic of China
| |
Collapse
|
12
|
Malin Igra A, Rahman A, Johansson AL, Pervin J, Svefors P, Arifeen SE, Vahter M, Persson LÅ, Kippler M. Early Life Environmental Exposure to Cadmium, Lead, and Arsenic and Age at Menarche: A Longitudinal Mother-Child Cohort Study in Bangladesh. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:27003. [PMID: 36729392 PMCID: PMC9894154 DOI: 10.1289/ehp11121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 12/07/2022] [Accepted: 01/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Several metals act as endocrine disruptors, but there are few large longitudinal studies about associations with puberty onset. OBJECTIVES We evaluated whether early life cadmium, lead, and arsenic exposure was associated with timing of menarche. METHODS In a mother-child cohort in rural Bangladesh (n=935), the exposure was assessed by concentrations in maternal erythrocytes in early pregnancy and in girls' urine at 5 and 10 years of age using inductively coupled plasma mass spectrometry. The girls were interviewed twice, at average ages 13.3 [standard deviation (SD)=0.43] and 13.8 (SD=0.43) y, and the date of menarche, if present, was recorded. Associations were assessed using Kaplan-Meier analysis and multivariable-adjusted Cox regression. RESULTS In total, 77% of the girls (n=717) had reached menarche by the second follow-up. The median age of menarche among all girls was 13.0 y (25th-75th percentiles: 12.4-13.7 y). At 10 years of age, median urinary cadmium was 0.25μg/L (5th-95th percentiles: 0.087-0.72μg/L), lead 1.6μg/L (0.70-4.2μg/L), and arsenic 54μg/L (19-395μg/L). Given the same age, girls in the highest quartile of urinary cadmium at 5 and 10 years of age had a lower rate of menarche than girls in the lowest quartile, with an adjusted hazard ratio of (HR) 0.80 (95% CI: 0.62, 1.01) at 5 years of age, and 0.77 (95% CI: 0.60, 0.98) at 10 years of age. This implies that girls in the highest cadmium exposure quartile during childhood had a higher age at menarche. Comparing girls in the highest to the lowest quartile of urinary lead at 10 years of age, the former had a higher rate of menarche [adjusted HR = 1.23 (95% CI: 0.97, 1.56)], implying lower age at menarche, whereas there was no association with urinary lead at 5 years of age. Girls born to mothers in the highest quartile of erythrocyte arsenic during pregnancy were less likely to have attained menarche than girls born to mothers in the lowest quartile [adjusted HR= 0.79 (95% CI: 0.62, 0.99)]. No association was found with girls' urinary arsenic exposure. DISCUSSION Long-term childhood cadmium exposure was associated with later menarche, whereas the associations with child lead exposure were inconclusive. Maternal exposure to arsenic, but not cadmium or lead, was associated with later menarche. https://doi.org/10.1289/EHP11121.
Collapse
Affiliation(s)
| | - Anisur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Anna L.V. Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jesmin Pervin
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Pernilla Svefors
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Marie Vahter
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lars-Åke Persson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- London School of Hygiene and Tropical Medicine, London, UK
| | - Maria Kippler
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
13
|
Machado M, Koch AJ. Letter to Editor: The Combined Relationship of Vitamin D and Weight-Bearing Sports Participation on Areal Bone Density and Geometry Among Adolescentes. J Clin Densitom 2023; 26:55. [PMID: 36543668 DOI: 10.1016/j.jocd.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Marco Machado
- Universidade Iguaçu, Campus V, Itaperuna, RJ, Brazil.
| | | |
Collapse
|
14
|
Lewis ME. Exploring adolescence as a key life history stage in bioarchaeology. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 179:519-534. [PMCID: PMC9825885 DOI: 10.1002/ajpa.24615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 08/05/2022] [Accepted: 08/17/2022] [Indexed: 04/16/2024]
Abstract
Adolescence is a unique period in the life history of an individual. It is characterized by a myriad of changes that bioarchaeologists are only just coming to appreciate, related to sexual maturation, linear growth, immunological transformation, and emotional and cognitive development. New methods allow us to measure this age of transition through the stages of the adolescent growth, as a proxy for the physical development associated with sexual maturation (puberty). This review outlines ways bioarchaeologists may draw on research developments from the fields of human biology, evolutionary theory and neurobiology to advance a more holistic approach to the study of adolescence in the past. It considers current theoretical and analytical approaches to highlight the research potential of this critical stage of life history. This synthesis integrates the most recent research in the medical sciences concerned with body and brain development, and outlines the biological processes involved with sexual and physical maturation of the adolescent. The goal of this review is to help inform potentially rewarding areas of research that bioarchaeologists can contribute to and draw from, as well as the challenges and limitations, theoretical and methodological questions, and ways in which we can develop the study of adolescence in the discipline going forward.
Collapse
Affiliation(s)
- Mary E. Lewis
- Department of ArchaeologyUniversity of ReadingReadingUK
| |
Collapse
|
15
|
Bezerra A, Freitas L, Maciel L, Fonseca H. Bone Tissue Responsiveness To Mechanical Loading-Possible Long-Term Implications of Swimming on Bone Health and Bone Development. Curr Osteoporos Rep 2022; 20:453-468. [PMID: 36401774 DOI: 10.1007/s11914-022-00758-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE OF REVIEW To revisit the bone tissue mechanotransduction mechanisms behind the bone tissue response to mechanical loading and, within this context, explore the possible negative influence of regular swimming practice on bone health, particularly during the growth and development period. RECENT FINDINGS Bone is a dynamic tissue, responsive to mechanical loading and unloading, being these adaptative responses more intense during the growth and development period. Cross-sectional studies usually report a lower bone mass in swimmers compared to athletes engaged in weigh-bearing sports. However, studies with animal models show contradictory findings about the effect of swimming on bone health, highlighting the need for longitudinal studies. Due to its microgravity characteristics, swimming seems to impair bone mass, but mostly at the lower limbs. It is unkown if there is a causal relationship between swimming and low BMD or if other confounding factors, such as a natural selection whithin the sport, are the cause.
Collapse
Affiliation(s)
- Andréa Bezerra
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADE/UP), 4200-450, Porto, Portugal.
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600, Porto, Portugal.
| | - Laura Freitas
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADE/UP), 4200-450, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600, Porto, Portugal
| | - Leonardo Maciel
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADE/UP), 4200-450, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600, Porto, Portugal
- Department of Physiotherapy, Federal University of Sergipe, Campus Lagarto, Lagarto, Brazil
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto (FADE/UP), 4200-450, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-600, Porto, Portugal
| |
Collapse
|
16
|
Osawa Y, Tanaka T, Semba RD, Fantoni G, Moaddel R, Candia J, Simonsick EM, Bandinelli S, Ferrucci L. Plasma Growth and Differentiation Factor 15 Predict Longitudinal Changes in Bone Parameters in Women, but Not in Men. J Gerontol A Biol Sci Med Sci 2022; 77:1951-1958. [PMID: 35363860 PMCID: PMC9536444 DOI: 10.1093/gerona/glac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Indexed: 11/13/2022] Open
Abstract
Bone fragility can progress with aging, but biomarkers to detect emerging osteopenia have not been fully elucidated. Growth/differentiation factor 15 (GDF-15) has pleiotropic roles in a broad range of age-related conditions, but its association with osteopenia is unknown. We examined the relationship between plasma GDF-15 levels and rate of change in bone parameters over 9 years of follow-up in 596 adults in the InCHIANTI study (baseline age, 65-94 years; women, 52.4%; mean follow-up, 7.0 ± 3.0 years). Plasma GDF-15 concentrations were measured using the 1.3k HTS SOMAscan assay. Eight bone parameters were measured in the right tibia by peripheral quantitative computed tomography; total bone density, trabecular bone density, medullary plus trabecular bone density, cortical bone density, total bone area, cortical bone area, medullary bone area, and minimum moment of inertia (mMOI). We ran sex-specific linear mixed-effect models with random intercepts and slopes adjusted for age, age-squared, education, body mass index, the rate of change in weight, smoking, sedentary behavior, cross-sectional areas of calf muscles and fat, 25-hydroxyvitamin D, parathyroid hormone, calcium, diabetes mellitus, and follow-up time. We found a significant association of "baseline GDF-15 × time" in models predicting cortical bone density and the mMOI in women, suggesting that the rates of decline in these bone parameters increased with higher GDF-15 (false discovery rate <0.05). Higher plasma levels GDF-15 predicted an accelerated decline in bone parameters in women, but was less associated in men. Furthermore studies are needed to understand the mechanisms underlying these sex differences.
Collapse
Affiliation(s)
- Yusuke Osawa
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland,USA
- Graduate School of Health Management, Keio University, Kanagawa, Japan
| | - Toshiko Tanaka
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland,USA
| | - Richard D Semba
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland,USA
| | - Giovanna Fantoni
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland,USA
| | - Ruin Moaddel
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland,USA
| | - Julián Candia
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland,USA
| | - Eleanor M Simonsick
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland,USA
| | | | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland,USA
| |
Collapse
|
17
|
Effect of Suppressive Levothyroxine Therapy on Bone Mineral Density in Young Patients with Differentiated Thyroid Carcinoma. Metabolites 2022; 12:metabo12090842. [PMID: 36144246 PMCID: PMC9500704 DOI: 10.3390/metabo12090842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/01/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022] Open
Abstract
Suppressive levothyroxine therapy (sT4) is a cornerstone in the management of differentiated thyroid cancer (DTC). Long-term sT4 may affect bone mineral density (BMD). We evaluated the effect of sT4 on the bone mass of young DTC patients. In this cross-sectional study, BMD was evaluated via dual-energy X-ray absorptiometry in DTC patients younger than 25 years at diagnosis and undergoing sT4 for ≥1 year. The two control groups comprised patients matched for sex, age, and body-mass-index who were thyroidectomized for indications other than DTC and undergoing L-T4-replacement therapy, and healthy individuals with no prior known thyroid disease. Ninety-three participants were included (thirty-one in each group). There were no differences in the mean age, female sex (77.4% in all groups), or BMI between the sT4 group and each control group. The median TSH level was lower (0.4 [0.04–6.5] vs. 2.7 [0.8–8.5] mIU/mL, p = 0.01) and the mean L-T4 mcg/Kg levels were higher (2.4 ± 0.6 vs. 1.6 ± 0.3, p = 0.01) in the sT4 group compared to the L-T4-replacement therapy group. Lumbar spine, femoral neck, and total femur BMD were all similar among the groups. sT4 does not impact BMD in young DTC patients after a median time of suppression of 8 years. These findings may help in the decision-making and risk/benefit evaluation of sT4 for this population.
Collapse
|
18
|
Rossi F, Tortora C, Paoletta M, Marrapodi MM, Argenziano M, Di Paola A, Pota E, Di Pinto D, Di Martino M, Iolascon G. Osteoporosis in Childhood Cancer Survivors: Physiopathology, Prevention, Therapy and Future Perspectives. Cancers (Basel) 2022; 14:cancers14184349. [PMID: 36139510 PMCID: PMC9496695 DOI: 10.3390/cancers14184349] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary Anti-cancer treatments induced an increase in the childhood cancer survival rate. However, they are responsible for several long-term side effects in childhood cancer survivors, including osteoporosis. Cancer itself, a sedentary lifestyle, and an unhealthy diet might adversely affect bone health. Early identification and adequate management of bone fragility in childhood cancer survivors could be useful to prevent osteoporosis onset and consequently fragility fractures. Abstract The improvement of chemotherapy, radiotherapy, and surgical interventions, together with hematopoietic stem cell transplantation, increased childhood cancer survival rate in the last decades, reaching 80% in Europe. Nevertheless, anti-cancer treatments are mainly responsible for the onset of long-term side effects in childhood cancer survivors (CCS), including alterations of the endocrine system function and activity. In particular, the most frequent dysfunction in CCS is a metabolic bone disorder characterized by low bone mineral density (BMD) with increased skeletal fragility. BMD loss is also a consequence of a sedentary lifestyle, malnutrition, and cancer itself could affect BMD, thus inducing osteopenia and osteoporosis. In this paper, we provide an overview of possible causes of bone impairment in CCS in order to propose management strategies for early identification and treatment of skeletal fragility in this population.
Collapse
Affiliation(s)
- Francesca Rossi
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 4, 80138 Napoli, Italy
- Correspondence: ; Tel.: +39-081-566-5423
| | - Chiara Tortora
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 4, 80138 Napoli, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 4, 80138 Napoli, Italy
| | - Maura Argenziano
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 4, 80138 Napoli, Italy
| | - Alessandra Di Paola
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 4, 80138 Napoli, Italy
| | - Elvira Pota
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 4, 80138 Napoli, Italy
| | - Daniela Di Pinto
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 4, 80138 Napoli, Italy
| | - Martina Di Martino
- Department of Woman, Child and General and Specialist Surgery, University of Campania “Luigi Vanvitelli”, Via L. De Crecchio 4, 80138 Napoli, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| |
Collapse
|
19
|
Farahmand M, Rahmati M, Azizi F, Behboudi Gandevani S, Ramezani Tehrani F. The Impact of Endogenous Estrogen Exposure Duration on Fracture Incidence: a Longitudinal Cohort Study. J Clin Endocrinol Metab 2022; 107:e3321-e3329. [PMID: 35512228 DOI: 10.1210/clinem/dgac248] [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: 09/22/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Although it is well documented that estrogen hormone is positively associated with bone mineral density and lower risk of fracture, there are limited studies on the association between duration of endogenous estrogen exposure (EEE) and fracture, especially by longitudinal design. OBJECTIVE This study aimed to investigate the relationship between EEE with fracture incidence by longitudinal design in a community-based study. METHODS A total of 5269 eligible postmenarcheal women, including 2411 premenopausal and 2858 menopausal women, were recruited from among the Tehran Lipid and Glucose Study. Cox proportional hazards regression model with adjustment of potential confounders was performed to assess the relationship between duration of EEE and incident of any hospitalized fractures. RESULTS A total of 26.7% (1409/5269) women were menopausal at the baseline, and 2858 of the remaining participants reached menopause at the end of follow-up. Results of the unadjusted model demonstrated that the EEE z-score was negatively associated with fracture incidence [unadjusted hazard ratio (HR) 0.81, 95% CI 0.68-0.96] in postmenarchal women, indicating that per 1-SD increase of EEE z-score, the hazard of fracture reduced by 19%. Results remained statistically unchanged after adjustment for potential confounders (adjusted HR 0.70, 95% CI 0.58-0.86). CONCLUSION The findings of this cohort study suggest that a longer duration of EEE has a protective effect on fracture incidence; a point that needs to be considered in fracture risk assessment.
Collapse
Affiliation(s)
- Maryam Farahmand
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Rahmati
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Fahimeh Ramezani Tehrani
- Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
20
|
Physical activity estimated by osteogenic potential and energy expenditure has differing associations with bone mass in young adults: the raine study. Arch Osteoporos 2022; 17:67. [PMID: 35434777 PMCID: PMC9013684 DOI: 10.1007/s11657-022-01100-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/15/2022] [Indexed: 02/03/2023]
Abstract
Ground impacts during physical activity may be important for peak bone mass. We found differences in how energy expenditure and impact scores estimated from a physical activity questionnaire related to bone health in young adults. Using both estimate types can improve our understanding of the skeletal benefits of physical activity. PURPOSE It is unclear whether mechanical loading during physical activity, estimated from physical activity questionnaires which assess metabolic equivalents of task (METs), is associated with skeletal health. This longitudinal study investigated how physical activity loading scores, assessed at ages 17 and 20 years, (a) compares with physical activity measured in METs, and (b) is associated with bone mass at age 20 years. METHODS A total of 826 participants from the Raine Study Gen2 were assessed for physical activity energy expenditure via the International Physical Activity Questionnaire (IPAQ) at age 17 and 20 years. Loading scores (the product of peak force and application rate) per week were subsequently estimated from the IPAQ. Whole-body and appendicular bone mineral density (BMD) at age 20 years were assessed by dual-energy X-ray absorptiometry. RESULTS Bland-Altman minimal detectable difference for physical activity Z- scores at age 17 and 20 years were 1.59 standard deviations (SDs) and 1.33 SDs, respectively, greater than the a priori minimal clinically important change of 0.5 SDs. Loading score, but not IPAQ score, had significant positive associations with whole-body and leg BMD after adjustment for covariates (β = 0.008 and 0.012 g/cm2, respectively, for age 17 and 20 years loading scores). IPAQ score at age 20 years, but not loading score, had a significant positive association with arm BMD (β = 0.007 g/cm2). CONCLUSION This study revealed disagreement in associations of self-reported METs and loading score estimates with bone health in young adults. Coupling traditional energy expenditure questionnaire outcomes with bone-loading estimates may improve understanding of the location-specific skeletal benefits of physical activity in young adults.
Collapse
|
21
|
Costa E Silva L, Teles J, Fragoso I. Sports injuries patterns in children and adolescents according to their sports participation level, age and maturation. BMC Sports Sci Med Rehabil 2022; 14:35. [PMID: 35264218 PMCID: PMC8908692 DOI: 10.1186/s13102-022-00431-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/04/2022] [Indexed: 11/13/2022]
Abstract
Background Growth can make young athletes more vulnerable to sports injuries. Increased knowledge about injury profile and its predictors is an important part of an overall risk management strategy but few studies have produced information. Methods Information about injury profile and sports participation (SP) level was obtained by LESADO and RAPIL II questionnaires. They were distributed to 651 participants aged between 10 and 18 years attending four schools. Maturity measures were evaluated through maturity offset (MO) and Tanner-Whitehouse III method. Bivariate analysis was used to identify the set of candidate predictors for multinomial logistic regression analysis that was used to determine significant predictors of injury type and body area injury location. Results Regarding injury type predictors recreative boys had more chances of having a sprain or a fracture than a strain. Also, recreative and scholar girls had more chances of having a sprain than a strain. As MO decreased, the chances of girls having a strain or a fracture when compared to sprains were higher. For body area location boys with 10–11 years were more likely to have upper limbs injuries than boys of other ages. This was also confirmed by MO. Spine and trunk injuries were more likely to occur in federate and no sports participation girls. Conclusions Injury type and body area injury location differed significantly by SP level, age group and MO.
Collapse
Affiliation(s)
- Lara Costa E Silva
- Laboratory of Physiology and Biochemistry of Exercise, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal. .,CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.
| | - Júlia Teles
- CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.,Mathematics Unit, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| | - Isabel Fragoso
- Laboratory of Physiology and Biochemistry of Exercise, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.,CIPER, Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal
| |
Collapse
|
22
|
Ha J, Jeong C, Han KD, Lim Y, Kim MK, Kwon HS, Song KH, Kang MI, Baek KH. Comparison of fracture risk between type 1 and type 2 diabetes: a comprehensive real-world data. Osteoporos Int 2021; 32:2543-2553. [PMID: 34333678 DOI: 10.1007/s00198-021-06032-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/11/2021] [Indexed: 12/24/2022]
Abstract
UNLABELLED Population-based cohort study of 6,548,784 Korean subjects demonstrates that the risk of fracture was higher in patients with diabetes than in nondiabetic subjects. Furthermore, patients with type 1 diabetes were associated with a higher risk of fracture than patients with type 2 diabetes for all measurement sites. INTRODUCTION Diabetes mellitus is associated with increased fracture risk. Although the pathophysiologic effect on bone metabolism differs according to the type of diabetes, a higher risk of fracture in patients with diabetes than in nondiabetic patients has been consistently demonstrated. Considering the ever-increasing number of patients with diabetes, we aimed to provide updated information on whether this phenomenon remains valid in real-world settings by using large-scale population datasets. METHODS We conducted a retrospective longitudinal study using data from the Korean National Health Insurance Service dataset of preventive health check-ups between January 2009 and December 2016. The hazard ratios were calculated for any fracture, vertebral fracture, and hip fracture and were analyzed according to the presence and type of diabetes. Among 10,585,818 subjects, 6,548,784 were eligible for the analysis (2418 patients with type 1 diabetes mellitus [T1DM] and 506,208 patients with type 2 diabetes mellitus [T2DM]). RESULTS The mean follow-up duration (in years) was 7.0 ± 1.3 for subjects without diabetes, 6.4 ± 2.0 for those with T1DM, and 6.7 ± 1.7 for T2DM. Patients with T1DM had a higher incidence rate for all types of fractures per 1000 person-years. The fully adjusted hazard ratios (HRs) for any fracture, vertebral fracture, and hip fracture were higher in T1DM than in T2DM (1.37 [95% confidence interval (CI): 1.23-1.52] for any fracture, 1.33 [95% CI: 1.09-1.63] for vertebral fracture, and 1.99 [95% CI: 1.56-2.53] for hip fracture). CONCLUSIONS In this large-scale population analysis, diabetes was associated with a higher risk of all types of fractures. Patients with T1DM had a higher risk of fracture than those with T2DM for all measurement sites, and hip fractures had the highest risk. Therefore, fracture prevention training for patients with diabetes is advisable.
Collapse
Affiliation(s)
- J Ha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - C Jeong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K-D Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Y Lim
- Division of General Internal Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - M K Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - H-S Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K-H Song
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - M I Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K-H Baek
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
23
|
CYP11B1 variants influence skeletal maturation via alternative splicing. Commun Biol 2021; 4:1274. [PMID: 34754074 PMCID: PMC8578655 DOI: 10.1038/s42003-021-02774-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/24/2021] [Indexed: 12/13/2022] Open
Abstract
We performed genome-wide association study meta-analysis to identify genetic determinants of skeletal age (SA) deviating in multiple growth disorders. The joint meta-analysis (N = 4557) in two multiethnic cohorts of school-aged children identified one locus, CYP11B1 (expression confined to the adrenal gland), robustly associated with SA (rs6471570-A; β = 0.14; P = 6.2 × 10-12). rs6410 (a synonymous variant in the first exon of CYP11B1 in high LD with rs6471570), was prioritized for functional follow-up being second most significant and the one closest to the first intron-exon boundary. In 208 adrenal RNA-seq samples from GTEx, C-allele of rs6410 was associated with intron 3 retention (P = 8.11 × 10-40), exon 4 inclusion (P = 4.29 × 10-34), and decreased exon 3 and 5 splicing (P = 7.85 × 10-43), replicated using RT-PCR in 15 adrenal samples. As CYP11B1 encodes 11-β-hydroxylase, involved in adrenal glucocorticoid and mineralocorticoid biosynthesis, our findings highlight the role of adrenal steroidogenesis in SA in healthy children, suggesting alternative splicing as a likely underlying mechanism.
Collapse
|
24
|
Neilan AM, Salvant Valentine S, Knopf AS. Case 27-2021: A 16-Year-Old Boy Seeking Human Immunodeficiency Virus Prophylaxis. N Engl J Med 2021; 385:1034-1041. [PMID: 34496178 DOI: 10.1056/nejmcpc1909626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anne M Neilan
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
| | - Sheila Salvant Valentine
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
| | - Amelia S Knopf
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
| |
Collapse
|
25
|
[Complication rate after femoral shaft fractures in childhood and adolescence depending on patient factors and treatment measures]. Chirurg 2021; 93:165-172. [PMID: 34132823 PMCID: PMC8821081 DOI: 10.1007/s00104-021-01437-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 01/26/2023]
Abstract
Hintergrund Die Behandlung der Femurschaftfrakturen bei Kindern war in den letzten Jahren einem zunehmenden Wandel unterzogen. Die früher dominierenden Therapieverfahren wurden durch minimal-invasive Techniken (z. B. elastisch stabile intramedulläre Nagelung [ESIN]) weitgehend abgelöst. Ziel der vorliegenden Studie war der Vergleich der Komplikationsraten in Abhängigkeit sowohl von Patientenfaktoren als auch von verschiedenen Behandlungsverfahren. Material und Methoden Bei der vorliegenden Arbeit handelt es sich um eine retrospektive röntgenmorphometrische Datenauswertung. Es wurden die Patientenakten und Röntgenbilder von 101 Kindern, die an zwei Level-I-Traumazentren behandelt wurden, ausgewertet. Ergebnisse In 19 % der Fälle wurde eine konservative Therapie durchgeführt. Bei den operativen Verfahren dominierte die ESIN-Technik (n = 60). Revisionspflichtige Komplikationen fanden sich nach konservativer Therapie bei ca. 10 % der Kinder. Bei den operativ behandelten Kindern musste in über 6 % der Fälle eine Revisionsoperation durchgeführt werden. Die ESIN-Stabilisierung zeigte bei den operativen Verfahren mit ca. 3 % die niedrigste Revisionsrate. Wurden im Verhältnis zum Markraumdurchmesser zu dünne ESIN-Drähte verwendet, so zeigte sich eine um 30 % höhere Komplikationswahrscheinlichkeit. Bei Kindern unter 3 Jahren und Adoleszenten war die Komplikationswahrscheinlichkeit erhöht. Diskussion In der durchgeführten Studie zeigt sich ein moderates Komplikationsrisiko bei der Behandlung von Femurschaftfrakturen bei Kindern. Das Komplikationsrisiko nach Fixateur-externe-Anlage und konservativer Behandlung war in dieser Studie am höchsten. Die ESIN-Technik zeigt insgesamt das geringste Komplikationsrisiko. Die vorliegende Arbeit konnte die bekannten Limitationen der ESIN-Technik in Abhängigkeit von Alter und Gewicht bestätigen.
Collapse
|
26
|
Saraiva BTC, Agostinete RR, Freitas Júnior IF, de Sousa DER, Gobbo LA, Tebar WR, Christofaro DGD. Association between handgrip strength and bone mineral density of Brazilian children and adolescents stratified by sex: a cross-sectional study. BMC Pediatr 2021; 21:207. [PMID: 33910521 PMCID: PMC8080340 DOI: 10.1186/s12887-021-02669-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background To examine the association of handgrip strength (HGS) and bone mineral density (BMD) of Brazilian children and adolescents. Methods The sample included 243 children and adolescents aged from 4 to 15 years (9.3 ± 2.2 years), 171 males and 72 females. The following measurements were performed: weight, height, trunk length, and years to the peak height velocity (PHV). The percentage lean soft tissue (PLST), percentage fat mass (PFM), and BMD were obtained using Dual Energy X-ray Absorptiometry (DXA) and HGS using a dynamometer. Results In girls, HGS was positively associated with higher BMD, even after the adjustments, by arms [β = 0.006; p < 0.001], legs [β = 0.014; p < 0.001], pelvis [β = 0.019; p < 0.001], trunk [β = 0.013; p < 0.001], spine [β = 0.013; p = 0.008], and total body [β = 0.009; p < 0.001]. The same occurred in the boys, even after the adjustments a positive relationship was observed, whereas higher HGS was related to greater BMD in arms [β = 0.006; p < 0.001], legs [β = 0.017; p < 0.001], pelvis [β = 0.014; p < 0.001], trunk [β = 0.009; p < 0.001], spine [β = 0.008; p < 0.001], and total body [β = 0.007; p < 0.001]. Conclusion HGS was positively associated to BMD in boys and girls, regardless of age, PHV, PLST, and PFM.
Collapse
Affiliation(s)
- Bruna Thamyres Ciccotti Saraiva
- Department of Physical Education, São Paulo State University (UNESP), School of Sciences and Technology, Presidente Prudente, SP, CEP 19060-900, Brazil
| | - Ricardo Ribeiro Agostinete
- Department of Physical Education, São Paulo State University (UNESP), School of Sciences and Technology, Presidente Prudente, SP, CEP 19060-900, Brazil.
| | - Ismael Forte Freitas Júnior
- Department of Physical Education, São Paulo State University (UNESP), School of Sciences and Technology, Presidente Prudente, SP, CEP 19060-900, Brazil
| | - Daniel Eduardo Rodrigues de Sousa
- Department of Physical Education, São Paulo State University (UNESP), School of Sciences and Technology, Presidente Prudente, SP, CEP 19060-900, Brazil
| | - Luis Alberto Gobbo
- Department of Physical Education, São Paulo State University (UNESP), School of Sciences and Technology, Presidente Prudente, SP, CEP 19060-900, Brazil
| | - William Rodrigues Tebar
- Department of Physical Education, São Paulo State University (UNESP), School of Sciences and Technology, Presidente Prudente, SP, CEP 19060-900, Brazil
| | - Diego Giulliano Destro Christofaro
- Department of Physical Education, São Paulo State University (UNESP), School of Sciences and Technology, Presidente Prudente, SP, CEP 19060-900, Brazil
| |
Collapse
|
27
|
Sherk VD, Heveran CM, Foright RM, Johnson GC, Presby DM, Ferguson VL, MacLean PS. Sex differences in the effect of diet, obesity, and exercise on bone quality and fracture toughness. Bone 2021; 145:115840. [PMID: 33418101 DOI: 10.1016/j.bone.2021.115840] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/03/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022]
Abstract
Bone fragility and obesity are both diseases that are multifactorial in etiology and pathology. The contributing role of high fat diet (HFD) versus energy overconsumption on bone health is controversial. Exercise is often prescribed for improving bone health, but it is unclear whether HFD or overconsumption influences skeletal adaptations to exercise. Female and male Wistar rats were fed HFD or low fat diet (LFD) for 10 weeks, starting at 8 weeks of age. Within HFD, rats were labeled Obesity-Resistant (OR) or Obesity-Prone (OP) based on weight and fat gain. Within each diet and phenotype group, rats were randomized to treadmill exercise or sedentary control (SED) for the final 4 weeks. Femurs were assessed for fracture toughness. Cortical lamellar and nonlamellar bone microscale material behavior and chemistry were assessed using nanoindentation and Raman spectroscopy. Female bones had higher fracture toughness and mineral: matrix ratio than male bones. Diet and energy overconsumption affected bone characteristics in a sex-dependent manner, where the divergence between OP and OR in response to HFD occurred more rapidly in males. Diet composition, in general, had a stronger effect on bone quality than overconsumption. HFD dramatically decreased bone size and lamellar mineral:matrix compared to LFD. Effects of short-term exercise training on microscale tissue properties were generally more robust with LFD. Exercise enhanced the contrast between lamellar and nonlamellar bone for nanoindentation modulus but decreased this contrast for plastic work. Our data demonstrate the complexities in the relationship between diet and obesity and highlight the importance of addressing both aspects when characterizing bone quality and fracture resistance.
Collapse
Affiliation(s)
- Vanessa D Sherk
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Chelsea M Heveran
- Department of Mechanical & Industrial Engineering, Montana State University, Bozeman, MT, United States of America
| | - Rebecca M Foright
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Ginger C Johnson
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - David M Presby
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| | - Virginia L Ferguson
- Department of Orthopedics, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Department of Mechanical Engineering, University of Colorado, Boulder, CO; (5)BioFrontiers Institute, University of Colorado, Boulder, CO, United States of America
| | - Paul S MacLean
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America
| |
Collapse
|
28
|
Troy KL, Mancuso ME, Johnson JE, Butler TA, Ngo BH, Schnitzer TJ. Dominant and nondominant distal radius microstructure: Predictors of asymmetry and effects of a unilateral mechanical loading intervention. Bone Rep 2021; 14:101012. [PMID: 33786342 PMCID: PMC7994725 DOI: 10.1016/j.bonr.2021.101012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 11/15/2022] Open
Abstract
Most information about distal radius microstructure is based on the non-dominant forearm, with little known about the factors that contribute to bilateral asymmetries in the general population, or what factors may influence bilateral changes over time. Here, we analyzed bilateral high resolution peripheral quantitative computed tomography (HRpQCT) data collected over a 12-month period as part of a clinical trial that prescribed a well-controlled, compressive loading task to the nondominant forearm. Baseline data from 102 women age 21–40, and longitudinal data from 66 women who completed the 12-month trial, were examined to determine factors responsible for side-to-side asymmetries in bone structure and change in structure over time. Cross-sectionally, the dominant radius had 2.4%–2.7% larger cross-sectional area, trabecular area, and bone mineral content than the nondominant radius, but no other differences were noted. Those who more strongly favored their dominant arm had significantly more, thinner, closely spaced trabecular struts in their dominant versus nondominant radius. Individuals assigned to a loading intervention had significant bilateral gains in total bone mineral density (2.0% and 1.2% in the nondominant versus dominant sides), and unilateral gains in the nondominant (loaded) cortical area (3.1%), thickness (3.0%), bone mineral density (1.7%) and inner trabecular density (1.3%). Each of these gains were significantly predicted by loading dose, a metric that included bone strain, number of cycles, and strain rate. Within individuals, change was negatively associated with age, meaning that women closer to age 40 experienced less of a gain in bone versus those closer to age 21. We believe that dominant/nondominant asymmetries in bone structure reflect differences in habitual loads during growth and past ability to adapt, while response to loading reflects current individual physiologic capacity to adapt. We examined relationships between physical activity, handedness, demographics, and asymmetries in distal radius structure. Trabecular and cross-sectional area were 2.4-2.7% larger in the dominant side. We examined factors that predicted 12-month change after a unilateral loading intervention on the nondominant side. The intervention caused unilateral (nondominant) increases in most variables, which scaled with loading dose. The results also suggest that greater dietary calcium is associated with endosteal bone apposition following loading.
Collapse
Affiliation(s)
- Karen L Troy
- Department of Biomedical Engienering, Worcester Polytechnic Institute, Worcester, MA, United States of America
| | - Megan E Mancuso
- Department of Biomedical Engienering, Worcester Polytechnic Institute, Worcester, MA, United States of America
| | - Joshua E Johnson
- Orthopaedic Biomechanics Laboratory, Dept. of Orthopaedic Surgery, University of Iowa, Iowa City, IA, United States of America
| | - Tiffiny A Butler
- Department of Biomedical Engienering, Worcester Polytechnic Institute, Worcester, MA, United States of America
| | - Bao Han Ngo
- Massachusetts Academy of Math and Science, Worcester, MA, United States of America
| | - Thomas J Schnitzer
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL, United States of America
| |
Collapse
|
29
|
Noirrit-Esclassan E, Valera MC, Tremollieres F, Arnal JF, Lenfant F, Fontaine C, Vinel A. Critical Role of Estrogens on Bone Homeostasis in Both Male and Female: From Physiology to Medical Implications. Int J Mol Sci 2021; 22:ijms22041568. [PMID: 33557249 PMCID: PMC7913980 DOI: 10.3390/ijms22041568] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 02/07/2023] Open
Abstract
Bone is a multi-skilled tissue, protecting major organs, regulating calcium phosphate balance and producing hormones. Its development during childhood determines height and stature as well as resistance against fracture in advanced age. Estrogens are key regulators of bone turnover in both females and males. These hormones play a major role in longitudinal and width growth throughout puberty as well as in the regulation of bone turnover. In women, estrogen deficiency is one of the major causes of postmenopausal osteoporosis. In this review, we will summarize the main clinical and experimental studies reporting the effects of estrogens not only in females but also in males, during different life stages. Effects of estrogens on bone involve either Estrogen Receptor (ER)α or ERβ depending on the type of bone (femur, vertebrae, tibia, mandible), the compartment (trabecular or cortical), cell types involved (osteoclasts, osteoblasts and osteocytes) and sex. Finally, we will discuss new ongoing strategies to increase the benefit/risk ratio of the hormonal treatment of menopause.
Collapse
Affiliation(s)
- Emmanuelle Noirrit-Esclassan
- I2MC, INSERM UMR 1297, University of Toulouse III, F-31000 Toulouse, France; (E.N.-E.); (M.-C.V.); (F.T.); (J.-F.A.); (F.L.); (C.F.)
- Department of Pediatric Dentistry, Faculty of Dental Surgery, University of Toulouse III, F-31000 Toulouse, France
| | - Marie-Cécile Valera
- I2MC, INSERM UMR 1297, University of Toulouse III, F-31000 Toulouse, France; (E.N.-E.); (M.-C.V.); (F.T.); (J.-F.A.); (F.L.); (C.F.)
- Department of Pediatric Dentistry, Faculty of Dental Surgery, University of Toulouse III, F-31000 Toulouse, France
| | - Florence Tremollieres
- I2MC, INSERM UMR 1297, University of Toulouse III, F-31000 Toulouse, France; (E.N.-E.); (M.-C.V.); (F.T.); (J.-F.A.); (F.L.); (C.F.)
- Menopause and Metabolic Bone Disease Center, Hôpital Paule de Viguier, University Hospital of Toulouse, F-31000 Toulouse, France
| | - Jean-Francois Arnal
- I2MC, INSERM UMR 1297, University of Toulouse III, F-31000 Toulouse, France; (E.N.-E.); (M.-C.V.); (F.T.); (J.-F.A.); (F.L.); (C.F.)
| | - Françoise Lenfant
- I2MC, INSERM UMR 1297, University of Toulouse III, F-31000 Toulouse, France; (E.N.-E.); (M.-C.V.); (F.T.); (J.-F.A.); (F.L.); (C.F.)
| | - Coralie Fontaine
- I2MC, INSERM UMR 1297, University of Toulouse III, F-31000 Toulouse, France; (E.N.-E.); (M.-C.V.); (F.T.); (J.-F.A.); (F.L.); (C.F.)
| | - Alexia Vinel
- I2MC, INSERM UMR 1297, University of Toulouse III, F-31000 Toulouse, France; (E.N.-E.); (M.-C.V.); (F.T.); (J.-F.A.); (F.L.); (C.F.)
- Department of Periodontology, Faculty of Dental Surgery, University of Toulouse III, F-31000 Toulouse, France
- Correspondence: ; Tel.: +33-5-61-77-36-10
| |
Collapse
|
30
|
Jacobson D, Liu JZ, Lindsey JC, Shiau S, Coull B, Aldrovandi G. Immune Markers and Their Association with Bone Density in Children, Adolescents, and Young Adults with Perinatally Acquired HIV. AIDS Res Hum Retroviruses 2021; 37:122-129. [PMID: 33066711 DOI: 10.1089/aid.2020.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
To describe distributions of immune markers in children and young adults by sex and HIV status, and within groups, investigate associations of immune markers with bone density across Tanner stage. Using data and samples from 353 participants in a cross-sectional study in youth with perinatally acquired HIV (PHIV) and matched HIV-negative controls, distributions of inflammation and activation immune markers were described by sex and HIV status. Correlations and structural equation models (SEM) were used to explore marginal and multivariable associations of the immune markers with bone density and to assess whether patterns of association varied by sex and HIV status. Immune marker distributions did not differ by sex, but there were some differences by HIV status. Correlation patterns among bone, body composition, and immune markers were similar across the sex and HIV status groups. Conclusions from SEMs were limited by small sample sizes, but there was some indication that patterns of association between bone density and certain immune markers differed in male PHIV with more advanced Tanner stage compared to the other three groups. In conclusion, distributions of bone density, body composition, and immune markers may vary by sex and HIV status, although associations among these outcomes within sex and HIV status groups appear similar. Bone density of male PHIV appears to be more negatively affected than females, regardless of female HIV status. Larger longitudinal studies across Tanner stages are needed to further explore potential biological relationships between immune markers and bone density in youth living with HIV.
Collapse
Affiliation(s)
- Denise Jacobson
- Center for Biostatistics in AIDS Research; Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Jeremiah Zhe Liu
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Jane C. Lindsey
- Center for Biostatistics in AIDS Research; Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Brent Coull
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Grace Aldrovandi
- Division of Infectious Diseases, Children's Hospital of Los Angeles, Los Angeles, California, USA
| |
Collapse
|
31
|
Abstract
Bone mass is a key determinant of osteoporosis and fragility fractures. Epidemiologic studies have shown that a 10% increase in peak bone mass (PBM) at the population level reduces the risk of fracture later in life by 50%. Low PBM is possibly due to the bone loss caused by various conditions or processes that occur during adolescence and young adulthood. Race, gender, and family history (genetics) are responsible for the majority of PBM, but other factors, such as physical activity, calcium and vitamin D intake, weight, smoking and alcohol consumption, socioeconomic status, age at menarche, and other secondary causes (diseases and medications), play important roles in PBM gain during childhood and adolescence. Hence, the optimization of lifestyle factors that affect PBM and bone strength is an important strategy to maximize PBM among adolescents and young people, and thus to reduce the low bone mass or osteoporosis risk in later life. This review aims to summarize the available evidence for the common but important factors that influence bone mass gain during growth and development and discuss the advances of developing high PBM.
Collapse
Affiliation(s)
- Xiaowei Zhu
- Disease & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, 310024, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Houfeng Zheng
- Disease & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, 310024, China.
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China.
- School of Life Sciences, Fudan University, Shanghai, 200433, China.
| |
Collapse
|
32
|
Abstract
PURPOSE The prevalence of childhood obesity has increased over past decades with a concomitant increase in metabolic and bariatric surgery (MBS). While MBS in adults is associated with bone loss, only a few studies have examined the effect of MBS on the growing skeleton in adolescents. METHODS This mini-review summarizes available data on the effects of the most commonly performed MBS (sleeve gastrectomy and gastric bypass) on bone in adolescents. A literature review was performed using PubMed for English-language articles. RESULTS Dual-energy x-ray absorptiometry (DXA) measures of areal bone mineral density (aBMD) and BMD Z scores decreased following all MBS. Volumetric BMD (vBMD) by quantitative computed tomography (QCT) decreased at the lumbar spine while cortical vBMD of the distal radius and tibia increased over a year following sleeve gastrectomy (total vBMD did not change). Reductions in narrow neck and intertrochanteric cross-sectional area and cortical thickness were observed over this duration, and hip strength estimates were deleteriously impacted. Marrow adipose tissue (MAT) of the lumbar spine increased while MAT of the peripheral skeleton decreased a year following sleeve gastrectomy. The amount of weight loss and reductions in lean and fat mass correlated with bone loss at all sites, and with changes in bone microarchitecture at peripheral sites. CONCLUSION MBS in adolescents is associated with aBMD reductions, and increases in MAT of the axial skeleton, while sleeve gastrectomy is associated with an increase in cortical vBMD and decrease in MAT of the peripheral skeleton. No reductions have been reported in peripheral strength estimates.
Collapse
Affiliation(s)
- Madhusmita Misra
- Division of Pediatric Endocrinology, Mass General Hospital for Children and Harvard Medical School, Boston, Massachusetts
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- Correspondence and Reprint Requests: Madhusmita Misra, MD, MPH, 175 Cambridge Street, 5th Floor, Boston, MA 02114, USA. E-mail:
| | - Miriam A Bredella
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
33
|
Yoo JE, Shin DW, Han K, Kim D, Yoon JW, Lee DY. Association of Female Reproductive Factors With Incidence of Fracture Among Postmenopausal Women in Korea. JAMA Netw Open 2021; 4:e2030405. [PMID: 33404618 PMCID: PMC7788464 DOI: 10.1001/jamanetworkopen.2020.30405] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
IMPORTANCE Although estrogen level is positively associated with bone mineral density, there are limited data on the risk of fractures after menopause. OBJECTIVE To investigate whether female reproductive factors are associated with fractures among postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used data from the Korean National Health Insurance Service database on 1 272 115 postmenopausal women without previous fracture who underwent both cardiovascular and breast and/or cervical cancer screening from January 1 to December 31, 2009. Outcome data were obtained through December 31, 2018. EXPOSURES Information was obtained about reproductive factors (age at menarche, age at menopause, parity, breastfeeding, and exogenous hormone use) by self-administered questionnaire. MAIN OUTCOMES AND MEASURES Incidence of any fractures and site-specific fractures (vertebral, hip, and others). RESULTS Among the 1 272 115 participants, mean (SD) age was 61.0 (8.1) years. Compared with earlier age at menarche (≤12 years), later age at menarche (≥17 years) was associated with a higher risk of any fracture (adjusted hazard ratio [aHR], 1.24; 95% CI, 1.17-1.31) and vertebral fracture (aHR, 1.42; 95% CI, 1.28-1.58). Compared with earlier age at menopause (<40 years), later age at menopause (≥55 years) was associated with a lower risk of any fracture (aHR, 0.89; 95% CI, 0.86-0.93), vertebral fracture (aHR, 0.77; 95% CI, 0.73-0.81), and hip fracture (aHR, 0.88; 95% CI, 0.78-1.00). Longer reproductive span (≥40 years) was associated with lower risk of fractures compared with shorter reproductive span (<30 years) (any fracture: aHR, 0.86; 95% CI, 0.84-0.88; vertebral fracture: aHR, 0.73; 95% CI, 0.71-0.76; and hip fracture: aHR, 0.87; 95% CI, 0.80-0.95). Parous women had a lower risk of any fracture than nulliparous women (aHR, 0.96; 95% CI, 0.92-0.99). Although breastfeeding for 12 months or longer was associated with a higher risk of any fractures (aHR, 1.05; 95% CI, 1.03-1.08) and vertebral fractures (aHR, 1.22; 95% CI, 1.17-1.27), it was associated with a lower risk of hip fracture (aHR, 0.84; 95% CI, 0.76-0.93). Hormone therapy for 5 years or longer was associated with lower risk of any factures (aHR, 0.85; 95% CI, 0.83-0.88), while use of oral contraceptives for 1 year or longer was associated with a higher risk of any fractures (aHR, 1.03; 95% CI, 1.01-1.05). CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that female reproductive factors are independent risk factors for fracture, with a higher risk associated with shorter lifetime endogenous estrogen exposure. Interventions to reduce fracture risk may be needed for women at high risk, including those without osteoporosis.
Collapse
Affiliation(s)
- Jung Eun Yoo
- Healthcare System Gangnam Center, Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Dahye Kim
- Department of Medical Statistics, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji Won Yoon
- Healthcare System Gangnam Center, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Yun Lee
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
34
|
Ribbans WJ, Aujla R, Dalton S, Nunley JA. Vitamin D and the athlete-patient: state of the art. J ISAKOS 2020; 6:46-60. [PMID: 33833045 DOI: 10.1136/jisakos-2020-000435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/20/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022]
Abstract
Vitamin D deficiency is common in athletes. The conventional measurement of vitamin D levels provides a general indicator of body stores. However, there are nuances in its interpretation as values of 25(OH)D do not correlate absolutely with the amount of 'bioavailable' vitamin to the cells. Vitamin D should be regarded as a hormone and influences between 5% and 10% of our total genome. Determining the precise effect of the vitamin, isolated from the actions of other cofactors, is not straightforward and restricts our complete understanding of all of its actions. Deficiency has harmful effects on not only bone and muscle but also wider areas, including immunity and respiratory and neurological activities. More caution should be applied regarding the ability of supranormal vitamin D levels to elevate athletic performance. Hopefully, future research will shed more light on optimal levels of vitamin D and supplementation regimes, and improved understanding of its intracellular control of our genetic mechanisms and how extrinsic influences modify its activity.
Collapse
Affiliation(s)
- William J Ribbans
- Faculty of Health, Education and Society, University of Northampton, Northampton, Northamptonshire, UK
| | - Randeep Aujla
- Perth Orthopaedic and Sports Medicine Centre, West Perth, Western Australia, Australia
| | - Seamus Dalton
- North Sydney Sports Medicine, Sydney, New South Wales, Australia
| | - James A Nunley
- Duke Orthopedics, Duke University, Durham, North Carolina, USA
| |
Collapse
|
35
|
Kim HS, Ng DK, Matheson MB, Atkinson MA, Warady BA, Furth SL, Ruebner RL. Delayed menarche in girls with chronic kidney disease and the association with short stature. Pediatr Nephrol 2020; 35:1471-1475. [PMID: 32337637 PMCID: PMC7977686 DOI: 10.1007/s00467-020-04559-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/10/2020] [Accepted: 03/27/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Children with chronic kidney disease (CKD) have delays in normal growth and pubertal development. We describe factors associated with delayed menarche and the association of delayed menarche with short stature in girls with CKD. METHODS Two hundred eighty-seven girls with CKD onset prior to menarche within the Chronic Kidney Disease in Children (CKiD) cohort were studied. Delayed menarche was defined as menarche at age 15 years or older; short stature was defined as last available height 2 standard deviations below projected adult height. Kaplan-Meier cumulative incidence function was used to estimate median age at menarche. Chi-squared and Wilcoxon rank-sum tests were used to assess factors associated with delayed menarche. Chi-squared test was used to evaluate the association between delayed menarche and short stature. RESULTS Among 287 girls, 68 enrolled with prevalent menarche, 131 were observed to have incident menarche, and 88 were pre-menarchal at their last study visit. Median age at menarche was 12 years. Ten percent had delayed menarche. African American race, lower estimated glomerular filtration rate, ever corticosteroid use, and longer CKD duration were associated with delayed menarche (p < 0.05). Girls with delayed menarche had lower height and weight percentiles at the time of menarche (p < 0.05). Sixty-one percent of girls with delayed menarche had short stature compared with only 35% of girls without delayed menarche (p = 0.03). CONCLUSION Median age at menarche is similar among girls with CKD and healthy girls. Ten percent of girls with CKD had delayed menarche and may be at risk for short stature.
Collapse
Affiliation(s)
- Hannah S. Kim
- Division of Pediatric Nephrology, Johns Hopkins University
| | - Derek K. Ng
- Department of Epidemiology, Johns Hopkins University
| | | | | | | | - Susan L. Furth
- Division of Pediatric Nephrology, Children’s Hospital of Philadelphia
| | | |
Collapse
|
36
|
Rozenberg S, Bruyère O, Bergmann P, Cavalier E, Gielen E, Goemaere S, Kaufman JM, Lapauw B, Laurent MR, De Schepper J, Body JJ. How to manage osteoporosis before the age of 50. Maturitas 2020; 138:14-25. [PMID: 32631584 DOI: 10.1016/j.maturitas.2020.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/23/2020] [Accepted: 05/08/2020] [Indexed: 12/16/2022]
Abstract
This narrative review discusses several aspects of the management of osteoporosis in patients under 50 years of age. Peak bone mass is genetically determined but can also be affected by lifestyle factors. Puberty constitutes a vulnerable period. Idiopathic osteoporosis is a rare, heterogeneous condition in young adults due in part to decreased osteoblast function and deficient bone acquisition. There are no evidence-based treatment recommendations. Drugs use can be proposed to elderly patients at very high risk. Diagnosis and management of osteoporosis in the young can be challenging, in particular in the absence of a manifest secondary cause. Young adults with low bone mineral density (BMD) do not necessarily have osteoporosis and it is important to avoid unnecessary treatment. A determination of BMD is recommended for premenopausal women who have had a fragility fracture or who have secondary causes of osteoporosis: secondary causes of excessive bone loss need to be excluded and treatment should be targeted. Adequate calcium, vitamin D, and a healthy lifestyle should be recommended. In the absence of fractures, conservative management is generally sufficient, but in rare cases, such as chemotherapy-induced osteoporosis, antiresorptive medication can be used. Osteoporosis in young men is most often of secondary origin and hypogonadism is a major cause; testosterone replacement therapy will improve BMD in these patients. Diabetes is characterized by major alterations in bone quality, implying that medical therapy should be started sooner than for other causes of osteoporosis. Primary hyperparathyroidism, hyperthyroidism, Cushing's syndrome and growth hormone deficiency or excess affect cortical bone more often than trabecular bone.
Collapse
Affiliation(s)
- S Rozenberg
- Department of Gynaecology-Obstetrics, CHU St Pierre, Université Libre de Bruxelles, Brussels, Belgium.
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - P Bergmann
- Honorary Consulent, Nuclear Medicine CHU Brugmann CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - E Cavalier
- Department of Clinical Chemistry, UnilabLg, CIRM, University of Liège, CHU de Liège, Domaine du Sart-Tilman, 4000 Liège, Belgium
| | - E Gielen
- Gerontology & Geriatrics, Department of Public Health and Primary Care, KU Leuven & Department of Geriatric Medicine, UZ Leuven, Leuven, Belgium
| | - S Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - J M Kaufman
- Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - B Lapauw
- Department of Endocrinology Ghent University Hospital, Ghent, Belgium
| | - M R Laurent
- Centre for Metabolic Bone Diseases, University Hospitals Leuven, Imelda Hospital, Bonheiden, Belgium
| | - J De Schepper
- Department of Pediatrics, UZ Brussel, Brussels, Belgium, Belgium
| | - J J Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
37
|
Santos D, Lopes T, Jesus P, Cruz S, Cordeiro A, Pereira S, Saboya C, Ramalho A. Bone Metabolism in Adolescents and Adults Undergoing Roux-En-Y Gastric Bypass: a Comparative Study. Obes Surg 2020; 29:2144-2150. [PMID: 30820885 DOI: 10.1007/s11695-019-03797-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To compare the bone metabolism of adolescents and adults with obesity before undergoing a Roux-en-Y gastric bypass (RYGB) and 6 and 12 months after the surgery. MATERIALS AND METHODS Adolescents (G1) and adults (G2) with obesity assessed before (T0), six (T1), and 12 months after (T2) RYGB. Sun exposure, serum concentrations of 25(OH)D, calcium, phosphorous, magnesium, zinc, alkaline phosphatase, parathyroid hormone (PTH), and bone mineral density (BMD) were evaluated. RESULTS Sixty adolescents and 60 adults were assessed. At T0, there was no significant difference between the groups' serum 25(OH)D levels (G1 21.87 + 7.52 ng/mL, G2 21.73 + 7.60 ng/mL, p = 0.94) or sun exposure (G1 17 ± 2.0 min/day, G2 13.2 ± 5.2 min/day, p = 0.85). G1 had high levels of inadequacy of calcium (66.7%), phosphorous (80.0%), and zinc (18.3%) at T0 and had a significant fall in their 25(OH)D (p < 0.01) and magnesium (p < 0.01) levels from T1 to T2. G2 saw a significant lowering of their serum zinc levels from T0 to T1 and T2 (T1 p < 0.01; T2 p < 0.01). In both groups, there was a significant rise in PTH from T1 to T2 (G1 p = 0.04, G2 p = 0.02) and from T0 to T2 (G1 and G2 p < 0.01). In G2, 40.4% of individuals with osteopenia and osteoporosis presented inadequacy of 25(OH)D. CONCLUSION RYGB was found to worsen the inadequacy of micronutrients related to bone metabolism and was associated with secondary hyperparathyroidism and low BMD values, especially among the adolescents. The irreversible damaging effects of obesity on bone metabolism can occur in adolescence.
Collapse
Affiliation(s)
- Débora Santos
- Researcher of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, 21.941-902, Brazil
| | - Tais Lopes
- Researcher of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, 21.941-902, Brazil
| | - Patrícia Jesus
- Researcher of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, 21.941-902, Brazil.,School of Medicine at Federal University of Rio de Janeiro (UFRJ), Carlos Chagas avenue, 373. Edifício do Centro de Ciências da Saúde, 2° floor, room 49. Cidade Universitária - Ilha do Fundão, Rio de Janeiro, 21.941-902, Brazil
| | - Sabrina Cruz
- Researcher of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, 21.941-902, Brazil. .,School of Medicine at Federal University of Rio de Janeiro (UFRJ), Carlos Chagas avenue, 373. Edifício do Centro de Ciências da Saúde, 2° floor, room 49. Cidade Universitária - Ilha do Fundão, Rio de Janeiro, 21.941-902, Brazil.
| | - Adryana Cordeiro
- Researcher of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, 21.941-902, Brazil.,School of Medicine at Federal University of Rio de Janeiro (UFRJ), Carlos Chagas avenue, 373. Edifício do Centro de Ciências da Saúde, 2° floor, room 49. Cidade Universitária - Ilha do Fundão, Rio de Janeiro, 21.941-902, Brazil
| | - Silvia Pereira
- Multidisciplinary Center for Bariatric and Metabolic Surgery, School of Medicine of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Researcher of the NPqM at Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil
| | - Carlos Saboya
- Multidisciplinary Center for Bariatric and Metabolic Surgery, School of Medicine of Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.,Researcher of the NPqM at Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil.,Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Andréa Ramalho
- Researcher of the NPqM at Federal University of Rio de Janeiro, (UFRJ), Rio de Janeiro, Brazil.,Department of Social and Applied Nutrition of the Institute of Nutrition at UFRJ. Coordinator of the Center for Research on Micronutrients (NPqM) of the Institute of Nutrition Josué de Castro of UFRJ, Rio de Janeiro, Brazil
| |
Collapse
|
38
|
Magnus MC, Guyatt AL, Lawn RB, Wyss AB, Trajanoska K, Küpers LK, Rivadeneira F, Tobin MD, London SJ, Lawlor DA, Millard LAC, Fraser A. Identifying potential causal effects of age at menarche: a Mendelian randomization phenome-wide association study. BMC Med 2020; 18:71. [PMID: 32200763 PMCID: PMC7087394 DOI: 10.1186/s12916-020-01515-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 02/10/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Age at menarche has been associated with various health outcomes. We aimed to identify potential causal effects of age at menarche on health-related traits in a hypothesis-free manner. METHODS We conducted a Mendelian randomization phenome-wide association study (MR-pheWAS) of age at menarche with 17,893 health-related traits in UK Biobank (n = 181,318) using PHESANT. The exposure of interest was the genetic risk score for age at menarche. We conducted a second MR-pheWAS after excluding SNPs associated with BMI from the genetic risk score, to examine whether results might be due to the genetic overlap between age at menarche and BMI. We followed up a subset of health-related traits to investigate MR assumptions and seek replication in independent study populations. RESULTS Of the 17,893 tests performed in our MR-pheWAS, we identified 619 associations with the genetic risk score for age at menarche at a 5% false discovery rate threshold, of which 295 were below a Bonferroni-corrected P value threshold. These included potential effects of younger age at menarche on lower lung function, higher heel bone-mineral density, greater burden of psychosocial/mental health problems, younger age at first birth, higher risk of childhood sexual abuse, poorer cardiometabolic health, and lower physical activity. After exclusion of variants associated with BMI, the genetic risk score for age at menarche was related to 37 traits at a 5% false discovery rate, of which 29 were below a Bonferroni-corrected P value threshold. We attempted to replicate findings for bone-mineral density, lung function, neuroticism, and childhood sexual abuse using 5 independent cohorts/consortia. While estimates for lung function, higher bone-mineral density, neuroticism, and childhood sexual abuse in replication cohorts were consistent with UK Biobank estimates, confidence intervals were wide and often included the null. CONCLUSIONS The genetic risk score for age at menarche was related to a broad range of health-related traits. Follow-up analyses indicated imprecise evidence of an effect of younger age at menarche on greater bone-mineral density, lower lung function, higher neuroticism score, and greater risk of childhood sexual abuse in the smaller replication samples available; hence, these findings need further exploration when larger independent samples become available.
Collapse
Affiliation(s)
- Maria C Magnus
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK.
- Population Health Sciences, Bristol Medical School, Bristol, UK.
- Centre for Fertility and Health, Norwegian Institute of Public Health, P.O. Box 222 Skøyen, 0213, Oslo, Norway.
| | - Anna L Guyatt
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Rebecca B Lawn
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Annah B Wyss
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Katerina Trajanoska
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Leanne K Küpers
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- Division of Human Nutrition and Health, Wageningen University & Research, Wageningen, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Martin D Tobin
- Department of Health Sciences, University of Leicester, Leicester, UK
- National Institute for Health Research, Leicester Respiratory Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - Stephanie J London
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services, Research Triangle Park, NC, USA
| | - Debbie A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| | - Louise A C Millard
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- Intelligent Systems Laboratory, Department of Computer Science, University of Bristol, Bristol, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- NIHR Bristol Biomedical Research Centre at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol, Bristol, UK
| |
Collapse
|
39
|
Xue S, Kemal O, Lu M, Lix LM, Leslie WD, Yang S. Age at attainment of peak bone mineral density and its associated factors: The National Health and Nutrition Examination Survey 2005-2014. Bone 2020; 131:115163. [PMID: 31760214 DOI: 10.1016/j.bone.2019.115163] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 10/25/2022]
Abstract
Osteoporosis is a major public health problem worldwide. Lower peak bone mineral density (BMD) in youth may be the single most important factor leading to the development of osteoporosis in the elderly. Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2005-2014, we included 18,713 individuals with complete and valid data on femoral neck, total hip and lumbar spine BMD. Generalized additive models were used to estimate the age at attainment of peak BMD and 95% confidence intervals (95%Cls); model covariates were sex, race, body mass index (BMI) and we also examine factors potentially affecting age at attainment of peak BMD. This study clearly stated that age at attainment of peak femoral neck, total hip and lumbar spine BMD were 20.5 years, 21.2 years and 23.6 years in males, and 18.7 years, 19.0 years and 20.1 years in females, respectively and age at attainment of peak BMD varied by skeletal sites and sex. The study also found that females achieved peak femoral neck, total hip and lumbar spine BMD earlier than males (all P < 0.001); race and BMI were not associated with the age at attainment of peak BMD (all P > 0.05). These results suggested that improving bone health among individuals before 20 years old may be useful for reducing future risk of osteoporosis and osteoporotic fractures.
Collapse
Affiliation(s)
- Shanshan Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Oumer Kemal
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Meihan Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Shuman Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China.
| |
Collapse
|
40
|
Brand JS, Hiyoshi A, Cao Y, Lawlor DA, Cnattingius S, Montgomery S. Maternal smoking during pregnancy and fractures in offspring: national register based sibling comparison study. BMJ 2020; 368:l7057. [PMID: 31996343 PMCID: PMC7190030 DOI: 10.1136/bmj.l7057] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the impact of maternal smoking during pregnancy on fractures in offspring during different developmental stages of life. DESIGN National register based birth cohort study with a sibling comparison design. SETTING Sweden. PARTICIPANTS 1 680 307 people born in Sweden between 1983 and 2000 to women who smoked (n=377 367, 22.5%) and did not smoke (n=1 302 940) in early pregnancy. Follow-up was until 31 December 2014. MAIN OUTCOME MEASURE Fractures by attained age up to 32 years. RESULTS During a median follow-up of 21.1 years, 377 970 fractures were observed (the overall incidence rate for fracture standardised by calendar year of birth was 11.8 per 1000 person years). The association between maternal smoking during pregnancy and risk of fracture in offspring differed by attained age. Maternal smoking was associated with a higher rate of fractures in offspring before 1 year of age in the entire cohort (birth year standardised fracture rates in those exposed and unexposed to maternal smoking were 1.59 and 1.28 per 1000 person years, respectively). After adjustment for potential confounders the hazard ratio for maternal smoking compared with no smoking was 1.27 (95% confidence interval 1.12 to 1.45). This association followed a dose dependent pattern (compared with no smoking, hazard ratios for 1-9 cigarettes/day and ≥10 cigarettes/day were 1.20 (95% confidence interval 1.03 to 1.39) and 1.41 (1.18 to 1.69), respectively) and persisted in within-sibship comparisons although with wider confidence intervals (compared with no smoking, 1.58 (1.01 to 2.46)). Maternal smoking during pregnancy was also associated with an increased fracture incidence in offspring from age 5 to 32 years in whole cohort analyses, but these associations did not follow a dose dependent gradient. In within-sibship analyses, which controls for confounding by measured and unmeasured shared familial factors, corresponding point estimates were all close to null. Maternal smoking was not associated with risk of fracture in offspring between the ages of 1 and 5 years in any of the models. CONCLUSION Prenatal exposure to maternal smoking is associated with an increased rate of fracture during the first year of life but does not seem to have a long lasting biological influence on fractures later in childhood and up to early adulthood.
Collapse
Affiliation(s)
- Judith S Brand
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 70185 Örebro, Sweden
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 70185 Örebro, Sweden
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 70185 Örebro, Sweden
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Sven Cnattingius
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 70185 Örebro, Sweden
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Solna, Sweden
- Department of Epidemiology and Public Health, University College London, London, UK
| |
Collapse
|
41
|
|
42
|
Cardona Attard C, Cameron-Pimblett A, Puri D, Elliot J, Wilson JC, Talaulikar VS, Davies MC, Conway GS. Fracture rate in women with oestrogen deficiency - Comparison of Turner syndrome and premature ovarian insufficiency. Clin Endocrinol (Oxf) 2019; 91:743-749. [PMID: 31612507 DOI: 10.1111/cen.14110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/01/2019] [Accepted: 10/13/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Women with early-onset oestrogen deficiency are at risk of reduced bone mineral density (BMD). We sought to assess fracture history and BMD in women with Turner syndrome (TS) and premature ovarian insufficiency (POI). DESIGN A cross-sectional observational study. PATIENTS Two hundred and sixty seven women with TS (median age 34.3 years) and 67 women with POI (median age 28.1 years). MEASUREMENTS A questionnaire was used to collect data on fracture history, co-morbidities and drug history including age at first oestrogen exposure. Clinical data included height, weight, serum vitamin D and hip and spine T-scores, which were adjusted for height and age. Fractures were subdivided into major osteoporotic fractures (MOF) and 'other' fracture types. RESULTS Overall fracture rate was similar in women with TS and POI (82 [30.5%] vs 22 [32.8%] respectively, P = .74). Compared to women with POI, those with TS had more fractures at MOF sites (30.2% vs 52.7%, P = .012) and fewer phalangeal fractures (27.9% vs 9.8%, P = .005). There was no difference in BMD between women who sustained a fracture compared to those who did not. Women with TS who fractured were more likely to suffer from hearing impairment compared to those with no fracture (62.2% vs 48.1%, P = .045). CONCLUSIONS TS is not associated with an overall excess risk of bone fracture. The higher rate of fractures at MOF sites in women with TS may be secondary to hearing impairment, thin cortical bone and abnormal bone remodelling.
Collapse
Affiliation(s)
| | | | - Davina Puri
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Jessica Elliot
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Jack C Wilson
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | | | - Melanie C Davies
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| | - Gerard S Conway
- Reproductive Medicine Unit, University College London Hospitals, London, UK
| |
Collapse
|
43
|
Abstract
Estrogens and progestogens influence the bone. The major physiological effect of estrogen is the inhibition of bone resorption whereas progestogens exert activity through binding to specific progesterone receptors. New estrogen-free contraceptive and its possible implication on bone turnover are discussed in this review. Insufficient bone acquisition during development and/or accelerated bone loss after attainment of peak bone mass (PBM) are 2 processes that may predispose to fragility fractures in later life. The relative importance of bone acquisition during growth versus bone loss during adulthood for fracture risk has been explored by examining the variability of areal bone mineral density (BMD) (aBMD) values in relation to age. Bone mass acquired at the end of the growth period appears to be more important than bone loss occurring during adult life. The major physiological effect of estrogen is the inhibition of bone resorption. When estrogen transcription possesses binds to the receptors, various genes are activated, and a variety modified. Interleukin 6 (IL-6) stimulates bone resorption, and estrogen blocks osteoblast synthesis of IL-6. Estrogen may also antagonize the IL-6 receptors. Additionally, estrogen inhibits bone resorption by inducing small but cumulative changes in multiple estrogen-dependent regulatory factors including TNF-α and the OPG/RANKL/RANK system. Review on existing data including information about new estrogen-free contraceptives. All progestins exert activity through binding to specific progesterone receptors; hereby, three different groups of progestins exist: pregnanes, gonanes, and estranges. Progestins also comprise specific glucocorticoid, androgen, or mineralocorticoid receptor interactions. Anabolic action of a progestogen may be affected via androgenic, anti-androgenic, or synadrogenic activity. The C 19 nortestosterone class of progestogens is known to bind with more affinity to androgen receptors than the C21 progestins. This article reviews the effect of estrogens and progestogens on bone and presents new data of the currently approved drospirenone-only pill. The use of progestin-only contraceptives leading to an estradiol level between 30 and 50 pg/ml does not seem to lead to an accelerate bone loss.
Collapse
Affiliation(s)
- P. Hadji
- Frankfurter Center of Bone Health, Goethestr. 23, 60313 Frankfurt/Main, Germany
- Philipps University of Marburg, Marburg, Germany
| | - E. Colli
- Exeltis HealthCare Madrid, C/ Manuel Pombo Angulo 28, 4th Floor, 28050 Madrid, Spain
| | - P.-A. Regidor
- Exeltis Europe, Adalperostr. 84, 85737 Ismaning, Germany
| |
Collapse
|
44
|
Pubertal timing and adult fracture risk in men: A population-based cohort study. PLoS Med 2019; 16:e1002986. [PMID: 31790400 PMCID: PMC6886748 DOI: 10.1371/journal.pmed.1002986] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Puberty is a critical period for bone mass accrual, and late puberty in boys is associated with reduced bone mass in adult men. The role of variations in pubertal timing within the normal range for adult fracture risk in men is, however, unknown. We, therefore, assessed the association between age at peak height velocity (PHV), an objective measure of pubertal timing, and fracture risk in adult men. METHODS AND FINDINGS In the BMI Epidemiology Study Gothenburg, 31,971 Swedish men born between January 1, 1945, and December 31, 1961, with detailed growth data (height and weight) available from centrally archived school healthcare records and the conscription register were followed until December 31, 2016. Age at PHV was calculated according to a modified infancy-childhood-puberty model, and fracture information was retrieved from the Swedish National Patient Register. The mean ± SD age at PHV was 14.1 ± 1.1 years. In total, 5,872 men (18.4%) sustained at least 1 fracture after 20 years of age and 5,731 men (17.9%) sustained a non-vertebral fracture after 20 years of age during a mean ± SD follow-up of 37.3 ± 11.7 years. Cox proportional hazards models adjusted for birth year and country of origin revealed that age at PHV was associated with the risk of any fracture and non-vertebral fracture. Participants with age at PHV in the highest tertile (after 14.5 years of age) were at greater risk of any fracture (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.08-1.22, P < 0.001) and non-vertebral fracture (HR 1.16, 95% CI 1.09-1.24, P < 0.001) compared with those with age at PHV in the lowest tertile (at 13.6 years of age or younger). Additional adjustments for birthweight, childhood BMI, adult educational level, and young adult height did not attenuate the associations between age at PHV and adult fracture risk. Limitations of this study include the inability to adjust for important risk factors for fracture, inadequate power to assess the relation between pubertal timing and specific fracture types, and the limited generalizability to other populations. CONCLUSIONS In this study, we observed that late pubertal timing was associated with increased adult fracture risk in men. These findings suggest that information on pubertal timing might aid in the identification of those men at greatest risk of fracture.
Collapse
|
45
|
Nilsen OA, Ahmed LA, Winther A, Christoffersen T, Thrane G, Evensen E, Furberg AS, Grimnes G, Dennison E, Emaus N. Body Weight and Body Mass Index Influence Bone Mineral Density in Late Adolescence in a Two-Year Follow-Up Study. The Tromsø Study: Fit Futures. JBMR Plus 2019; 3:e10195. [PMID: 31667452 PMCID: PMC6808229 DOI: 10.1002/jbm4.10195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/15/2019] [Accepted: 03/02/2019] [Indexed: 01/01/2023] Open
Abstract
Determinants of bone acquisition in late adolescence and early adulthood are not well‐described. This 2‐year follow‐up study explored the associations of body weight (BW), body mass index (BMI), and changes in weight status with adolescent bone accretion in a sample of 651 adolescents (355 girls and 296 boys) between 15 and 19 years of age from The Tromsø Study: Fit Futures. This Norwegian population‐based cohort study was conducted from 2010 to 2011 and was repeated from 2012 to 2013. We measured femoral neck, total hip, and total body bone mineral content and areal bone mineral density (aBMD) by dual‐energy X‐ray absorptiometry. We measured height, BW, calculated BMI (kg/m
2), and collected information on lifestyle at both surveys. Mean BMI (SD) at baseline was 22.17 (3.76) and 22.18 (3.93) in girls and boys, respectively. Through multiple linear regression, baseline BW and BMI were positively associated with ∆aBMD over 2 years of follow‐up at all skeletal sites in boys (
p < 0.05), but not in girls. ∆BW and ∆BMI predicted ∆aBMD and ∆BMC in both sexes, but the strength of the associations was moderate. Individuals who lost weight during follow‐up demonstrated a slowed progression of aBMD accretion compared with those gaining weight, but loss of BW or reduction of BMI during 2 years was not associated with net loss of aBMD. In conclusion, our results confirm that adequate BW for height in late adolescence is important for bone health. Associations between change in weight status and bone accretion during follow‐up were moderate and unlikely to have any clinical implication on adolescents of normal weight. Underweight individuals, particularly boys, are at risk of not reaching optimal peak bone mass and could benefit from an increase in BMI. © 2019 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Ole Andreas Nilsen
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway
| | - Luai Awad Ahmed
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway
| | - Anne Winther
- Division of Neurosciences, Orthopedics and Rehabilitation Services University Hospital of North Norway Tromsø Norway
| | - Tore Christoffersen
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway.,Department of Health and Care Sciences Finnmark Hospital Trust, Alta Norway
| | - Gyrd Thrane
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway
| | - Elin Evensen
- Department of Clinical Research University Hospital of North Norway, Tromsø, Norway, and Department of Health and Care Sciences, The Arctic University of Norway Tromsø Norway
| | - Anne-Sofie Furberg
- Department of Community Medicine The Arctic University of Norway Tromsø Norway.,Department of Microbiology and Infection Control Division of Internal Medicine University Hospital of North Norway Tromsø Norway
| | - Guri Grimnes
- Division of Internal Medicine University Hospital of North Norway, Tromsø, Norway, and Endocrine Research Group, Department of Clinical Medicine, The Arctic University of Norway Tromsø Norway
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, Southampton UK and Victoria University Wellington New Zealand
| | - Nina Emaus
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway
| |
Collapse
|
46
|
DiVasta AD, Feldman HA, O’Donnell JM, Long J, Leonard MB, Gordon CM. Impact of Adrenal Hormone Supplementation on Bone Geometry in Growing Teens With Anorexia Nervosa. J Adolesc Health 2019; 65:462-468. [PMID: 31227390 PMCID: PMC7001735 DOI: 10.1016/j.jadohealth.2019.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Adolescents with anorexia nervosa (AN) have decreased dehydroepiandrosterone (DHEA) and estrogen concentrations that may contribute to skeletal deficits. We sought to determine whether DHEA + estrogen replacement (ERT) prevented bone loss in young adolescents with AN. METHODS We recruited females with AN (n = 70, ages 11-18 years) into a 12-month, randomized, double-blind placebo-controlled trial. Participants were randomized to oral micronized DHEA 50 mg + 20 mcg ethinyl estradiol/.1 mg levonorgestrel daily (n = 35) or placebo (n = 35). Outcomes included serial measures of bone mineral density (BMD) by dual-energy X-ray absorptiometry (total body, hip, spine) and peripheral quantitative computed tomography (pQCT; tibia). Magnetic resonance imaging of T1-weighted images of the left knee determined physeal status (open/closed). RESULTS Sixty-two subjects completed the trial. Physeal closure status was the strongest predictor of aBMD changes. Among girls with open physes, those who received DHEA + ERT showed a decline in BMD Z-scores compared with those receiving placebo, whereas there was no effect in those with at least one closed physis. Treatment did not affect any pQCT measures, regardless of physeal closure status. CONCLUSIONS Combined DHEA + ERT did not significantly improve dual-energy X-ray absorptiometry or pQCT BMD measurements in young adolescent girls with AN, in contrast to an earlier trial showing benefit in older adolescents and young women. In girls with open physes, the mean change in the placebo arm was greater than that of the DHEA + ERT group. We conclude that DHEA + ERT is ineffective for preserving bone health in growing young adolescents with AN at the dose and route of administration described in this report.
Collapse
Affiliation(s)
- Amy D. DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA,Division of Gynecology, Boston Children’s Hospital, Boston, MA, USA
| | - Henry A. Feldman
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA,Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA
| | | | - Jin Long
- Division of Pediatric Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mary B. Leonard
- Division of Pediatric Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Catherine M. Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
| |
Collapse
|
47
|
Attfield KR, Pinney SM, Sjödin A, Voss RW, Greenspan LC, Biro FM, Hiatt RA, Kushi LH, Windham GC. Longitudinal study of age of menarche in association with childhood concentrations of persistent organic pollutants. ENVIRONMENTAL RESEARCH 2019; 176:108551. [PMID: 31376650 DOI: 10.1016/j.envres.2019.108551] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Age at female puberty is associated with adult morbidities, including breast cancer and diabetes. Hormonally active chemicals are suspected of altering pubertal timing. We examined whether persistent organic pollutants (POPs) are associated with age at menarche in a longitudinal study. METHODS We analyzed data for females enrolled at age 6-8 years in the Breast Cancer and Environment Research Program from California and Ohio. Participants were followed annually 2004-2013 and provided serum (mean age 7.8 years) for measurement of polychlorinated biphenyl (PCB), organochlorine pesticide (OCP), and polybrominated diphenyl ether (PBDE) concentrations. Age of menarche was assigned based on parental and participant reported dates and ages of menarche. Adjusted hazard ratios (aHRs) for menarchal onset were calculated with Cox proportional regression. Body mass index (BMI), potentially on the causal pathway, was added to parallel analyses. RESULTS Age of menarche was later with higher summed PCB levels (median 11.9 years in quartile 1 [Q1] versus 12.7 in quartile 4 [Q4]) and OCP levels (12.1 years versus 12.4, respectively). When adjusting for all covariates except BMI, higher POP concentrations were associated with later age at menarche (Q4 versus Q1 aHRs: PBDEs 0.75 [95% CI 0.58, 0.97], PCBs 0.67 [95% CI 0.5, 0.89], and OCPs 0.66 [95% CI 0.50, 0.89]). Additional adjustment for BMI attenuated aHRs; PCB aHR approached the null. CONCLUSION Findings revealed later onset of menarche with higher concentrations of certain POPs, possibly through an association with BMI. Altered pubertal timing may have long lasting effects on reproductive health and disease risk, so continued attention is important for understanding the biological processes affected by hormonally active chemicals.
Collapse
Affiliation(s)
- Kathleen R Attfield
- California Department of Public Health, Richmond, CA, USA; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Susan M Pinney
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andreas Sjödin
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert W Voss
- California Department of Public Health, Richmond, CA, USA
| | | | - Frank M Biro
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert A Hiatt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | | |
Collapse
|
48
|
Elhakeem A, Frysz M, Tilling K, Tobias JH, Lawlor DA. Association Between Age at Puberty and Bone Accrual From 10 to 25 Years of Age. JAMA Netw Open 2019; 2:e198918. [PMID: 31397863 PMCID: PMC6692837 DOI: 10.1001/jamanetworkopen.2019.8918] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 06/17/2019] [Indexed: 01/22/2023] Open
Abstract
Importance Bone health in early life is thought to influence the risk of osteoporosis in later life. Objective To examine whether puberty timing is associated with bone mineral density accrual up to adulthood. Design, Setting, and Participants This cohort study used data from the Avon Longitudinal Study of Parents and Children, a prospective population-based birth cohort initiated in 1991 to 1992 in southwest England. The participants were 6389 healthy British people who underwent regular follow-up, including up to 6 repeated bone density scans from ages 10 to 25 years. Data analysis was performed from June 2018 to June 2019. Exposures Age at puberty from estimated age at peak height velocity (years). Main Outcomes and Measures Gains per year in whole-body bone mineral density (grams per square centimeter), assessed by dual-energy x-ray absorptiometry at ages 10, 12, 14, 16, 18, and 25 years and modeled using linear splines. Results A total of 6389 participants (3196 [50.0%] female) were included. The mean (SD) age at peak height velocity was 13.5 (0.9) years for male participants and 11.6 (0.8) years for female participants. Male participants gained bone mineral density at faster rates than did female participants, with the greatest gains in both male participants (0.139 g/cm2/y; 95% CI, 0.127-0.151 g/cm2/y) and female participants (0.106 g/cm2/y; 95% CI, 0.098-0.114 g/cm2/y) observed between the year before and 2 years after peak height velocity. When aligned by chronological age, per 1-year older age at puberty was associated with faster subsequent gains in bone mineral density; the magnitudes of faster gains were greatest between ages 14 and 16 years in both male participants (0.013 g/cm2/y; 95% CI, 0.011-0.015 g/cm2/y) and female participants (0.014 g/cm2/y; 95% CI, 0.014-0.015 g/cm2/y), were greater in male participants (0.011 g/cm2/y; 95% CI, 0.010-0.013 g/cm2/y) than in female participants (0.003 g/cm2/y; 95% CI, 0.003-0.004 g/cm2/y) between ages 16 and 18 years, and were least in both male participants (0.002 g/cm2/y; 95% CI, 0.001-0.003 g/cm2/y) and female participants (0.000 g/cm2/y; 95% CI, -0.001 to 0.000 g/cm2/y) between ages 18 and 25 years. Despite faster gains, older age at puberty was associated with persistently lower bone mineral density, changing from 0.050 g/cm2 (95% CI, -0.056 to -0.045 g/cm2) lower at age 14 years to 0.047 g/cm2 (95% CI, -0.051 to -0.043 g/cm2) lower at age 25 years in male participants and from 0.044 g/cm2 (95% CI, -0.046 to -0.041 g/cm2) to 0.034 g/cm2 (95% CI, -0.036 to -0.032 g/cm2) lower at the same ages in female participants. Conclusions and Relevance People with older pubertal age should be advised on how to maximize bone mineral density and minimize its decrease in later life to help prevent fracture and osteoporosis.
Collapse
Affiliation(s)
- Ahmed Elhakeem
- Medical Research Council Integrative Epidemiology Unit at University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kate Tilling
- Medical Research Council Integrative Epidemiology Unit at University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jon H. Tobias
- Medical Research Council Integrative Epidemiology Unit at University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Deborah A. Lawlor
- Medical Research Council Integrative Epidemiology Unit at University of Bristol, Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
49
|
Cameron-Pimblett A, Davies MC, Burt E, Talaulikar VS, La Rosa C, King TFJ, Conway GS. Effects of Estrogen Therapies on Outcomes in Turner Syndrome: Assessment of Induction of Puberty and Adult Estrogen Use. J Clin Endocrinol Metab 2019; 104:2820-2826. [PMID: 30726925 DOI: 10.1210/jc.2018-02137] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/01/2019] [Indexed: 12/27/2022]
Abstract
CONTEXT Turner syndrome (TS) is often associated with delayed puberty. To induce puberty, estrogen is administered in incremental doses at an age determined by age of presentation. After puberty, various types of maintenance estrogen replacement therapy (ERT) are used. OBJECTIVE We sought associations between age of induction of puberty and type of ERT on adult health outcomes. DESIGN Health surveillance data included blood profiles, bone density, and blood pressure. We assessed interactions between these data and age at first estrogen exposure in women with primary amenorrhea. We also assessed these data according to ERT subgroups [combined oral contraceptive pill (OCP), oral estrogen (OE), and transdermal estradiol (TE)] using data from each of 6679 clinic visits, controlling for age, body mass index, and height. SETTING Adult TS clinic at University College London Hospital. PATIENTS Of 799 women with TS, 624 had primary amenorrhea and 599 had accurate maintenance ERT data. MAIN OUTCOME MEASURES Parameters of health surveillance derived from clinical guidelines. RESULTS Estrogen start age was negatively correlated with adult bone density (spine: r = -0.20 and hip: r = -0.022; P ≤ 0.001). OCP users had higher blood pressure and an adverse lipid profile compared with other ERT subgroups. TE was associated with elevated liver enzymes and hemoglobin A1c compared with OE (P ≤ 0.01). CONCLUSIONS An earlier age of induction of puberty may be beneficial for adult bone density. Given the high prevalence of hypertension in TS, the use of OCP for ERT should be limited. OE may be a benefit for steatohepatitis.
Collapse
Affiliation(s)
| | - Melanie C Davies
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
| | - Elizabeth Burt
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
| | | | - Clementina La Rosa
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
| | - Thomas F J King
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
| | - Gerard S Conway
- Reproductive Medicine Unit, University College London Hospital, London, United Kingdom
| |
Collapse
|
50
|
Liu X, Wan M. A tale of the good and bad: Cell senescence in bone homeostasis and disease. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2019; 346:97-128. [PMID: 31122396 DOI: 10.1016/bs.ircmb.2019.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Historically, cellular senescence has been viewed as an irreversible cell-cycle arrest process with distinctive phenotypic alterations that were implicated primarily in aging and tumor suppression. Recent discoveries suggest that cellular senescence represents a series of diverse, dynamic, and heterogeneous cellular states with the senescence-associated secretory phenotype (SASP). Although senescent cells typically contribute to aging and age-related diseases, accumulating evidence has shown that they also have important physiological functions during embryonic development, late pubertal bone growth cessation, and adulthood tissue remodeling. Here, we review the recent research on cellular senescence and SASP, highlighting the key pathways that mediate senescence cell-cycle arrest and initiate SASP. We also summarize recent literature on the role of cellular senescence in maintaining bone homeostasis and mediating age-associated osteoporosis, discussing both the beneficial and adverse roles of cellular senescence in bone during different physiological stages, including bone development, childhood bone growth, adulthood bone remodeling, and bone aging.
Collapse
Affiliation(s)
- Xiaonan Liu
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mei Wan
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| |
Collapse
|