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Slart RHJA, Punda M, Ali DS, Bazzocchi A, Bock O, Camacho P, Carey JJ, Colquhoun A, Compston J, Engelke K, Erba PA, Harvey NC, Krueger D, Lems WF, Lewiecki EM, Morgan S, Moseley KF, O'Brien C, Probyn L, Rhee Y, Richmond B, Schousboe JT, Shuhart C, Ward KA, Van den Wyngaert T, Zhang-Yin J, Khan AA. Updated practice guideline for dual-energy X-ray absorptiometry (DXA). Eur J Nucl Med Mol Imaging 2024:10.1007/s00259-024-06912-6. [PMID: 39316095 DOI: 10.1007/s00259-024-06912-6] [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: 07/02/2024] [Accepted: 08/28/2024] [Indexed: 09/25/2024]
Abstract
The introduction of dual-energy X-ray absorptiometry (DXA) technology in the 1980s revolutionized the diagnosis, management and monitoring of osteoporosis, providing a clinical tool which is now available worldwide. However, DXA measurements are influenced by many technical factors, including the quality control procedures for the instrument, positioning of the patient, and approach to analysis. Reporting of DXA results may be confounded by factors such as selection of reference ranges for T-scores and Z-scores, as well as inadequate knowledge of current standards for interpretation. These points are addressed at length in many international guidelines but are not always easily assimilated by practising clinicians and technicians. Our aim in this report is to identify key elements pertaining to the use of DXA in clinical practice, considering both technical and clinical aspects. Here, we discuss technical aspects of DXA procedures, approaches to interpretation and integration into clinical practice, and the use of non-bone mineral density measurements, such as a vertebral fracture assessment, in clinical risk assessment.
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Affiliation(s)
- Riemer H J A Slart
- Medical Imaging Centre, Department of Nuclear Medicine & Molecular Imaging (EB50), University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO 9700 RB, Groningen, The Netherlands.
| | - Marija Punda
- Department of Oncology and Nuclear Medicine, University Hospital Centre Sestre Milosrdnice, Vinogradska 29, Zagreb, Croatia
| | - Dalal S Ali
- Department of Endocrinology, McMaster University, Hamilton, L8S 4L8, Canada
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Oliver Bock
- Department of Osteoporosis, Inselspital, Bern University Hospital, Switzerland, IG Osteoporose, Bern, Switzerland
| | - Pauline Camacho
- Loyola University Medical Center (LUMC), 2160 S 1st Ave, Maywood, IL, 60153, USA
| | | | - Anita Colquhoun
- Centre for Osteoporosis & Bone Health, Women's College Hospital, Toronto, ON, Canada
| | | | - Klaus Engelke
- Department of Medicine, Institute of Medical Physics, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Ulmenweg 18, 91054, Erlangen, Germany
| | - Paola A Erba
- Department of Medicine and Surgery, Nuclear Medicine Unit, ASST Ospedale Papa Giovanni, University of Milan-Bicocca, Piazza, Bergamo, Italy
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust, Southampton, UK
| | - Diane Krueger
- School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Willem F Lems
- Department of Rheumatology, Amsterdam University Medical, Center, The Netherlands
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, 87106, USA
| | - Sarah Morgan
- The UAB Osteoporosis Prevention and Treatment Clinic, The University of Alabama at Birmingham, Birmingham, Al, USA
| | - Kendall F Moseley
- Division of Endocrinology, Johns Hopkins University, Baltimore, MD, 21201, USA
| | | | - Linda Probyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave., Toronto, ON, M4N 3M5, Canada
| | - Yumie Rhee
- Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Bradford Richmond
- Diagnostic Radiology, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Minneapolis, MN, USA
| | - Christopher Shuhart
- Swedish Bone Health and Osteoporosis Center, 1600 E Jefferson St Ste 300, Seattle, WA, 98122, USA
| | - Kate A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | | | - Jules Zhang-Yin
- Department of Nuclear Medicine, Clinique Sud Luxembourg, Vivalia, B-6700, Arlon, Belgium
| | - Aliya A Khan
- Department of Endocrinology, McMaster University, Hamilton, L8S 4L8, Canada
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Onizuka N, Onizuka T. Disparities in Osteoporosis Prevention and Care: Understanding Gender, Racial, and Ethnic Dynamics. Curr Rev Musculoskelet Med 2024; 17:365-372. [PMID: 38916641 PMCID: PMC11335991 DOI: 10.1007/s12178-024-09909-8] [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] [Accepted: 06/09/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Osteoporosis, the most prevalent metabolic bone disease, significantly impacts global public health by increasing fracture risks, particularly among post-menopausal women and the elderly. Osteoporosis is characterized by decreased bone mineral density (BMD) and deterioration of bone tissue, which leads to enhanced fragility. The disease is predominantly diagnosed using dual X-ray absorptiometry (DXA) and is significantly influenced by demographic factors such as age and hormonal changes. This chapter delves into the condition's complex nature, emphasizing the pervasive gender and racial disparities in its screening, diagnosis, and treatment. RECENT FINDINGS Recent findings highlight a substantial gap in the management of osteoporosis, with many individuals remaining under-screened and under-treated. Factors contributing to this include the asymptomatic early stages of the disease, lack of awareness, economic barriers, and inconsistent screening practices, especially in under-resourced areas. These challenges are compounded by disparities that affect different genders and races unevenly, influencing both the prevalence of the disease and the likelihood of receiving adequate healthcare services. The summary of this chapter underscores the urgent need for targeted strategies to overcome these barriers and improve health equity in osteoporosis care. Proposed strategies include enhancing public and healthcare provider awareness of osteoporosis, broadening access to diagnostic screenings, and integrating personalized treatment approaches. These efforts aim to align with global health objectives to mitigate the impacts of osteoporosis and ensure equitable health outcomes across all demographic groups.
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Affiliation(s)
- Naoko Onizuka
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA.
- TRIA Orthopedics Park Nicollet Methodist Hospital, St. Louis Park, MN, USA.
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Kanis JA, Harvey NC, Lorentzon M, Liu E, Schini M, Abrahamsen B, Adachi JD, Alokail M, Borgstrom F, Bruyère O, Carey JJ, Clark P, Cooper C, Curtis EM, Dennison EM, Díaz-Curiel M, Dimai HP, Grigorie D, Hiligsmann M, Khashayar P, Lems W, Lewiecki EM, Lorenc RS, Papaioannou A, Reginster JY, Rizzoli R, Shiroma E, Silverman SL, Simonsick E, Sosa-Henríquez M, Szulc P, Ward KA, Yoshimura N, Johansson H, Vandenput L, McCloskey EV. Race-specific FRAX models are evidence-based and support equitable care: a response to the ASBMR Task Force report on Clinical Algorithms for Fracture Risk. Osteoporos Int 2024; 35:1487-1496. [PMID: 38960982 DOI: 10.1007/s00198-024-07162-w] [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: 06/04/2024] [Accepted: 06/19/2024] [Indexed: 07/05/2024]
Abstract
Task Force on 'Clinical Algorithms for Fracture Risk' commissioned by the American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee has recommended that FRAX® models in the US do not include adjustment for race and ethnicity. This position paper finds that an agnostic model would unfairly discriminate against the Black, Asian and Hispanic communities and recommends the retention of ethnic and race-specific FRAX models for the US, preferably with updated data on fracture and death hazards. In contrast, the use of intervention thresholds based on a fixed bone mineral density unfairly discriminates against the Black, Asian and Hispanic communities in the US. This position of the Working Group on Epidemiology and Quality of Life of the International Osteoporosis Foundation (IOF) is endorsed both by the IOF and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).
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Affiliation(s)
- John A Kanis
- Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mattias Lorentzon
- Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Enwu Liu
- Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia
| | - Marian Schini
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Bo Abrahamsen
- Odense Patient Data Explorative Network, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Majed Alokail
- Biochemistry Department, College of Science, Riyadh, Kingdom of Saudi Arabia
| | | | - Olivier Bruyère
- Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - John J Carey
- School of Medicine, University of Galway, Galway, Ireland
| | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de Mexico "Federico Gomez", Mexico City, Mexico
- Faculty of Medicine of National Autonomous University of Mexico (Universidad, Nacional Autónoma de México), Mexico City, Mexico
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - Manuel Díaz-Curiel
- Metabolic Bone Diseases Unit, Department of Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma Madrid, Madrid, Spain
| | - Hans P Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Styria, Austria
| | - Daniel Grigorie
- Carol Davila University of Medicine, Bucharest, Romania
- Department of Endocrinology & Bone Metabolism, National Institute of Endocrinology, Bucharest, Romania
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Patricia Khashayar
- International Institute for Biosensing, University of Minnesota, Minneapolis, USA
| | - Willem Lems
- Department of Rheumatology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| | - Roman S Lorenc
- Multidisciplinary Osteoporosis Forum, Warsaw, Poland, Poland
| | | | - Jean-Yves Reginster
- Protein Research Chair, Biochemistry Dept, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Eric Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA
| | - Stuart L Silverman
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Eleanor Simonsick
- Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA
| | | | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Hospital Edouard Herriot, Lyon, France
| | - Kate A Ward
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- MRC Unit The Gambia, London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - Helena Johansson
- Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Liesbeth Vandenput
- Mary McKillop Institute for Health Research, Catholic University, AustralianMelbourne, Australia
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
- Mellanby Centre for Musculoskeletal Research, MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, University of Sheffield, Sheffield, UK
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Ozawa H, Ohki T, Shukuzawa K, Nakamura K, Nishide R, Kasa K, Nakagawa H, Shirouzu M, Omori M, Fukushima S. Impact of osteoporosis on overall survival following endovascular repair for abdominal aortic aneurysms. J Vasc Surg 2024:S0741-5214(24)01787-7. [PMID: 39208917 DOI: 10.1016/j.jvs.2024.08.034] [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: 07/17/2024] [Revised: 08/10/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE To evaluate the impact of osteoporosis on overall survival following endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs). METHODS This was a retrospective, single-center cohort study on 172 patients who had undergone primary EVAR for AAA between 2016 and 2018. Bone mineral density (BMD) was assessed by measuring the Hounsfield units (HUs) of the 11th thoracic vertebra on preoperative computed tomography; a BMD value of <110 HU was considered osteoporosis. All patients were divided into those with osteoporosis and those without osteoporosis, and long-term outcomes were compared. In addition, hazard ratios of each variable for all-cause mortality were evaluated using univariate and multivariate analysis. RESULTS All 172 patients were divided into two groups: 72 patients (41.9%) with osteoporosis and 100 patients (58.1%) without osteoporosis. The mean age was higher and mean BMD was lower in osteoporosis patients than non-osteoporosis patients (mean ± standard deviation [SD], 79.2 ± 7.2 vs. 75.0 ± 8.7 years, respectively; P < 0.05; 78.1 ± 26.7 vs. 155.1 ± 36.3 HU, respectively; P < 0.05). During the median follow-up period of 68 months, overall survival was significantly lower in osteoporosis patients than non-osteoporosis patients (osteoporosis: 63.9% and 36.7% at 5 years and 7 years; non-osteoporosis: 83.8% and 74.6% at 5 years and 7 years, respectively; log-rank P < 0.05); freedom from aneurysm-related mortality did not differ significantly between groups (osteoporosis: 94.3% and 89.0% at 5 years and 7 years; non-osteoporosis: 100.0% and 96.7% at 5 years and 7 years, respectively; log-rank P = 0.078). In a multivariate analysis for overall survival following EVAR, coexistence of osteoporosis was found to be an independent risk factor for all-cause mortality (hazard ratio, 1.76, 95% confidence interval, 1.01-3.06; P < 0.05), as well as variables including age, statin use, sarcopenia, and aneurysm diameter. CONCLUSIONS Patients with osteoporosis showed a higher all-cause mortality following EVAR than patients without osteoporosis. We believe that comorbidity of osteoporosis may be useful in estimating the life expectancy of patients with AAA.
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Affiliation(s)
- Hirotsugu Ozawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
| | - Kota Shukuzawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Koki Nakamura
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Ryo Nishide
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kentaro Kasa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hikaru Nakagawa
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Miyo Shirouzu
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Makiko Omori
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Soichiro Fukushima
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Burnett-Bowie SAM, Wright NC, Yu EW, Langsetmo L, Yearwood GMH, Crandall CJ, Leslie WD, Cauley JA. The American Society for Bone and Mineral Research Task Force on clinical algorithms for fracture risk report. J Bone Miner Res 2024; 39:517-530. [PMID: 38590141 DOI: 10.1093/jbmr/zjae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/23/2024] [Accepted: 03/13/2024] [Indexed: 04/10/2024]
Abstract
Using race and ethnicity in clinical algorithms potentially contributes to health inequities. The American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee convened the ASBMR Task Force on Clinical Algorithms for Fracture Risk to determine the impact of race and ethnicity adjustment in the US Fracture Risk Assessment Tool (US-FRAX). The Task Force engaged the University of Minnesota Evidence-based Practice Core to conduct a systematic review investigating the performance of US-FRAX for predicting incident fractures over 10 years in Asian, Black, Hispanic, and White individuals. Six studies from the Women's Health Initiative (WHI) and Study of Osteoporotic Fractures (SOF) were eligible; cohorts only included women and were predominantly White (WHI > 80% and SOF > 99%), data were not consistently stratified by race and ethnicity, and when stratified there were far fewer fractures in Black and Hispanic women vs White women rendering area under the curve (AUC) estimates less stable. In the younger WHI cohort (n = 64 739), US-FRAX without bone mineral density (BMD) had limited discrimination for major osteoporotic fracture (MOF) (AUC 0.53 (Black), 0.57 (Hispanic), and 0.57 (White)); somewhat better discrimination for hip fracture in White women only (AUC 0.54 (Black), 0.53 (Hispanic), and 0.66 (White)). In a subset of the older WHI cohort (n = 23 918), US-FRAX without BMD overestimated MOF. The Task Force concluded that there is little justification for estimating fracture risk while incorporating race and ethnicity adjustments and recommends that fracture prediction models not include race or ethnicity adjustment but instead be population-based and reflective of US demographics, and inclusive of key clinical, behavioral, and social determinants (where applicable). Research cohorts should be representative vis-à-vis race, ethnicity, gender, and age. There should be standardized collection of race and ethnicity; collection of social determinants of health to investigate impact on fracture risk; and measurement of fracture rates and BMD in cohorts inclusive of those historically underrepresented in osteoporosis research.
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Affiliation(s)
- Sherri-Ann M Burnett-Bowie
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Nicole C Wright
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Elaine W Yu
- Endocrine Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Lisa Langsetmo
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care Center, Minneapolis, MN 55417, United States
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
| | - Gabby M H Yearwood
- Department of Anthropology and Center for Civil Rights and Racial Justice, University of Pittsburgh, Pittsburgh, PA 15260, United States
| | - Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095, United States
| | - William D Leslie
- Departments of Internal Medicine and Radiology, Max Rady College of Medicine, University of Manitoba, Winnipeg R3E 0T6, Canada
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, United States
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Kolliopoulos V, Harley BA. Mineralized collagen scaffolds for regenerative engineering applications. Curr Opin Biotechnol 2024; 86:103080. [PMID: 38402689 PMCID: PMC10947798 DOI: 10.1016/j.copbio.2024.103080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/27/2024]
Abstract
Collagen is a primary constituent of the tissue extracellular matrix. As a result, collagen has been a common component of tissue engineering biomaterials, including those to promote bone regeneration or to investigate cell-material interactions in the context of bone homeostasis or disease. This review summarizes key considerations regarding current state-of-the-art design and use of collagen biomaterials for these applications. We also describe strategic opportunities for collagen biomaterials to address a new era of challenges, including immunomodulation and appropriate consideration of sex and other patient characteristics in biomaterial design.
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Affiliation(s)
- Vasiliki Kolliopoulos
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Brendan Ac Harley
- Department of Chemical and Biomolecular Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; Cancer Center at Illinois, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; Carl R. Woese Institute for Genomic Biology, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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Li RX, Xu N, Guo YN, Wang Y, Liang YW, Zhou XL, Jiang WT, Wei JX, Zhang XY, Zhou LN, Zhu L, Zhou YM, Xu J. Hemoglobin is associated with BMDs and risk of the 10-year probability of fractures in patients with type 2 diabetes mellitus. Front Endocrinol (Lausanne) 2024; 15:1305713. [PMID: 38323109 PMCID: PMC10846305 DOI: 10.3389/fendo.2024.1305713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/02/2024] [Indexed: 02/08/2024] Open
Abstract
Purpose This study aimed to investigate the associations between hemoglobin (HGB) levels and bone mineral density (BMD) and fracture risk in type 2 diabetes mellitus(T2DM) population of different ages. Method This cross-sectional study included 641 patients with T2DM (57.9% males). BMD of the femoral neck (FN), total hip (TH), and lumbar spine (LS) were measured using dual-energy X-ray absorptiometry. The 10-year probability of fracture was assessed using a fracture risk assessment tool (FRAX). HGB and other biochemical indices were measured in a certified laboratory at our hospital. Statistical analysis was performed using SPSS 26.0 and R language (R version 4.1.0). Generalized additive models (GAMs) were used to identify the associations between HGB and BMD and fracture risk. Results Patients with osteoporosis have lower HGB levels than the non-osteoporotic population and lower FN BMD in patients with anemia than in the non-anemic population. In patients with T2DM, there was sex- and age-related variability in the correlation between HGB levels and BMDs and fracture risk. In older men, HGB level was an independent determinant of BMD and was positively correlated with FN and TH BMD. In non-older women, HGB level was an independent determinant of BMD and fracture risk, positively associated with BMDs and negatively associated with 10-year probability of fracture risk. GAMs revealed a positive linear association between HGB level and BMDs in non-older female patients but not in older male patients. Conclusion Our study provides a new perspective on the association of HGB level and BMDs with fracture risk. Relatively high HGB levels are a protective factor for bone quality in patients with T2DM. However, the bone-protective effect of HGB is influenced by age and sex and persists only in older men and non-older women with T2DM.
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Affiliation(s)
- Ren-xuan Li
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
| | - Na Xu
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
| | - Yu-ning Guo
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
| | - Yan Wang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
| | - Yan-wei Liang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiao-lian Zhou
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Wen-tong Jiang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
| | - Jian-xia Wei
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
| | - Xin-yuan Zhang
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
| | - Li-na Zhou
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Lei Zhu
- Department of Endocrinology, Shandong Provincial Third Hospital, Jinan, Shandong, China
| | - Yan-man Zhou
- Department of Nephrology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jin Xu
- Department of Endocrinology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- Key Laboratory of Endocrine Glucose & Lipids Metabolism and Brain Aging, Ministry of Education; Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- Department of Endocrinology, Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Institute of Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, “Chuangxin China” Innovation Base of Stem Cell and Gene Therapy for Endocrine Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, Shandong, China
- Department of Endocrinology, Shandong Engineering Research Center of Stem Cell and Gene Therapy for Endocrine and Metabolic Diseases, Jinan, Shandong, China
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8
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Su Y, Zhou B, Kwok T. Fracture risk prediction in old Chinese people-a narrative review. Arch Osteoporos 2023; 19:3. [PMID: 38110842 DOI: 10.1007/s11657-023-01360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
With aging, the burden of osteoporotic fracture (OF) increases substantially, while China is expected to carry the greatest part in the future. The risk of fracture varies greatly across racial groups and geographic regions, and systematically organized evidence on the potential predictors for fracture risk is needed for Chinese. This review briefly introduces the epidemiology of OF and expands on the predictors and predictive tools for the risk of OF, as well as the challenges for their potential translation in the old Chinese population. There are regional differences of fracture incidence among China. The fracture incidences in Hong Kong and Taiwan have decreased in recent years, while it is still increasing in mainland China. Although the application of dual-energy X-ray absorptiometry (DXA) is limited among old Chinese in the mainland, bone mineral density (BMD) by DXA has a predictive value similar to that worldwide. Other non-DXA modalities, especially heel QUS, are helpful in assessing bone health. The fracture risk assessment tool (FRAX) has a good discrimination ability for OFs, especially the FRAX with BMD. And some clinical factors have added value to FRAX, which has been verified in old Chinese. In addition, although the application of the osteoporosis self-assessment tool for Asians (OSTA) in Chinese needs further validation, it may help identify high-risk populations in areas with limited resources. Moreover, the translation use of the muscle quality and genetic or serum biomarkers in fracture prediction needs further works. More applicable and targeted fracture risk predictors and tools are still needed for the old Chinese population.
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Affiliation(s)
- Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Bei Zhou
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Timothy Kwok
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, SAR, China.
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9
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Fink HA, Butler ME, Claussen AM, Collins ES, Krohn KM, Taylor BC, Tikabo SS, Vang D, Zerzan NL, Ensrud KE. Performance of Fracture Risk Assessment Tools by Race and Ethnicity: A Systematic Review for the ASBMR Task Force on Clinical Algorithms for Fracture Risk. J Bone Miner Res 2023; 38:1731-1741. [PMID: 37597237 DOI: 10.1002/jbmr.4895] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/18/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023]
Abstract
The American Society of Bone and Mineral Research (ASBMR) Professional Practice Committee charged an ASBMR Task Force on Clinical Algorithms for Fracture Risk to review the evidence on whether current approaches for differentiating fracture risk based on race and ethnicity are necessary and valid. To help address these charges, we performed a systematic literature review investigating performance of calculators for predicting incident fractures within and across race and ethnicity groups in middle-aged and older US adults. We included English-language, controlled or prospective cohort studies that enrolled US adults aged >40 years and reported tool performance predicting incident fractures within individual race and ethnicity groups for up to 10 years. From 4838 identified references, six reports met eligibility criteria, all in women. Just three, all from one study, included results in non-white individuals. In these three reports, non-white women experienced relatively few major osteoporotic fractures (MOFs), especially hip fractures, and risk thresholds for predicting fractures in non-white women were derived from risks in the overall, predominantly white study population. One report suggested the Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) overestimated hip fracture similarly across race and ethnicity groups (black, Hispanic, American Indian, Asian, white) but overestimated MOF more in non-white than White women. However, these three reports were inconclusive regarding whether discrimination of FRAX or the Garvan calculator without BMD or of FRAX with BMD for MOF or hip fracture differed between white versus black women. This uncertainty was at least partly due to imprecise hip fracture estimates in black women. No reports examined whether ratios of observed to predicted hip fracture risks within each race or ethnicity group varied across levels of predicted hip fracture risk. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.
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Affiliation(s)
- Howard A Fink
- Geriatric Research Education and Clinical Center, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Mary E Butler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Amy M Claussen
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Erin S Collins
- Masters of Public Health Program, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kristina M Krohn
- Division of Hospital Medicine, School of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Brent C Taylor
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Sina S Tikabo
- Masters of Public Health Program, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Denny Vang
- Masters of Public Health Program, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Nicholas L Zerzan
- Masters of Public Health Program, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kristine E Ensrud
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
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10
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Billington EO, Miyagishima RC, Hasselaar C, Arain M. Women's perspectives regarding osteoporosis, fracture risk, and pharmacologic treatment: a cross-sectional study. Osteoporos Int 2023; 34:2069-2076. [PMID: 37608123 DOI: 10.1007/s00198-023-06890-9] [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: 01/28/2023] [Accepted: 08/15/2023] [Indexed: 08/24/2023]
Abstract
We assessed women's perspectives regarding early preventative therapy for osteoporosis. More than a third of early menopausal women were concerned about bone loss and future fractures, and approximately half were willing to take an intravenous or oral bisphosphonate around the time of menopause to preserve bone health. PURPOSE Bisphosphonate medications can prevent the substantial bone loss that occurs during early menopause, but little is known about whether women would accept bisphosphonate treatment at this time in their life, when imminent fracture risk is low. We assessed women's perspectives regarding bone loss, fracture risk, and preventative pharmacotherapy in early menopause. METHODS In this cross-sectional study, Canadian women aged ≥ 45 years were recruited via Facebook advertisement to complete an electronic survey. Primary outcome was the proportion of early menopausal respondents (≤ 5 years since final menstrual period) who were worried about bone loss and fractures. Secondary outcomes were the proportion of early menopausal women willing to accept pharmacologic intervention aimed at preventing either bone loss or future fractures. We compared responses between early menopausal women and older women (> 5 years since final menstrual period). RESULTS 2033 women responded to the Facebook advertisement, 1195 eligible women (aged: 45 to 89 years) started the survey, and 966 completed it. Among early menopausal respondents (N = 98), 38 (42%) were worried about future fractures and 9 of 25 (36%) who had a prior bone mineral density scan were worried about their results. A total of 42 (47%) were willing to start medication to prevent fractures, and 48 (54%) would start medication to prevent bone loss. Responses were comparable between early menopausal women and older women. CONCLUSION Menopausal women are concerned about bone loss and fractures. Many women would consider early menopausal pharmacotherapy, with the goals of preserving bone health and lowering their risk of fractures.
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Affiliation(s)
- Emma O Billington
- Cumming School of Medicine, Division of Endocrinology & Metabolism, University of Calgary, Richmond Road Diagnostic & Treatment Centre, Room 18118, 1820 Richmond Road SW, Calgary, AB, Canada.
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada.
| | | | - Charley Hasselaar
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada
| | - Mubashir Arain
- Health Systems Knowledge & Evaluation, Alberta Health Services, Alberta, Canada
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11
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Morin SN, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D. Author response to letter to editor OSIN-D-23-00809: ALDH2 polymorphism rs671 and alcohol consumption: possible explanatory factors for race/ethnic differences in bone density. Osteoporos Int 2023; 34:2137-2138. [PMID: 37695338 DOI: 10.1007/s00198-023-06911-7] [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: 08/22/2023] [Accepted: 08/31/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Suzanne N Morin
- McGill University, Montreal, QC, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the, McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, QC, H4A 3S5, Canada.
| | - Claudie Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the, McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, QC, H4A 3S5, Canada
| | | | | | - Elham Rahme
- McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the, McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, QC, H4A 3S5, Canada
| | | | - David Goltzman
- McGill University, Montreal, QC, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the, McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, QC, H4A 3S5, Canada
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12
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Wu Q, Dai J. Racial/Ethnic Differences in Bone Mineral Density for Osteoporosis. Curr Osteoporos Rep 2023; 21:670-684. [PMID: 38019343 DOI: 10.1007/s11914-023-00838-y] [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: 11/13/2023] [Indexed: 11/30/2023]
Abstract
PURPOSE OF REVIEW We primarily aim to review differences in bone mineral density (BMD) for osteoporosis among different racial/ethnic groups and to highlight the magnitude of racial/ethnic differences in obesity and diabetes. We also explore the factors contributing to the BMD differences among various subgroups. In addition, we investigate the existing disparities in research, educational initiatives, screening practices, and treatment options for osteoporosis and discuss these findings' clinical and public health implications. RECENT FINDINGS Racial/ethnic differences in BMD for osteoporosis exist in the USA and other countries. There are disparities regarding osteoporosis screening and treatment. Understanding the factors contributing to these differences can help develop targeted interventions and policies to reduce their impact. Clinicians should consider the racial/ethnic differences in BMD when making treatment decisions and providing preventive care. Future research could contribute to developing effective strategies for preventing osteoporosis among different racial/ethnic groups. This review offered a comprehensive examination of differences in BMD across various racial and ethnic groups, elucidating the influence of genetic, lifestyle, and cultural factors on these differences. This review also highlighted the disparities in osteoporosis screening, treatment options, research on medical effectiveness, and educational outreach tailored to each subgroup. Recognizing the importance of addressing these inequalities, we present this review to advocate for targeted interventions to reduce disparities in osteoporosis and improve bone health for all populations.
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Affiliation(s)
- Qing Wu
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA.
| | - Jingyuan Dai
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA
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13
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Lo JC, Yang W, Park-Sigal JJ, Ott SM. Osteoporosis and Fracture Risk among Older US Asian Adults. Curr Osteoporos Rep 2023; 21:592-608. [PMID: 37542683 PMCID: PMC10858302 DOI: 10.1007/s11914-023-00805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE OF REVIEW This review summarizes the current knowledge regarding osteoporosis and fracture among older US Asian adults. RECENT FINDINGS Asian adults have lower (areal) bone density than non-Hispanic White adults and thus are more likely to be diagnosed and treated for osteoporosis, despite their lower risk of hip fracture. The latter may relate to favorable characteristics in hip geometry, volumetric bone density, and bone microarchitecture; lower risk of falls; and other clinical factors. The fracture risk calculator FRAX accounts for the lower risk of hip fracture among US Asian adults. However, data on major osteoporotic fracture risk remain limited. Fracture rates also vary by Asian subgroup, which may have implications for fracture risk assessment. Furthermore, among women receiving bisphosphonate drugs, Asian race is a risk factor for atypical femur fracture, an uncommon complication associated with treatment duration. Recent clinical trial efficacy data pertaining to lower bisphosphonate doses and longer dosing intervals may be relevant for Asian adults. More research is needed to inform osteoporosis care of US Asian adults, including risk-benefit considerations and the optimal duration of bisphosphonate treatment. Greater evidence-based guidance for primary fracture prevention among US Asian adults will ensure health equity in the prevention of osteoporotic fractures.
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Affiliation(s)
- Joan C Lo
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA.
- The Permanente Medical Group, Oakland, CA, USA.
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA, USA.
| | - Wei Yang
- The Permanente Medical Group, Oakland, CA, USA
- Department of Endocrinology, Kaiser Permanente San Jose Medical Center, San Jose, CA, USA
| | - Jennifer J Park-Sigal
- The Permanente Medical Group, Oakland, CA, USA
- Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA
| | - Susan M Ott
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
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14
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Omidvar S, Jafari Jozani M, Nematollahi N, Leslie WD. Estimating the prevalence of osteoporosis using ranked-based methodologies and Manitoba's population-based BMD registry. J Appl Stat 2023; 51:2090-2115. [PMID: 39247655 PMCID: PMC11378117 DOI: 10.1080/02664763.2023.2260572] [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: 02/13/2023] [Accepted: 09/12/2023] [Indexed: 09/10/2024]
Abstract
Osteoporosis is a metabolic bone disorder that is characterized by reduced bone mineral density (BMD) and deterioration of bone microarchitecture. Osteoporosis is highly prevalent among women over 50, leading to skeletal fragility and risk of fracture. Early diagnosis and treatment of those at high risk for fracture is very important in order to avoid morbidity, mortality and economic burden from preventable fractures. The province of Manitoba established a BMD testing program in 1997. The Manitoba BMD registry is now the largest population-based BMD registry in the world, and has detailed information on fracture outcomes and other covariates for over 160,000 BMD assessments. In this paper, we develop a number of methodologies based on ranked-set type sampling designs to estimate the prevalence of osteoporosis among women of age 50 and older in the province of Manitoba. We use a parametric approach based on finite mixture models, as well as the usual approaches using simple random and stratified sampling designs. Results are obtained under perfect and imperfect ranking scenarios while the sampling and ranking costs are incorporated into the study. We observe that rank-based methodologies can be used as cost-efficient methods to monitor the prevalence of osteoporosis.
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Affiliation(s)
- Sedigheh Omidvar
- Department of Statistics, Allameh Tabataba'i University, Tehran, Iran
| | | | | | - Wiliam D. Leslie
- Department of Statistics, University of Manitoba, Winnipeg, Canada
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15
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El Miedany Y, El Gaafary M, Gadallah N, Mahran S, Fathi N, Abu-Zaid MH, Tabra SAA, Shalaby RH, Abdelrafea B, Hassan W, Farouk O, Nafady M, Ibrahim SIM, Ali MA, Elwakil W. Incidence and geographic characteristics of the population with osteoporotic hip fracture in Egypt- by the Egyptian Academy of Bone Health. Arch Osteoporos 2023; 18:115. [PMID: 37688741 DOI: 10.1007/s11657-023-01325-8] [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: 06/14/2023] [Accepted: 08/25/2023] [Indexed: 09/11/2023]
Abstract
This work studies the epidemiology of hip fracture in Egypt. While the incidence of hip fracture in Egypt matches that of the Mediterranean region, there was geographic variation in osteoporotic hip fracture incidence between the north and south of Egypt. PURPOSE To assess the incidence of hip fracture in Egypt, with special emphasis on the geographic and demographic variation among the Egyptian population. METHODS The incidence of hip fractures treated in two Egyptian FLS centers was calculated for the period of February 2022-February 2023. Demographic information was recorded for every patient on the national register. All patients completed a baseline questionnaire, had clinical evaluation, fracture risk, falls, and sarcopenia risk assessment. A DXA scan was carried out for every patient. RESULTS The annual incidence of low-energy hip fracture in individuals aged 40 years or more in Egypt in 2022-2023 was 123.34 per 100,000 in women and 55.19 per 100,000 in men. The incidence of hip fractures was higher in south Egypt (113.62) versus north Egypt (64.8). This was consistent for both genders. Bone mineral density was significantly (p < 0.01) lower in south Egypt at both the spine, distal forearm, as well as hip trochanters, whereas there was no significant difference between both locations in terms of the total hip and neck of the femur. Yet, falls risk, sarcopenia, as well as functional disability rates were significantly (p < 0.001) higher in the north. CONCLUSION In Egypt, the hip fracture incidence was higher in the south compared to the north. Several modifiable factors contribute to fragility fracture risk independent of BMD, creating complex interrelationships between BMD, risk factors, and fracture risk.
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Affiliation(s)
- Yasser El Miedany
- Canterbury Christ Church University, England, UK.
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt.
| | - Maha El Gaafary
- Community and Public Health, Ain Shams University, Cairo, Egypt
| | - Naglaa Gadallah
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - Safaa Mahran
- Physical Medicine, Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
| | - Nihal Fathi
- Physical Medicine, Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
| | | | | | - Radwa H Shalaby
- Rheumatology and Rehabilitation, Tanta University, Tanta, Egypt
| | | | - Waleed Hassan
- Rheumatology and Rehabilitation, Benha University, Banha, Egypt
| | - Osama Farouk
- Orthopedic Surgery and Traumatology, Assiut University, Assiut, Egypt
| | - Mahmoud Nafady
- Orthopedic Surgery and Traumatology, Alexandria University, Alexandria, Egypt
| | | | | | - Walaa Elwakil
- Physical Medicine, Rheumatology and Rehabilitation, Alexandria University, Alexandria, Egypt
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16
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Kalaitzoglou ME, Lambrianidis T. Understanding root fenestration: A systematic scoping review of prevalence and clinical factors. AUST ENDOD J 2023; 49:428-443. [PMID: 35852910 DOI: 10.1111/aej.12647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 06/18/2022] [Indexed: 11/29/2022]
Abstract
The aim of this systematic scoping review is to explore the literature on root fenestration prevalence and its possible etiologic, aggravating and predisposing clinical factors. A systematic search was conducted in 5 electronic databases, by two independent reviewers, without any language and date restrictions. Forty-six full-text records were included in the study, out of which 27 were used for prevalence analysis and 42 for clinical factor analysis. The results suggest that the literature is heterogenous, with major differences in the study protocols and results' presentation, providing limited information regarding root fenestration prevalence and possible racial distribution patterns. Further documentation is also required regarding clinical parameters that may affect root fenestration's presence and severity. Despite their few limitations, retrospective cone beam computed tomography studies with high-resolution protocols, as well as open flap studies for direct observation of possible root fenestration sites, seem the most reliable methods to better comprehend its presence and possible distribution patterns.
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Affiliation(s)
- Maria-Elpida Kalaitzoglou
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Lambrianidis
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Macdonald HM, Maan EJ, Berger C, Côte HCF, Murray MCM, Pick N, Prior JC. Long-Term Change in Bone Mineral Density in Women Living With HIV: A 10-Year Prospective Controlled Cohort Study. JBMR Plus 2023; 7:e10761. [PMID: 37614300 PMCID: PMC10443077 DOI: 10.1002/jbm4.10761] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 08/25/2023] Open
Abstract
Women living with HIV (WLWH) may be at higher risk for osteoporosis and fragility fractures. However, limited prospective data describe long-term trajectories of bone mineral density (BMD) in WLWH versus women without HIV. Thus, in this prospective study, we aimed to compare 10-year change in areal BMD (aBMD) between WLWH (n = 49; 36.8 ± 8.8 years; 96% pre/perimenopausal) and HIV-negative women (population-based controls; n = 49; 41.9 ± 9.2 years; 80% pre/perimenopausal). In an exploratory analysis, we compared fracture history between WLWH and controls. Outcomes were lumbar spine (L1 to L4), total hip, and femoral neck aBMD at baseline and follow-up, which occurred at 13 and 10 years in WLWH and controls, respectively. We fit multivariable regression models to compare baseline and 10-year change in aBMD between groups, adjusting for osteoporosis risk factors. Within WLWH, we examined associations between aBMD and HIV-related factors, including combination antiretroviral therapy (cART) duration. WLWH were diagnosed 6.5 ± 3.7 years before baseline, 80% were on cART for 241 ± 142 weeks, and 49% had HIV plasma viral load <40 copies/mL. Before and after adjusting for osteoporosis risk factors, baseline and 10-year change in aBMD did not differ between WLWH and controls at any site. At baseline, more WLWH than controls reported a history of low-trauma fracture (30% versus 10%, p < 0.05) and major osteoporotic fracture (17% versus 4%, p < 0.05). During follow-up, the number of WLWH and controls with incident fragility fracture was not significantly different. Lifetime cART duration and tenofovir use were not associated with aBMD 10-year percent change. Higher CD4 count at baseline was positively associated with femoral neck aBMD 10-year percent change. Long-term aBMD change in this small WLWH cohort paralleled normal aging, with no evidence of influence from cART use; however, these results should be interpreted with caution given the small sample size. Larger cohort studies are needed to confirm these findings. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Heather M. Macdonald
- Active Aging Research TeamUniversity of British ColumbiaVancouverBCCanada
- Department of Family PracticeFaculty of Medicine, University of British ColumbiaVancouverBCCanada
| | - Evelyn J. Maan
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
| | - Claudie Berger
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | - Hélène C. F. Côte
- Department of Pathology & Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
- Centre for Blood ResearchFaculty of Medicine, University of British ColumbiaVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
| | - Melanie C. M. Murray
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
- Department of Medicine, Division of Infectious DiseasesUniversity of British ColumbiaVancouverBCCanada
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
- Department of Medicine, Division of Infectious DiseasesUniversity of British ColumbiaVancouverBCCanada
| | - Jerilynn C. Prior
- Women's Health Research InstituteVancouverBCCanada
- Centre for Menstrual Cycle and Ovulation Research, Department of Medicine, Division of EndocrinologyUniversity of British ColumbiaVancouverBCCanada
- School of Population and Public HealthFaculty of Medicine, University of British ColumbiaVancouverBCCanada
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Khandelwal S, Lane NE. Osteoporosis: Review of Etiology, Mechanisms, and Approach to Management in the Aging Population. Endocrinol Metab Clin North Am 2023; 52:259-275. [PMID: 36948779 DOI: 10.1016/j.ecl.2022.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Osteoporosis is the most common metabolic bone disease. With special respect to the aging population, it is very common, not only due to changes in lifestyle and diet but as a result of the aging process there is low-grade inflammation and immune system activation that directly affects bone strength and quality. This article provides a review of the incidence, etiology, and approach to screening and management of osteoporosis in the aging population. A thorough screening of lifestyle, environmental, and clinical conditions will be reviewed which identifies appropriate candidates for screening and treatment.
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Affiliation(s)
- Sonali Khandelwal
- Rush University Medical Center, 1611 West Harrison Suite 510, Chicago, IL 60612, USA.
| | - Nancy E Lane
- University of California at Davis School of Medicine
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Hu K, Cassimatis M, Nguyen M, Girgis CM. Ethnic determinants of skeletal health in female patients with fragility fracture in a culturally diverse population. Bone Rep 2023; 18:101677. [PMID: 37101568 PMCID: PMC10123337 DOI: 10.1016/j.bonr.2023.101677] [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: 09/12/2022] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
Background Low bone density leads to fragility fracture, with significant impact on morbidity and mortality. While ethnic differences in bone density have been observed in healthy subjects, this has not yet been explored in fragility fracture patients. Aims To assess if ethnicity is associated with bone mineral density and serum markers of bone health in female patients who experience fragility fractures. Methods 219 female patients presenting with at least one fragility fracture at a major tertiary hospital in Western Sydney Australia were studied. Western Sydney is a region with great cultural diversity, comprising people from over 170 ethnicities. Within this cohort, the three largest broad ethnic groups were Caucasians (62.1 %), Asians (22.8 %), and Middle Eastern patients (15.1 %). Location and nature of the presenting fracture and other relevant past medical history were obtained. Bone mineral density, measured by dual-energy X-ray absorptiometry, and bone-related serum markers were compared between ethnicities. Covariates (age, height, weight, diabetes, smoking, and at-risk drinking) were adjusted in multiple linear regression model. Results Although Asian ethnicity was associated with lower bone mineral density at the lumbar spine in fragility fracture patients, this association was no longer significant after adjustment for weight. Ethnicity (Asian or Middle Eastern) was not a determinant of bone mineral density at any other skeletal site. Caucasians had lower estimated glomerular filtration rate compared to Asian and Middle Eastern subjects. Serum parathyroid hormone concentrations were significantly lower in Asians compared to other ethnicities. Conclusion Asian ethnicity and Middle Eastern ethnicity were not major determinants of bone mineral density at the lumbar spine, femoral neck, or total hip.
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Affiliation(s)
- Katherine Hu
- Sydney Medical School, University of Sydney, Sydney, Australia
- Corresponding author.
| | - Maree Cassimatis
- Discipline of Exercise and Sports Science, Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Minh Nguyen
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Australia
| | - Christian M. Girgis
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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Xu N, Wang Y, Chen Y, Guo YN, Li RX, Zhou YM, Xu J. The associations between uric acid with BMDs and risk of the 10-year probability of fractures in Chinese patients with T2DM stratified by age and gender. Endocrine 2023; 80:520-528. [PMID: 36991286 DOI: 10.1007/s12020-023-03353-3] [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: 10/16/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Accumulating evidence suggests that serum uric acid (SUA) plays a beneficial role in bone health in the general population through antioxidant mechanisms. However, there is controversy over the association between SUA and bone in patients with type 2 diabetes mellitus (T2DM). We aimed to investigate the association of serum UA with BMDs and future fracture risks and its potential influencing factors in those patients. METHOD This was a cross-sectional study of 485 patients. BMDs at femoral neck (FN), Troch and the lumbar spine (LS) were measured by DXA. The 10-year probability of fracture risk was assessed using the fracture risk assessment tool (FRAX). SUA level and other biochemical indexes were measured. RESULTS There were lower SUA concentrations in patients with osteoporosis/osteopenia compared with those in the normal group, which only existed in non-elderly men and elderly women with T2DM. After adjustment for potential confounders, SUA was positively associated with BMD and negatively with 10-year probability of fracture risk only in non-elderly men and elderly women with T2DM. Multiple stepwise regression analysis showed that SUA was an independent determinant of BMD and 10-year probability of fracture risk, which also occurred in the above patients. CONCLUSION These results implied that relatively high SUA is a protective factor for bone in T2DM patients, but the osteoprotective effect of SUA was mediated by age and gender, and persisted only in non-elderly men and elderly women. Large intervention studies are needed to further confirm the outcomes and provide possible explanations.
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Affiliation(s)
- Na Xu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
| | - Yan Wang
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
| | - Yu Chen
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
| | - Yu-Ning Guo
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
| | - Ren-Xuan Li
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
- Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China
- Department of Endocrinology, Shandong Provincial Hospital, Jinan, 250021, Shandong, China
| | - Yan-Man Zhou
- Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
| | - Jin Xu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China.
- Shandong Clinical Research Center of Diabetes and Metabolic Diseases, Jinan, 250021, Shandong, China.
- Shandong Institute of Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China.
- Shandong Engineering Laboratory of Prevention and Control for Endocrine and Metabolic Diseases, Jinan, 250021, Shandong, China.
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21
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Kuba VM, Castro ABS, Leone C, Damiani D. Osteometabolic profile and bone mass in the transition phase: ethnic differences in Brazilians treated with somatropin during childhood. J Pediatr (Rio J) 2023; 99:168-173. [PMID: 36155741 PMCID: PMC10031360 DOI: 10.1016/j.jped.2022.08.001] [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: 03/10/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood. METHODS The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal. RESULTS The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters. CONCLUSION As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring special strategies to increase bone accrual and body weight. More studies are necessary to compare ethnic differences in this population.
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Affiliation(s)
- Valesca M Kuba
- Faculdade de Medicina, Unidade de Endocrinologia Pediátrica, Universidade de São Paulo (USP), Instituto da Criança, São Paulo, SP, Brazil; Faculdade de Medicina de Campos, Rio de Janeiro, RJ, Brazil.
| | - Antonia B S Castro
- Faculdade de Medicina, Unidade de Endocrinologia Pediátrica, Universidade de São Paulo (USP), Instituto da Criança, São Paulo, SP, Brazil
| | - Cláudio Leone
- Faculdade de Medicina, Departamento de Saúde Materno-Infantil da Escola de Saúde Pública, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Durval Damiani
- Faculdade de Medicina, Unidade de Endocrinologia Pediátrica, Universidade de São Paulo (USP), Instituto da Criança, São Paulo, SP, Brazil
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22
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Calikyan A, Silverberg J, McLeod KM. Osteoporosis Screening Disparities among Ethnic and Racial Minorities: A Systematic Review. J Osteoporos 2023; 2023:1277319. [PMID: 37138642 PMCID: PMC10151144 DOI: 10.1155/2023/1277319] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/29/2022] [Accepted: 04/13/2023] [Indexed: 05/05/2023] Open
Abstract
Background Osteoporosis is a preventable disease that is simple and cost-effective to screen based on clinical practice guidelines, yet many patients go undiagnosed and untreated leading to increased burden of the disease. Specifically, racial and ethnic minorities have lower rates of dual energy absorptiometry (DXA) screening. Inadequate screening may lead to an increased risk of fracture, higher health care costs, and increased morbidity and mortality disproportionately experienced by racial-ethnic minority populations. Purpose This systematic review assessed and summarized the racial and ethnic disparities that exist for osteoporosis screening by DXA. Methods Using terms related to osteoporosis, racial and ethnic minorities, and DXA, an electronic search of databases was performed in SCOPUS, CINAHL, and PubMed. Articles were screened using predefined inclusion and exclusion criteria which dictated the final articles used in the review. Full text articles that were selected for inclusion underwent quality appraisal and data extraction. Once extracted, data from the articles were combined at an aggregate level. Results The search identified 412 articles. After screening, a total of 16 studies were included in the final review. The overall quality of the studies included was high. Of the 16 articles reviewed, 14 identified significant disparities between racial minority and majority groups and determined that the eligible patients in racial minority groups were less likely to be referred to DXA screening. Conclusion There is a significant disparity in osteoporosis screening among racial and ethnic minorities. Future efforts should focus on addressing these inconsistencies in screening and removing bias from the healthcare system. Additional research is required to determine the consequence of this discrepancy in screening and methods of equitizing osteoporosis care.
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Affiliation(s)
- Anoush Calikyan
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Jillian Silverberg
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
- University of Connecticut Health Sciences Library, Farmington, CT, USA
| | - Katherine M. McLeod
- Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
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Morin SN, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D. Race/ethnic differences in the prevalence of osteoporosis, falls and fractures: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Osteoporos Int 2022; 33:2637-2648. [PMID: 36044061 DOI: 10.1007/s00198-022-06539-z] [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: 05/02/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
UNLABELLED Most of the published epidemiology on osteoporosis is derived from White populations; still many countries have increasing ethno-culturally diverse populations, leading to gaps in the development of population-specific effective fracture prevention strategies. We describe differences in prevalent fracture and bone mineral density patterns in Canadians of different racial/ethnic backgrounds. INTRODUCTION We described prevalent fracture and bone mineral density (BMD) patterns in Canadians by their racial/ethnic backgrounds. METHODS For this cross-sectional analysis, we used the Canadian Longitudinal Study on Aging baseline data (2011-2015) of 22,091 randomly selected participants of Black, East Asian, South or Southeast Asian (SSEA) and White race/ethnic backgrounds, aged 45-85 years with available information on the presence or absence of self-reported prevalent low trauma fractures and femoral neck BMD (FNBMD) measurement. Logistic and linear regression models examined associations of race/ethnic background with fracture and FNBMD, respectively. Covariates included sex, age, height, body mass index (BMI), grip strength and physical performance score. RESULTS We identified 11,166 women and 10,925 men. Self-reported race/ethnic backgrounds were: 139 Black, 205 East Asian, 269 SSEA and 21,478 White. White participants were older (mean 62.5 years) than the other groups (60.5 years) and had a higher BMI (28.0 kg/m2) than both Asian groups, but lower than the Black group. The population-weighted prevalence of falls was 10.0%, and that of low trauma fracture was 12.0% ranging from 3.3% (Black) to 12.3% (White), with Black and SSEA Canadians having lower adjusted odds ratios (aOR) of low trauma fractures than White Canadians (Black, aOR = 0.3 [95% confidence interval: 0.1-0.7]; SSEA, aOR = 0.5 [0.3-0.8]). The mean (SD) FNBMD varied between groups: Black, 0.907 g/cm2 (0.154); East Asian, 0.748 g/cm2 (0.119); SSEA, 0.769 g/cm2 (0.134); and White, 0.773 g/cm2 (0.128). Adjusted linear regressions suggested that Black and both Asian groups had higher FNBMD compared to White. CONCLUSION Our results support the importance of characterizing bone health predictors in Canadians of different race/ethnic backgrounds to tailor the development of population-specific fracture prevention strategies.
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Affiliation(s)
- Suzanne N Morin
- McGill University, Montreal, Quebec, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
| | - Claudie Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | | | | | - Elham Rahme
- McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | | | - David Goltzman
- McGill University, Montreal, Quebec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O, Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
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24
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Kanto A, Kotani Y, Murakami K, Tamaki J, Sato Y, Kagamimori S, Matsumura N, Iki M. Risk factors for future osteoporosis in perimenopausal Japanese women. Menopause 2022; 29:1176-1183. [PMID: 35969496 PMCID: PMC9512233 DOI: 10.1097/gme.0000000000002034] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/10/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVE The aims of this study were to investigate trends in bone mineral density (BMD) loss and related factors in early postmenopausal women in Japan, identify risk factors for future osteoporosis, and predict osteoporosis before it occurs. METHODS The study population consisted of women who were 50 to 54 years old at the time of the survey in 2002 or 2006. The study included a questionnaire and physical measurement findings (BMD, height, body weight [WT], body mass index [BMI], and handgrip strength). One hundred sixty-seven women continued to participate in the study and had BMD measurements at the 9- or 10-year follow-up of the Japanese Population-based Osteoporosis study. Statistical analyses were performed using Pearson correlation to examine each factor of physical measurement and BMD for lumbar spine (LS) and femoral neck (FN). The receiver operating characteristic curve of this data was also predictive of osteoporosis in 2011 for 2002 data; BMD at the age of 50 to 54 years was then used to predict the likelihood of being diagnosed with osteoporosis 9 and 10 years later. RESULTS At the baseline in 2002 and 2006, WT, BMI, height, and handgrip strength were positively correlated with BMD. The optimal cutoff values for BMD in 2006 to predict osteoporosis in 2016 were LS less than 0.834 g/cm 2 and FN less than 0.702 g/cm 2 . These data were also predictive of osteoporosis in 2011 for 2002 data; applying this to the 2002 data, LS/FN had a sensitivity of 92%/100%, a specificity of 87%/81%, a positive predictive value of 55%/48%, and a negative predictive value of 98%/100%. The larger WT and BMI also resulted in a greater decrease in BMD of FN after 9 or 10 years. CONCLUSIONS We have identified a cutoff value for BMD to predict future osteoporosis in menopausal women and found a negative correlation between WT and BMI in menopausal women and changes in BMD of the FN over the next 10 years.
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Affiliation(s)
- Akiko Kanto
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yasushi Kotani
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Kosuke Murakami
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Junko Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Osaka Medical Pharmaceutical University, Osaka, Japan
| | - Yuho Sato
- Department of Human Life, Jin-ai University, Fukui, Japan
| | | | - Noriomi Matsumura
- From the Department of Obstetrics and Gynecology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Masayuki Iki
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
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25
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Gandham A, Scott D, Bonham MP, Kulkarni B, Kinra S, Ebeling PR, Zengin A. Sex Differences in Bone Health Among Indian Older Adults with Obesity, Sarcopenia, and Sarcopenic Obesity. Calcif Tissue Int 2022; 111:152-161. [PMID: 35507092 PMCID: PMC9300534 DOI: 10.1007/s00223-022-00981-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/06/2022] [Indexed: 01/01/2023]
Abstract
Age-related changes in fat and lean mass contribute to bone health, but these associations may be influenced by sex and ethnicity. This study investigated sex-specific associations of obesity and sarcopenia with bone mineral density (BMD) and bone mineral apparent density (BMAD) among Indian older adults. 1057 adults aged ≥ 50 years were included. Dual-energy X-ray absorptiometry (DXA) measured BMD at the hip, spine and whole-body, and BMAD was calculated as BMD/√bone area. Obesity was defined by body fat percentage (cut points; > 25% for men and > 35% for women), and sarcopenia was defined using the revised Asian Working Group for Sarcopenia classification with low hand grip strength (< 28 kg for men and < 18 kg for women) and appendicular lean mass index (< 7.0 kg/m2 for men and < 5.4 kg/m2 for women). Participants were classified into four groups: controls (no obesity or sarcopenia), obesity, sarcopenia, or sarcopenic obesity. Linear regression (β-coefficients and 95%CI) analyses were performed with adjustments for age, smoking status, protein intake, and socioeconomic status. Prevalence of sarcopenia (37%) and sarcopenic obesity (6%) were higher in men than women (17% and 4%, respectively). Compared with controls, men with obesity had lower whole-body BMD and BMAD, but women with obesity had higher hip and spine BMD and BMAD (all p < 0.05). Men, but not women, with sarcopenic obesity, had lower hip and whole-body BMD and BMAD (all p < 0.05) than controls. Men with sarcopenia had lower BMD and BMAD at the hip only, whereas women had lower BMD at all three sites and had lower BMAD at the hip and spine (all p < 0.05), compared with controls. Obesity, sarcopenia, and sarcopenic obesity have sex-specific associations with BMD and BMAD in Indian older adults. With the aging population in India, it is important to understand how body composition contributes to poor bone health among older adults.
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Affiliation(s)
- Anoohya Gandham
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Maxine P Bonham
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Bharati Kulkarni
- Clinical Division, National Institute of Nutrition, Jamai Osmania PO, Hyderabad, India
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, 3168, Australia.
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Canto-Cetina T, Silva-Nicanor D, Coral-Vázquez RM, Cano-Martínez LJ, González Herrera L, García S, Lara Padilla E, Canto P. FNDC5/Irisin polymorphisms are associated with osteopenia in postmenopausal Mayan-Mestizo women. Climacteric 2022; 25:603-608. [PMID: 35866470 DOI: 10.1080/13697137.2022.2097866] [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: 11/03/2022]
Abstract
OBJECTIVE This study aimed to analyze the association between rs3480 and rs16835198 of FNDC5/Irisin and their haplotypes with variations in bone mineral density (BMD) and osteopenia/osteoporosis in postmenopausal Mayan-Mestizo women. METHODS We studied 547 postmenopausal women of Maya-Mestizo origin. BMD was measured in the lumbar spine and total hip by dual-energy X-ray absorptiometry. DNA was obtained from blood leukocytes. rs3480 and rs16835198 of FNDC5/Irisin were studied using real-time PCR allelic discrimination. Differences between the means of BMD according to genotype were analyzed with covariance. Allele frequency differences were assessed by χ2 and logistic regression was used to test for associations. Pairwise linkage disequilibrium between polymorphisms was calculated by direct correlation r2, and haplotype analysis was conducted. RESULTS Under a recessive model, we observed a significant association of rs3480 with the presence of osteopenia at the total hip and femoral neck (p = 0.008 and p = 0.003, respectively). For rs16835198, we found an association with osteopenia at the total hip and femoral neck in a dominant model (p = 0.043 and p = 0.009, respectively). CONCLUSIONS We found an association of rs3480 with risk to present osteopenia at the total hip and femoral neck, while rs16835198 was associated as a protector for presence of osteopenia only at the femoral neck.
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Affiliation(s)
- T Canto-Cetina
- Laboratorio de Biología de la Reproducción, Centro de Investigaciones Regionales 'Dr. Hideyo Noguchi', Mérida Yucatán, México
| | - D Silva-Nicanor
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | - R M Coral-Vázquez
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México.,Subdirección de Enseñanza e Investigación, Centro Médico Nacional '20 de Noviembre', Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - L J Cano-Martínez
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México.,Subdirección de Enseñanza e Investigación, Centro Médico Nacional '20 de Noviembre', Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - L González Herrera
- Laboratorio de Genética, Centro de Investigaciones Regionales 'Dr. Hideyo Noguchi', Mérida Yucatán, México
| | - S García
- Subdirección de Enseñanza e Investigación, Centro Médico Nacional '20 de Noviembre', Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México
| | - E Lara Padilla
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, México
| | - P Canto
- Unidad de Investigación en Obesidad, Facultad de Medicina, Universidad Nacional Autónoma de Ciudad de México, México.,Subdirección de Investigación Clínica, Dirección de Investigación, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Ciudad de México, México
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Baughman DJ, Akinpelu T, Waheed A, Trojian T. Racial Disparity in Pediatric Radiography for Forearm Fractures. Cureus 2022; 14:e22850. [PMID: 35399421 PMCID: PMC8980235 DOI: 10.7759/cureus.22850] [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] [Accepted: 03/04/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: The most common pediatric fractures involve the upper extremity. But there is limited study on racial disparity in diagnostic radiography for pediatric fractures. The literature has described the diagnostic accuracy of alternative diagnostic modalities with promising evidence of its ability to mitigate health inequity in primary care. Our objective was to understand if racial disparity exists in radiography for pediatric fractures. Methods: In this four-year retrospective cohort study, we analyzed rates of radiographic imaging and abnormal radiograph detection in 4280 pediatric patients (ages 3-18 years) who presented with chief complaints of arm or wrist pain and trauma-related International Classification of Diseases 10th Revision (ICD-10) codes. We compared White children to all other races and stratified by emergency departments (ED) vs all other primary care ambulatory service lines. Results: Non-White patients had lower imaging rate differences and lower odds receiving imaging in both ambulatory settings (0.65915, P = 0.0162; -5.4%, P = 0.0143) and in EDs (0.7732, P = 0.0369; -4.7%, P = 0.0368). Additionally, non-Whites in the ED had lower rates and lower odds of abnormal radiographs (-7.3%, P = 0.0084; 0.6794, P = 0.0089). Conclusion: Non-White patients seen in emergency and ambulatory settings had lower imaging rates for traumatic arm and wrist pain compared to White patients, indicating a healthcare disparity in pediatric imaging. Higher-level studies investigating the effect of social determinants of health, more detailed patient data, and provider bias on facture care equity are needed to understand underlying reasons for observed differences.
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Koy EHS, Amouzougan A, Biver E, Chapurlat R, Chevalley T, Ferrari SL, Fouilloux A, Locrelle H, Marotte H, Normand M, Rizzoli R, Vico L, Thomas T. Reference microarchitectural values measured by HR-pQCT in a Franco-Swiss cohort of young adult women. Osteoporos Int 2022; 33:703-709. [PMID: 34642812 DOI: 10.1007/s00198-021-06193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED Bone microarchitecture assessed by high-resolution peripheral quantitative computed tomography varies across populations of different origin. The study presents a reference dataset of microarchitectural parameters in a homogeneous group of participants aged within 22-27 range determined by a discriminant analysis of a larger cross-sectional cohort of 339 women. INTRODUCTION High-resolution peripheral quantitative computed tomography (HR-pQCT) non-invasively measures three-dimensional bone microarchitectural parameters and volumetric bone mineral density. Previous studies established normative reference HR-pQCT datasets for several populations, but there were few data assessed in a reference group of young women with Caucasian ethnicity living in Western Europe. It is important to obtain different specific reference dataset for a valid interpretation of cortical and trabecular microarchitecture data. The aim of our study was to find the population with the most optimal bone status in order to establish a descriptive reference HR-pQCT dataset in a young and healthy normal-weight female cohort living in a European area including Geneva, Switzerland, Lyon and Saint-Etienne, France. METHODS We constituted a cross-sectional cohort of 339 women aged 19-41 years with a BMI > 18 and < 30 kg/m2. All participants had HR-pQCT measurements at both non-dominant distal radius and tibia sites. RESULTS We observed that microarchitectural parameters begin to decline before the age of 30 years. Based on a discriminant analysis, the optimal bone profile in this population was observed between the age range of 22 to 27 years. Consequently, we considered 43 participants aged 22-27 years to establish a reference dataset with median values and percentiles. CONCLUSION This is the first study providing reference values of HR-pQCT measurements considering specific age bounds in a Franco-Swiss female cohort at the distal radius and tibia sites.
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Affiliation(s)
- E How Shing Koy
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - A Amouzougan
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - E Biver
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - R Chapurlat
- INSERM U1033, Hôpital Edouard Herriot, HCL, Lyon, France
| | - T Chevalley
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - S L Ferrari
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - A Fouilloux
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - H Locrelle
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - H Marotte
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - M Normand
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - L Vico
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - T Thomas
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France.
- INSERM U1059, Université de Lyon, Saint-Etienne, France.
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Okayama A, Nakayama N, Kashiwa K, Horinouchi Y, Fukusaki H, Nakamura H, Katayama S. Prevalence of Sarcopenia and Its Association with Quality of Life, Postural Stability, and Past Incidence of Falls in Postmenopausal Women with Osteoporosis: A Cross-Sectional Study. Healthcare (Basel) 2022; 10:healthcare10020192. [PMID: 35206807 PMCID: PMC8872599 DOI: 10.3390/healthcare10020192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 12/01/2022] Open
Abstract
In this cross-sectional analysis of 61 postmenopausal osteoporosis patients who regularly visited an osteoporosis outpatient clinic, we aimed to clarify the prevalence of sarcopenia and its related clinical factors. Of 61 patients (mean age 77.6 ± 8.1 years), 24 (39.3%) had osteosarcopenia and 37 (60.7%) had osteoporosis alone. Age, nutritional status, and the number of prescribed drugs were associated with the presence of sarcopenia (p = 0.002, <0.001, and 0.001, respectively), while bone mineral density (BMD) and % young adult mean BMD were not (p = 0.119 and 0.119, respectively). Moreover, patients with osteosarcopenia had lower quality of life (QOL) scores, greater postural instability, and a higher incidence of falls in the past year than patients with osteoporosis alone. In contrast, BMD status showed no correlation with the nutritional status, QOL score, postural instability, or incidence of falls in the past year. In conclusion, the incidence of sarcopenia was relatively high among postmenopausal osteoporosis female patients in an osteoporosis outpatient clinic. Our results suggest that in addition to routine BMD evaluation, assessment and management of sarcopenia may be promoted at osteoporosis outpatient clinics to limit the risk of falls and prevent consequent fragility fractures in osteoporosis patients.
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Affiliation(s)
- Akira Okayama
- Department of General Medicine and Community Health Science, School of Medicine, Hyogo College of Medicine, Sasayama Medical Center, Tanbasasayama 669-2321, Japan; (A.O.); (K.K.); (Y.H.); (H.F.); (H.N.); (S.K.)
| | - Naomi Nakayama
- Department of General Medicine and Community Health Science, School of Medicine, Hyogo College of Medicine, Sasayama Medical Center, Tanbasasayama 669-2321, Japan; (A.O.); (K.K.); (Y.H.); (H.F.); (H.N.); (S.K.)
- Faculty of Health and Nutrition, The University of Shimane, Izumo 693-8550, Japan
- Correspondence: ; Tel.: +81-(79)-5527534
| | - Kaori Kashiwa
- Department of General Medicine and Community Health Science, School of Medicine, Hyogo College of Medicine, Sasayama Medical Center, Tanbasasayama 669-2321, Japan; (A.O.); (K.K.); (Y.H.); (H.F.); (H.N.); (S.K.)
| | - Yutaka Horinouchi
- Department of General Medicine and Community Health Science, School of Medicine, Hyogo College of Medicine, Sasayama Medical Center, Tanbasasayama 669-2321, Japan; (A.O.); (K.K.); (Y.H.); (H.F.); (H.N.); (S.K.)
| | - Hayato Fukusaki
- Department of General Medicine and Community Health Science, School of Medicine, Hyogo College of Medicine, Sasayama Medical Center, Tanbasasayama 669-2321, Japan; (A.O.); (K.K.); (Y.H.); (H.F.); (H.N.); (S.K.)
| | - Hirosuke Nakamura
- Department of General Medicine and Community Health Science, School of Medicine, Hyogo College of Medicine, Sasayama Medical Center, Tanbasasayama 669-2321, Japan; (A.O.); (K.K.); (Y.H.); (H.F.); (H.N.); (S.K.)
| | - Satoru Katayama
- Department of General Medicine and Community Health Science, School of Medicine, Hyogo College of Medicine, Sasayama Medical Center, Tanbasasayama 669-2321, Japan; (A.O.); (K.K.); (Y.H.); (H.F.); (H.N.); (S.K.)
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Kalaitzoglou ME, Angelopoulos C, Lyroudia K, Lambrianidis T. Frequency of root fenestration in a Greek subpopulation: A cone beam computed tomography clinical study. AUST ENDOD J 2021; 47:580-591. [PMID: 34190384 DOI: 10.1111/aej.12523] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/28/2021] [Accepted: 04/13/2021] [Indexed: 12/29/2022]
Abstract
This cone beam computed tomography (CBCT) study aimed to assess the root fenestration (RF) frequency in healthy, intact teeth and analyse their features in a Greek subpopulation. 432 CBCT scans were examined. 5486 teeth were evaluated for RF prevalence. RF prevalence and distribution were recorded for each jaw, tooth group, as well as patient age and sex. RF symmetry, distribution to the affected root surface and the effects of age and sex were evaluated. The prevalence of RF ranged from 0.57% (central incisors) to 7.18% (first premolars) and from 0.48% (second premolars) to 10.79% (lateral incisors) for the maxilla and the mandible, respectively. No symmetrical occurrence of RF was detected. Most RF patients presented one or two defects in both jaws. Types I and IV were the most prevalent in the maxilla, while Types III, II and V were the most prevalent in the mandible. No statistical difference was detected between different sexes and age groups (P > 0.05).
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Affiliation(s)
- Maria-Elpida Kalaitzoglou
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Angelopoulos
- Department of Oral Diagnosis & Radiology, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Kleoniki Lyroudia
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Lambrianidis
- Department of Endodontology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ju B, Moon YJ, Lee KB. Use of Lesser Trochanter Profile as a Rotational Alignment Guide in Intramedullary Nailing for Femoral Shaft Fracture. J Bone Joint Surg Am 2021; 103:e89. [PMID: 34424871 DOI: 10.2106/jbjs.21.00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Malrotation after nailing of femoral shaft fractures occurs in about 25% of cases. It can cause substantial functional problems. The lesser trochanter (LT) profile has been used to assess rotational alignment. However, the extent to which the LT profile is symmetrical between limbs, whether the LT profile varies as a function of age or sex, and the efficacy of the LT profile technique remain unknown. The purpose of this study was to determine if there was a significant side-to-side length difference in the LT profile (LTD) according to age and sex. METHODS We attempted to determine the amount of medial prominence of the lesser trochanter relative to the medial cortex of the femoral shaft (the LT profile) using 3-dimensional computed tomography (3D-CT) images of normal femora obtained bilaterally (366 subjects) in anatomic positions. We also compared the left and right sides to determine the amount of natural asymmetry by age and sex. In addition, we compared the side-to-side difference in the LT version with the LTD to determine whether the LTD represented the difference in femoral rotation. RESULTS The LTD was <4 mm (meaning an LT version difference of <10°) in 83% of the subjects, but was ≥4 mm (an LT version difference of ≥10°) in 17%. Subset analysis demonstrated that the differences were greatest in women >70 years of age. The largest LTD (both sexes) was observed in individuals over 70 years of age (2.62 ± 1.37 mm, compared with <55 years: 1.55 ± 1.36 mm and 55 to 70 years: 2.27 ± 1.70 mm). There was no significant difference between sexes in the under-70 age groups. However, the LTD was significantly greater in women over 70 years than in men over 70 years (3.10 ± 1.42 versus 2.41 ± 1.30 mm). CONCLUSIONS Since the LTD demonstrated side-to-side symmetry within 4 mm, or 10° of rotation, in 83% of all subjects, we consider the LT profile to be useful as a guide to assess rotational reduction clinically. However, surgeons should recognize that, in 17% of cases, using this technique could result in malrotation of ≥10°. The rate of malrotation may be even higher in women over 70, for whom supplemental techniques to ensure correct rotation may be appropriate.
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Affiliation(s)
- Baruenchan Ju
- Department of Orthopaedic Surgery, Muju General Hospital, Muju, Republic of Korea
| | - Young Jae Moon
- Department of Orthopaedic Surgery and Biochemistry, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital and Research Institute for Endocrine Sciences, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Kwang-Bok Lee
- Department of Orthopaedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
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Relationship between bone mineral density and fragility fracture risk: a case-control study in Changsha, China. BMC Musculoskelet Disord 2021; 22:728. [PMID: 34429080 PMCID: PMC8386058 DOI: 10.1186/s12891-021-04616-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/13/2021] [Indexed: 12/01/2022] Open
Abstract
Background Fragility fracture is associated with bone mineral density (BMD), and most databases used in related researches are instrument-matched. Little is known about the relationship between BMD and fragility fracture risk of native Chinese, especially using local databases as reference databases. Objective To investigate relationship between BMD and risk of fragility fracture in native China. Methods 3,324 cases, including 2,423 women (67.7 ± 8.9 years) and 901 men (68.4 ± 11.6 years) having radiological fragility fractures and 3,324 age- and gender-matched controls participated in the study. We measured BMD at posteroanterior spine and hip using dual-energy X-ray absorptiometry (DXA), calculated BMD measurement parameters based on our own BMD reference database. Results BMDs and mean T-scores were lower in case group (with clinical fragility) than in control group (without clinical fragility). In patients with fragility fractures, prevalence of lumbar osteoporosis, low bone mass, and normal BMD were 78.9 %, 19.3 %, and 1.8 %, respectively, in women, and 49.5, 44.8 %, and 5.7 %, respectively, in men. In hip, these prevalence rates were 67.2 %, 28.4 %, and 4.4 % in females, and 43.2 %, 45.9 %, and 10.9 % in males, respectively, showing differences between females and males. Multivariate Cox regression analysis showed that after adjusting age, height, weight, and body mass index, fracture hazard ratio (HR) increased by 2.7–2.8 times (95 % CI 2.5–3.1) and 3.6–4.1 times (95 %CI 3.0–5.1) for women and men respectively with decreasing BMD parameters. In both sexes, risk of fragility fracture increased approximately 1.6–1.7 times (95 % CI 1.5–1.8) for every 1 T-score reduction in BMD. Conclusions Risk of clinical fragility fracture increases with decreasing BMD measurement parameters and anthropometric indicators in native China, and fracture HR varies from gender and site.
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Koo HC, Lim GP, Kaur S, Chan KQ, Chan KE, Chung C, Wong M, Danaselvam U. Bone Health and Its Positive Relationships with Body Composition in Malaysian Schoolchildren: Findings from a Cross-Sectional Study. CHILDREN-BASEL 2021; 8:children8070569. [PMID: 34356548 PMCID: PMC8303397 DOI: 10.3390/children8070569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/14/2021] [Accepted: 06/30/2021] [Indexed: 01/02/2023]
Abstract
Background: Optimal bone health is vital in children to prevent osteoporosis later in life, and body composition plays a crucial role in it. However, the literature reports contradictory results when considering the relationship between body composition and bone health in children. This study aimed to examine the bone health and its relationship with body composition in Malaysian schoolchildren. Methods: In this cross sectional study, body composition data (weight, height, body fat percentage [% fat], fat mass, fat free mass, visceral fat, waist circumference [WC] and body mass index-for-age [BMI z-score]) and bone health data (Z-score and broadband ultrasound attenuation [BUA]) were collected from 415 schoolchildren aged 9–12 years, cluster sampled from randomly selected primary schools in Kuala Lumpur, Malaysia. Results: Girls generally had significantly higher height, body fat percentage, fat mass, visceral fat and Z-score as compared to boys. A steady increase of the mean BUA value was observed with increasing age in both sexes. The mean BUA value of the present study across the population was significantly higher than that of schoolchildren from Nigeria (p < 0.001), Colombia (p < 0.001) and Spain (p = 0.002). Significant positive correlations were found between all the body composition variables and bone outcome variables across the population. Further, BUA was significantly correlated with weight (β = 0.172; p = 0.001), height (β = 0.299; p < 0.001), % fat (β = 0.131; p = 0.007), fat mass (β = 0.130; p = 0.007), fat free mass (β = 0.209; p < 0.001), visceral fat (β = 0.127, p = 0.008), WC (β = 0.165; p = 0.001) and BMI z-score (β = 0.162; p = 0.001), after controlling for sex, age and ethnicity. Similarly, after confounders adjusted, Z-score was significantly predicted by weight (β = 0.160; p = 0.001), height (β = 0.310; p < 0.001), % fat (β = 0.104; p = 0.032), fat mass (β = 0.107; p = 0.026), fat free mass (β = 0.218; p < 0.001), visceral fat (β = 0.107, p = 0.026), WC (β = 0.145; p = 0.002) and BMI z-score (β = 0.150; p = 0.002). Conclusions: Our findings have revealed that body composition variables were positive correlated with bone outcome variables, suggesting that adipose tissue acts to stimulate bone growth. Further clinical and molecular studies in the future is recommended to fully illustrate the complex interactions between adiposity and bone health.
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Affiliation(s)
- Hui Chin Koo
- Department of Bioscience, Faculty of Applied Sciences, Tunku Abdul Rahman University College, Kuala Lumpur 53300, Malaysia; (G.P.L.); (K.Q.C.); (K.E.C.); (C.C.); (M.W.); (U.D.)
- Correspondence:
| | - Geok Pei Lim
- Department of Bioscience, Faculty of Applied Sciences, Tunku Abdul Rahman University College, Kuala Lumpur 53300, Malaysia; (G.P.L.); (K.Q.C.); (K.E.C.); (C.C.); (M.W.); (U.D.)
| | - Satvinder Kaur
- Faculty of Applied Sciences, UCSI University, Kuala Lumpur 56000, Malaysia;
| | - Kai Quin Chan
- Department of Bioscience, Faculty of Applied Sciences, Tunku Abdul Rahman University College, Kuala Lumpur 53300, Malaysia; (G.P.L.); (K.Q.C.); (K.E.C.); (C.C.); (M.W.); (U.D.)
| | - Keh En Chan
- Department of Bioscience, Faculty of Applied Sciences, Tunku Abdul Rahman University College, Kuala Lumpur 53300, Malaysia; (G.P.L.); (K.Q.C.); (K.E.C.); (C.C.); (M.W.); (U.D.)
| | - Casey Chung
- Department of Bioscience, Faculty of Applied Sciences, Tunku Abdul Rahman University College, Kuala Lumpur 53300, Malaysia; (G.P.L.); (K.Q.C.); (K.E.C.); (C.C.); (M.W.); (U.D.)
| | - Michelle Wong
- Department of Bioscience, Faculty of Applied Sciences, Tunku Abdul Rahman University College, Kuala Lumpur 53300, Malaysia; (G.P.L.); (K.Q.C.); (K.E.C.); (C.C.); (M.W.); (U.D.)
| | - Ugunesh Danaselvam
- Department of Bioscience, Faculty of Applied Sciences, Tunku Abdul Rahman University College, Kuala Lumpur 53300, Malaysia; (G.P.L.); (K.Q.C.); (K.E.C.); (C.C.); (M.W.); (U.D.)
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Mohamed A, Nandyala S, Martinez-Enriquez E, Heilman BM, Augusteyn RC, de Castro A, Ruggeri M, Parel JMA, Marcos S, Manns F. Isolated human crystalline lens three-dimensional shape: A comparison between Indian and European populations. Exp Eye Res 2021; 205:108481. [PMID: 33545121 DOI: 10.1016/j.exer.2021.108481] [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: 11/09/2020] [Revised: 01/07/2021] [Accepted: 01/26/2021] [Indexed: 11/25/2022]
Abstract
There have been many studies on lens properties in specific populations (e.g. in China, Europe, Singapore, etc.) some of which suggest there may be differences between populations. Differences could be caused by ethnic or environmental influences or experimental procedures. The purpose of this study is to evaluate if any differences exist between Indian and European populations in the central geometric and full shape properties of human lenses. Two custom-developed spectral domain optical coherence tomography systems were used to acquire the crystalline lens geometry: one in India (69 lenses from 59 donors) and the other in Spain (24 lenses from 19 donors). The steps for obtaining accurate 3-D models from optical coherence tomography raw images comprised of image segmentation, fan and optical distortion correction, tilt removal and registration. The outcome variables were lens equatorial diameter, lens thickness, anterior and posterior lens thicknesses and their ratio, central radius of curvature of the anterior and posterior lens surfaces, lens volume and lens surface area. A mixed effects model by maximum likelihood estimation was used to evaluate the effect of age, population and their interaction (age*population) on lens parameters. After adjusting for age, there were no population differences observed in anterior and posterior radii of curvature, equatorial diameter, lens thickness, anterior and posterior lens thicknesses and their ratio, volume and surface area (all p ≥ 0.08). There was also no effect of the interaction term on anterior and posterior radii of curvature, equatorial diameter, lens thickness, anterior and posterior lens thicknesses and their ratio, volume and surface area (all p ≥ 0.06). All central geometric and full shape parameters appeared to be comparable between the European and Indian populations. This is the first study to compare geometric and full shape lens parameters between different populations in vitro.
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Affiliation(s)
- Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India; Brien Holden Vision Institute Limited, Sydney, Australia.
| | - Sushma Nandyala
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Eduardo Martinez-Enriquez
- Visual Optics and Biophotonics Lab, Institute of Optics, Consejo Superior de Investigaciones Científicas (IO-CSIC), Madrid, Spain
| | - Bianca Maceo Heilman
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Robert C Augusteyn
- Brien Holden Vision Institute Limited, Sydney, Australia; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alberto de Castro
- Visual Optics and Biophotonics Lab, Institute of Optics, Consejo Superior de Investigaciones Científicas (IO-CSIC), Madrid, Spain
| | - Marco Ruggeri
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
| | - Jean-Marie A Parel
- Brien Holden Vision Institute Limited, Sydney, Australia; Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA; Anne Bates Leach Eye Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susana Marcos
- Visual Optics and Biophotonics Lab, Institute of Optics, Consejo Superior de Investigaciones Científicas (IO-CSIC), Madrid, Spain
| | - Fabrice Manns
- Ophthalmic Biophysics Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Biomedical Engineering, University of Miami College of Engineering, Coral Gables, FL, USA
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Naot D, Bentley J, Macpherson C, Pitto RP, Bava U, Choi AJ, Matthews BG, Callon KE, Gao R, Horne A, Gamble GD, Reid IR, Cornish J. Molecular characterisation of osteoblasts from bone obtained from people of Polynesian and European ancestry undergoing joint replacement surgery. Sci Rep 2021; 11:2428. [PMID: 33510208 PMCID: PMC7844412 DOI: 10.1038/s41598-021-81731-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022] Open
Abstract
Population studies in Aotearoa New Zealand found higher bone mineral density and lower rate of hip fracture in people of Polynesian ancestry compared to Europeans. We hypothesised that differences in osteoblast proliferation and differentiation contribute to the differences in bone properties between the two groups. Osteoblasts were cultured from bone samples obtained from 30 people of Polynesian ancestry and 25 Europeans who had joint replacement surgeries for osteoarthritis. The fraction of cells in S-phase was determined by flow cytometry, and gene expression was analysed by microarray and real-time PCR. We found no differences in the fraction of osteoblasts in S-phase between the groups. Global gene expression analysis identified 79 differentially expressed genes (fold change > 2, FDR P < 0.1). Analysis of selected genes by real-time PCR found higher expression of COL1A1 and KRT34 in Polynesians, whereas BGLAP, DKK1, NOV, CDH13, EFHD1 and EFNB2 were higher in Europeans (P ≤ 0.01). Osteoblasts from European donors had higher levels of late differentiation markers and genes encoding proteins that inhibit the Wnt signalling pathway. This variability may contribute to the differences in bone properties between people of Polynesian and European ancestry that had been determined in previous studies.
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Affiliation(s)
- Dorit Naot
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Jarome Bentley
- Middlemore Hospital, Counties Manukau District Health Board, Auckland, 1062, New Zealand
| | | | - Rocco P Pitto
- Middlemore Hospital, Counties Manukau District Health Board, Auckland, 1062, New Zealand
- Department of Orthopaedic Surgery, South Auckland Clinical Campus, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Usha Bava
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Ally J Choi
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, Australia
| | - Brya G Matthews
- Department of Molecular Medicine and Pathology, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Karen E Callon
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Ryan Gao
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Anne Horne
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Gregory D Gamble
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Ian R Reid
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Jillian Cornish
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
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Bone mineral density in healthy adult Indian population: the Chandigarh Urban Bone Epidemiological Study (CUBES). Arch Osteoporos 2021; 16:17. [PMID: 33479804 DOI: 10.1007/s11657-020-00868-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/01/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Osteoporosis is a disease with a high burden of morbidity. For its accurate diagnosis, using indigenous data as reference standards is needed. However, normative data on bone density is lacking in India. Therefore, we aimed to determine the reference range for bone density for the healthy population of north India. INTRODUCTION Osteoporosis is a major public health problem around the globe including India, resulting in significant morbidity, mortality, and health care burden. However, the reference values used for its diagnosis are largely based on data from the western population, which may lead to over- or underdiagnosis of osteoporosis in Indians. Our study aimed to determine the reference range for bone mineral density for the healthy population of India. METHODS This is a cross-sectional study of 825 subjects (men 380, women 445) (median age: 41 years, IQR 32-55 years), recruited by a house-to-house survey. The population was stratified into decade-wise groups and biochemical measurements including renal and liver function tests, glycated hemoglobin, serum calcium, 25-hydroxyvitamin D, parathyroid hormone, and bone mineral density were performed in all the subjects. The T-scores for men aged > 50 years and post-menopausal women were calculated based on the data generated from this study in young men and women aged 20-40 years. RESULTS According to the BMD manufacturer's data, which is based on the western population, 70% of the Indian men (> 50 years) and 48% of the post-menopausal Indian women had osteopenia while 18% of the men and 25% of the women had osteoporosis. However, according to the re-calculated T-scores from the current study, only 56% and 7.2% of men and 33% and 5% of women had osteopenia and osteoporosis, respectively. An age-related decline in bone mineral density, as seen in the western population, was also seen in both Indian men and women. CONCLUSION We have established a reference database for BMD in healthy Indian adult population, which may have clinical implications for the diagnosis and intervention strategies for the management of osteoporosis.
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Thejaswi SG, Rai A, Sherpa M, Singh A, Bhutia R. Bone alkaline phosphatase and urine hydroxyproline assay in pre and postmenopausal women in the state of sikkim and its correlation with bone mineral density. J Midlife Health 2021; 12:304-309. [PMID: 35264838 PMCID: PMC8849151 DOI: 10.4103/jmh.jmh_73_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/11/2021] [Accepted: 12/07/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction: Osteoporosis could be viewed as a metabolic disease. The WHO guidelines for diagnosing osteoporosis reflect structural damage only and not the metabolic imbalance that leads to it. Biochemical markers of bone turnover have been shown to provide valuable information for diagnosing and monitoring metabolic bone disease. The present study analyzed bone-specific alkaline phosphatase (BALP) and urinary hydroxyproline in pre- and postmenopausal women and correlated them with changes in bone mineral density (BMD) in the state of Sikkim. The study also intended to know the ethnicity-based disease burden in Sikkim. Materials and Methods: A hospital-based cross-sectional study was done at a tertiary hospital in Sikkim. Blood and 24-h urine samples from 50 premenopausal and 50 postmenopausal women were analyzed for total alkaline phosphatase (ALP), BALP, and Urine Hydroxyproline. BMD was measured using the quantitative ultrasound technique by Achilles densitometer. Results: There was a statistically significant increase in serum calcium (P = 0.01), ALP (P = 0.01), and urine hydroxyproline (P = 0.03) levels in postmenopausal women as compared to premenopausal women. Although ALP was higher in postmenopausal women, BALP isoform was more elevated in premenopausal women (P = 0.001). BMD was significantly lower in postmenopausal women (P < 0.001). It was also noted that there was a significant difference in BMD between tribal and nontribal populations (P = 0.003). Total ALP and BALP as the bone formation marker and urine hydroxyproline as a bone resorption marker added statistically significant r to BMD prediction (P < 0.05). Conclusion: In this study, BALP combined with Urine Hydroxyproline was helpful as a screening biomarker to predict osteoporosis in postmenopausal women.
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Lopez-Gonzalez D, Wells JC, Cortina-Borja M, Fewtrell M, Partida-Gaytán A, Clark P. Reference values for bone mineral density in healthy Mexican children and adolescents. Bone 2021; 142:115734. [PMID: 33166709 DOI: 10.1016/j.bone.2020.115734] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/19/2020] [Accepted: 11/01/2020] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Clinical assessment of bone health by Dual-Energy X-ray Absorptiometry (DXA) in the paediatric population requires robust reference values. The International Society for Clinical Densitometry (ISCD) recommends that country/regional reference values ideally should be used to improve precision in bone health assessment. OBJECTIVE The aim of this study was to provide reference values for relevant bone health variables for healthy Mexican children and adolescents aged 5 to 18 years. METHODS This was a cross-sectional, stratified and population-based study, that measured a representative sample of healthy Mexican children and adolescents with DXA. We constructed age- and sex-smoothed reference values for areal bone mineral density (aBMD) of total body less head (TBLH), total body (TB), lumbar spine (LS), and bone mineral apparent density (BMAD) for LS, by means of Generalized Additive Models for Location, Scale and Shape (GAMLSS). RESULTS Reference data including the 3th, 5th, 10th, 25th, 50th, 75th, 90th, 95th and 97th centiles, along with lambda (L), mu (M) and sigma (S) values, are given for each variable of interest for each sex at 0.25 years intervals. Reference values relative to height and Tanner-stage for both sexes are also provided. Finally, formulas to enable Z score estimation for clinical use are also presented CONCLUSIONS: The sex, age, height, Tanner-stage and ethnic-specific reference data provided in this study should enable more precise assessment of bone health in the Mexican paediatric population. The data presented may also allow for future evaluation of potential similarities and differences across different ethnic groups.
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Affiliation(s)
- Desiree Lopez-Gonzalez
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autonoma de México, Mexico City, Mexico.
| | - Jonathan C Wells
- Childhood Nutrition Research Centre, Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Mario Cortina-Borja
- Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | - Mary Fewtrell
- Childhood Nutrition Research Centre, Population, Policy and Practice Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, United Kingdom.
| | | | - Patricia Clark
- Clinical Epidemiology Research Unit, Hospital Infantil de México Federico Gómez, Mexico; Universidad Nacional Autonoma de México, Mexico City, Mexico.
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Yeap SS, Thambiah SC, Samsudin IN, Appannah G, Zainuddin N, Mohamad-Ismuddin S, Shahifar N, Md-Said S, Zahari-Sham SY, Suppiah S, Hew FL. Different reference ranges affect the prevalence of osteoporosis and osteopenia in an urban adult Malaysian population. Osteoporos Sarcopenia 2020; 6:168-172. [PMID: 33426304 PMCID: PMC7783114 DOI: 10.1016/j.afos.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/16/2020] [Accepted: 11/17/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To determine the prevalence of osteopenia (OPe) and osteoporosis (OP) in an urban adult population in Malaysia, and to compare the change in the prevalence when using a Caucasian compared to an Asian reference range. METHODS A cross-sectional random sample of the population aged between 45 and 90 years from the state of Selangor, Malaysia, was invited to attend a bone health check-up. Participants with diseases known to affect bone metabolism or who were on treatment for OP were excluded. Bone mineral density was measured using dual energy X-ray absorptiometry. Based on the World Health Organization definitions, the prevalence of OPe and OP was calculated using the Asian and Caucasian T-scores. RESULTS A total of 342 subjects (222 females, 120 males), with a mean age of 59.68 (standard deviation: 8.89) years, who fulfilled the study criteria were assessed. Based on the Asian reference range, there were 140 (40.9%) subjects with OPe and 48 (14.0%) with OP. On applying the Caucasian reference range, there were 152 (44.4%) subjects with OPe and 79 (23.1%) with OP, with significant increases in males, females, and Chinese ethnic groups. Overall, 75 (21.9%) of subjects had a change in their diagnostic status. T-scores were consistently lower when the Caucasian reference range was used. CONCLUSIONS In a healthy urban Malaysian population, the prevalence of OP is 14.0% and OPe is 40.9%. Application of a Caucasian reference range significantly increased the number of subjects with OP and may potentially lead to over-treatment.
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Affiliation(s)
- Swan Sim Yeap
- Puchong Specialist Centre, Puchong, Selangor, Malaysia
- Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
| | - Subashini C. Thambiah
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Intan Nureslyna Samsudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Geeta Appannah
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Nurunnaim Zainuddin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Safarina Mohamad-Ismuddin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Nasrin Shahifar
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Salmiah Md-Said
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Siti Yazmin Zahari-Sham
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Subapriya Suppiah
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia
| | - Fen Lee Hew
- Puchong Specialist Centre, Puchong, Selangor, Malaysia
- Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
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Lewiecki EM, Wright NC, Singer AJ. Racial disparities, FRAX, and the care of patients with osteoporosis. Osteoporos Int 2020; 31:2069-2071. [PMID: 32980922 PMCID: PMC7938336 DOI: 10.1007/s00198-020-05655-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/22/2020] [Indexed: 01/07/2023]
Affiliation(s)
- E M Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, 300 Oak St. NE, Albuquerque, NM, 87106, USA.
| | - N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - A J Singer
- MedStar Georgetown University Hospital, Washington, DC, USA
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Li F, Du Y. Bone mineral density of proximal femur in adult Chinese females. J Orthop 2020; 22:53-58. [PMID: 32280169 PMCID: PMC7138931 DOI: 10.1016/j.jor.2020.03.048] [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: 03/04/2020] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study was designed to establish bone mineral density (BMD) reference data of proximal femur, research the effect of age, height and weight on BMD of proximal femur, and estimate the prevalence of osteoporosis in a Chinese female population. In addition we compared the results with Lebanese and USA white women reference data. METHODS Our study was conducted at one center, including 1578 Chinese women, aged 20-79years. We measured the BMD for proximal femur using dual-energy X-ray absorptiometry, and then established a reference database of proximal femur and set up regression equations of age, height and weight for BMD at proximal femur to research the effects of age, height and weight on BMD. After that, we calculated the standardized BMD and compared them with Lebanese and USA white women reference data. RESULTS The peak BMD occurred in the age range 30-39 years for femoral neck and Ward's triangle, and 40-49 years for trochanter in Chinese women, which were later than in Lebanese and USA white women. The BMD of proximal femur in Chinese women were lower than Lebanese and USA white women in most age ranges. Weight profoundly influenced BMD in all age groups, and age and height mainly effected BMD in older age groups. The standardized prevalence of osteoporosis among Chinese women of 50-79 years old was 9.6% in femoral neck, which was higher than Lebanese but lower than USA white women. CONCLUSION The BMD database of proximal femur in Chinese women we established is normative and different from Lebanese and USA white women reference data, which provides more reliable information on the prevalence of osteoporosis in China.
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Affiliation(s)
| | - Yibin Du
- Department of Orthopaedics, Third Affliated Hospital, Anhui Medical University, Hefei, Anhui, 230022, PR China
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Moradifard S, Hoseinbeyki M, Emam MM, Parchiniparchin F, Ebrahimi-Rad M. Association of the Sp1 binding site and -1997 promoter variations in COL1A1 with osteoporosis risk: The application of meta-analysis and bioinformatics approaches offers a new perspective for future research. MUTATION RESEARCH. REVIEWS IN MUTATION RESEARCH 2020; 786:108339. [PMID: 33339581 DOI: 10.1016/j.mrrev.2020.108339] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 08/11/2020] [Accepted: 10/06/2020] [Indexed: 12/21/2022]
Abstract
As a complex disease, osteoporosis is influenced by several genetic markers. Many studies have examined the link between the Sp1 binding site +1245 G > T (rs1800012) and -1997 G > T (rs1107946) variations in the COL1A1 gene with osteoporosis risk. However, the findings of these studies have been contradictory; therefore, we performed a meta-analysis to aggregate additional information and obtain increased statistical power to more efficiently estimate this correlation. A meta-analysis was conducted with studies published between 1991-2020 that were identified by a systematic electronic search of the Scopus and Clarivate Analytics databases. Studies with bone mineral density (BMD) data and complete genotypes of the single-nucleotide variations (SNVs) for the overall and postmenopausal female population were included in this meta-analysis and analyzed using the R metaphor package. A relationship between rs1800012 and significantly decreased BMD values at the lumbar spine and femoral neck was found in individuals carrying the "ss" versus the "SS" genotype in the overall population according to a random effects model (p < 0.0001). Similar results were also found in the postmenopausal female population (p = 0.003 and 0.0002, respectively). Such findings might be an indication of increased osteoporosis risk in both studied groups in individuals with the "ss" genotype. Although no association was identified between the -1997 G > T and low BMD in the overall population, those individuals with the "GT" genotype showed a higher level of BMD than those with "GG" in the subgroup analysis (p = 0.007). To determine which transcription factor (TF) might bind to the -1997 G > T in COL1A1, 45 TFs were identified based on bioinformatics predictions. According to the GSE35958 microarray dataset, 16 of 45 TFs showed differential expression profiles in osteoporotic human mesenchymal stem cells relative to normal samples from elderly donors. By identifying candidate TFs for the -1997 G > T site, our study offers a new perspective for future research.
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Affiliation(s)
| | | | - Mohammad Mehdi Emam
- Rheumatology Ward, Loghman Hospital, Shahid Beheshti Medical University (SBMU), Tehran, Iran
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Differences in fracture prevalence and in bone mineral density between Chinese and White Canadians: the Canadian Multicentre Osteoporosis Study (CaMos). Arch Osteoporos 2020; 15:147. [PMID: 32955674 DOI: 10.1007/s11657-020-00822-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Fracture determinants differ between Canadians of Chinese and White descent, the former constituting the second largest visible minority group in Canada. The results of this study support the importance of characterizing bone health predictors in Canadians of different ethnicity to improve population-specific fracture prevention and treatment strategies. PURPOSE We aimed to compare clinical risk factors, bone mineral density, prevalence of osteoporosis, and fractures between Chinese and White Canadians to identify ethnicity-specific risks. METHODS We studied 236 Chinese and 8945 White Canadians aged 25+ years from the Canadian Multicentre Osteoporosis Study (CaMos). The prevalence of osteoporosis using ethnicity-specific peak bone mass (PBM), and of prior and incident low trauma fractures were assessed and compared between groups. Linear regressions, adjusting for age and anthropometric measures, were used to examine the association between baseline and 5-year changes in BMD and ethnicity. RESULTS Chinese participants had shorter stature, lower BMI, and lower rate of falls than White participants. Adjusted models showed no significant differences in baseline BMD between ethnic groups except in younger men where total hip BMD was 0.059 g/cm2 (0.009; 0.108) lower in Chinese. Adjusted 5-year BMD change at lumbar spine was higher in older Chinese women and men compared with Whites. When using Chinese-specific PBM, the prevalence of osteoporosis in Chinese women was 2-fold lower than when using that of White women The prevalence of fractures was higher in White women compared with Chinese with differences up to 14.5% (95% CI 9.2; 19.7) and 10.5% (95% CI 4.5-16.4) in older White men. Incident fractures were rare in young Chinese compared with White participants and not different in the older groups. CONCLUSION Our results support the importance of characterizing bone strength predictors in Chinese Canadians and the development of ethnicity-specific fracture prediction and prevention strategies.
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Kim M, Kim H, Ahn SH, Tabatabaie V, Choi SW, Sohn G, Lee SB, Ko BS, Chung IY, Kim J, Lee JW, Son BH, Kim HJ. Changes in bone mineral density during 5 years of adjuvant treatment in premenopausal breast cancer patients. Breast Cancer Res Treat 2020; 180:657-663. [PMID: 32072339 DOI: 10.1007/s10549-020-05566-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/03/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Adjuvant treatment for breast cancer in postmenopausal women is a risk factor for bone loss. However, the association between bone mineral density (BMD) changes in premenopausal breast cancer patients and various adjuvant treatment regimens is not well characterized. In this study, we evaluated the changes in BMD according to adjuvant treatment in premenopausal women with breast cancer. METHODS Between 2006 and 2010, BMD data of 910 premenopausal women with breast cancer before operation and 1, 2, 3.5, and 5 years post-operation were retrospectively analyzed. The patients were divided according to the type of treatment: observation (O), tamoxifen (T), chemotherapy (C), C followed by T (C → T), and gonadotropin-releasing hormone (GnRH) agonist with T (G + T). RESULTS After 5 years of follow-up, BMD changes were similar between the T and O groups (all p > 0.05). Within 1 year of treatment, the C group showed the most significant BMD loss. The C → T and G + T groups showed more significant BMD loss in the lumbar spine and femur than the O and T groups (both p < 0.001, both). After 1 year of treatment, BMD loss in the lumbar spine was significantly greater in the C → T and G + T groups than in the T group; this tendency was maintained for 5 years of treatment (all p < 0.005). CONCLUSION Premenopausal women who received adjuvant treatment which induced menopause showed significant bone loss which lasted for 5 years. Although no significant difference was observed between the O and T groups, tamoxifen treatment during chemotherapy or GnRH agonist treatment might prevent bone loss.
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Affiliation(s)
- Minsung Kim
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Republic of Korea
| | - Hanna Kim
- Saint Louis University School of Medicine, St. Louis, USA
| | - Sei Hyun Ahn
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Republic of Korea
| | - Vafa Tabatabaie
- Division of Endocrinology, Department of Medicine, and Department of Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, USA
| | | | - Guiyun Sohn
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Republic of Korea
| | - Sae Byul Lee
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Republic of Korea
| | - Beom Seok Ko
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Republic of Korea
| | - Il Yong Chung
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Republic of Korea
| | - Jisun Kim
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Republic of Korea
| | - Jong Won Lee
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Republic of Korea
| | - Byung Ho Son
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Republic of Korea
| | - Hee Jeong Kim
- Division of Breast, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Song pa-gu, Seoul, 05505, Republic of Korea.
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Wu Q, Xiao X, Xu Y. Evaluating the Performance of the WHO International Reference Standard for Osteoporosis Diagnosis in Postmenopausal Women of Varied Polygenic Score and Race. J Clin Med 2020; 9:E499. [PMID: 32059423 PMCID: PMC7074342 DOI: 10.3390/jcm9020499] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Whether the bone mineral density (BMD) T-score performs differently in osteoporosis classification in women of different genetic profiling and race background remains unclear. METHODS The genomic data in the Women's Health Initiative study was analyzed (n = 2417). The polygenic score (PGS) was calculated from 63 BMD-associated single nucleotide polymorphisms (SNPs) for each participant. The World Health Organization's (WHO) definition of osteoporosis (BMD T-score ≤-2.5) was used to estimate the cumulative incidence of fracture. RESULTS T-score classification significantly underestimated the risk of major osteoporotic fracture (MOF) in the WHI study. An enormous underestimation was observed in African American women (POR: 0.52, 95% CI: 0.30-0.83) and in women with low PGS (predicted/observed ratio [POR]: 0.43, 95% CI: 0.28-0.64). Compared to Caucasian women, African American, African Indian, and Hispanic women respectively had a 59%, 41%, and 55% lower hazard of MOF after the T-score was adjusted for. The results were similar when used for any fractures. CONCLUSIONS Our study suggested the BMD T-score performance varies significantly by race in postmenopausal women.
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Affiliation(s)
- Qing Wu
- Nevada Institute of Personalized Medicine, University of Nevada, Las Vegas, NV 89154, USA; (X.X.); (Y.X.)
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, NV 89154, USA
| | - Xiangxue Xiao
- Nevada Institute of Personalized Medicine, University of Nevada, Las Vegas, NV 89154, USA; (X.X.); (Y.X.)
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, NV 89154, USA
| | - Yingke Xu
- Nevada Institute of Personalized Medicine, University of Nevada, Las Vegas, NV 89154, USA; (X.X.); (Y.X.)
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada Las Vegas, NV 89154, USA
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Abstract
Osteoporosis (OP) is a condition where there is low bone density and microarchitectural deterioration which can predispose to fragility fractures. There is a wealth of literature on OP from the developed countries, but less so from Asia. This review will explore the field of OP research in South-East Asia with regard to the epidemiology, the diagnosis of OP and the role of laboratory tests in the management of OP, with emphasis on 25-dihydroxyvitamin D and bone turnover markers.
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Affiliation(s)
- Subashini C Thambiah
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, 43400 UPM, Selangor, Malaysia
| | - Swan Sim Yeap
- Department of Medicine, Subang Jaya Medical Centre, 47500 Subang Jaya, Selangor, Malaysia
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Ethnic differences in bone mineral density among midlife women in a multi-ethnic Southeast Asian cohort. Arch Osteoporos 2019; 14:80. [PMID: 31324992 DOI: 10.1007/s11657-019-0631-0] [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: 04/30/2019] [Accepted: 07/07/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED Chinese Singaporean middle-aged women have significantly lower femoral neck bone mineral density and higher lumbar spine bone mineral density than Malays and Indians, after adjustment for age, body mass index, and height. PURPOSE Information regarding mediators of differences in bone mineral density (BMD) among Asian ethnicities are limited. Since the majority of hip fractures are predicted to be from Asia, differences in BMD in Asian ethnicities require further exploration. We compared BMD among the Chinese, Malay, or Indian ethnicities in Singapore, aiming to identify potential mediators for the observed differences. METHODS BMD of 1201 women aged 45-69 years was measured by dual-energy X-ray absorptiometry. We examined the associations between ethnicity and BMD at both sites, before and after adjusting for potential mediators measured using standardized questionnaires and validated performance tests. RESULTS Chinese women had significantly lower femoral neck BMD than Malay and Indian women. Of the more than 20 variables examined, age, body mass index, and height accounted for almost all the observed ethnic differences in femoral neck BMD between Chinese and Malays. However, Indian women still retained 0.047 g/cm2 (95% CI, 0.024, 0.071) higher femoral neck BMD after adjustment, suggesting that additional factors may contribute to the increased BMD in Indians. Although no crude ethnic differences in lumbar spine BMD were observed, adjusted regression model unmasked ethnic differences, wherein Chinese women had 0.061(95% CI, - 0.095, 0.026) and 0.065 (95% CI, - 0.091, 0.038) g/cm2 higher lumbar spine BMD compared to Malay and Indian women, respectively. CONCLUSION BMD in middle-aged Asian women differ by ethnicity and site. Particular attention should be paid to underweight women of Chinese ethnic origin, who may be at highest risk of osteoporosis at the femoral neck and hence hip fractures.
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Kaushal N, Vohora D, Jalali RK, Jha S. Review of the Literature Examining the Association of Serum Uric Acid with Osteoporosis and Mechanistic Insights into Its Effect on Bone Metabolism. Endocr Metab Immune Disord Drug Targets 2019; 19:259-273. [DOI: 10.2174/1871530318666181102115106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 12/11/2022]
Abstract
Background And Objective:Osteoporosis is a common bone disorder that increases susceptibility to fragility bone fractures. The clinical and public health repercussions of osteoporosis are huge due to the morbidity, mortality, and cost of medical care linked with fragility fractures. Clinical assessment of osteoporotic risk factors can help to identify candidates at an early stage that will benefit from medical intervention and potentially lowering the morbidity and mortality seen with fractures and complications. Given this, research is ongoing to evaluate the association of osteoporosis with some novel or less well-studied risk factors/bio-markers such as uric acid (UA).Discussion:Uric acid’s antioxidant activity has been proposed to be one of the factors responsible for increasing longevity and lowering rates of age-related cancers during primate evolution, the level of which increased markedly due to loss of uricase enzyme activity (mutational silencing). Accumulated evidence shows that oxidative stress is the fundamental mechanism of age-related bone loss and acts via enhancing osteoclastic activity and increasing bone resorption. Antioxidant substances such as ascorbic acid scavenge free radicals are positively related to bone health. Thus, it is hypothesized that uric acid holds bone-protective potential owing to its potent antioxidative property. Several correlation studies have been conducted globally to investigate the relationship between serum uric acid with bone mineral density and osteoporosis. Few pre-clinical studies have tried to investigate the interaction between uric acid and bone mineral density and reported important role played via Runt-related transcription factor 2 (RUNX2)/core-binding factor subunit alpha-1 (CBF-alpha-1), Wingless-related integration site (Wnt)-3a/β-catenin signaling pathway and 11β Hydroxysteroid Dehydrogenase type 1.Conclusion:In this review, the authors provided a comprehensive summary of the literature related to association studies reported in humans as well work done until date to understand the potential cellular and molecular mechanisms that interplay between uric acid and bone metabolism.
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Affiliation(s)
- Neelam Kaushal
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Divya Vohora
- Pharmaceutical Medicine, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Rajinder K Jalali
- Medical Affairs & Clinical Research, Sun Pharmaceutical Industries Limited, Gurgaon, India
| | - Sujeet Jha
- Institute of Endocrinology, Diabetes and Metabolism, Max Healthcare Inst. Ltd, India
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Veldscholte K, Barjaktarovic M, Trajanoska K, Jaddoe VWV, Visser TJ, de Rijke YB, Peeters RP, Rivadeneira F, Korevaar TIM. The Association of Thyroid Function With Bone Density During Childhood. J Clin Endocrinol Metab 2018; 103:4125-4134. [PMID: 30020476 DOI: 10.1210/jc.2018-00294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/12/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Although the skeleton is a well-known thyroid hormone target organ, very little data are available on the association of thyroid function with bone outcomes during childhood. OBJECTIVE To study the association of thyroid function with bone mass during childhood. DESIGN, SETTING, AND PARTICIPANTS Population-based prospective cohort including 4204 children with TSH and free T4 (FT4) measured at the age of 6 years. MAIN OUTCOME MEASURES Bone density was assessed by a total body dual-energy X-ray absorptiometry scan at the median age of 6 years (95% range, 5.6 to 7.9) and at the age of 10 years (95% range, 9.0 to 10.9) in 4204 and 3404 participants, respectively. RESULTS There was an inverse association of TSH with bone mineral density (BMD) at the age of 6 (β -0.028 ± 0.011, P = 0.009) and with follow-up measurements at the age of 10 (β -0.027 ± 0.011, P = 0.014), but not with bone mineral content (BMC) at the age of 6 (β -0.028 ± 0.015, P = 0.06) or for follow-up measurements of BMC at the age of 10 (β -0.011 ± 0.015, P = 0.47). There was an inverse association of FT4 with BMD (β -0.016 ± 0.006, P = 0.014) and BMC (β -0.023 ± 0.009, P = 0.009) cross-sectionally, and also at the age of 10 years (BMD: β -0.018 ± 0.007, P = 0.007; BMC: β -0.021 ± 0.009, P = 0.020). CONCLUSION A higher FT4 concentration is associated with lower bone mass at the age of 6 and at the age of 10 years. These data provide insights into the effects of thyroid function on bone physiology during childhood.
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Affiliation(s)
- Karlien Veldscholte
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- The Generation R. Study Group, Erasmus Medical Center and Sophia Children's Hospital, GE Rotterdam, Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Mirjana Barjaktarovic
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- The Generation R. Study Group, Erasmus Medical Center and Sophia Children's Hospital, GE Rotterdam, Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Katerina Trajanoska
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- The Generation R. Study Group, Erasmus Medical Center and Sophia Children's Hospital, GE Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, GE Rotterdam, Netherlands
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, GE Rotterdam, Netherlands
| | - Theo J Visser
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Yolanda B de Rijke
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- Department of Clinical Chemistry, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- The Generation R. Study Group, Erasmus Medical Center and Sophia Children's Hospital, GE Rotterdam, Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- The Generation R. Study Group, Erasmus Medical Center and Sophia Children's Hospital, GE Rotterdam, Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, GE Rotterdam, Netherlands
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50
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Cherian KE, Kapoor N, Asha HS, Thomas N, Paul TV. Influence of Different Reference Databases on Categorization of Bone Mineral Density: A Study on Rural Postmenopausal Women from Southern India. Indian J Endocrinol Metab 2018; 22:579-583. [PMID: 30294563 PMCID: PMC6166560 DOI: 10.4103/ijem.ijem_77_18] [Citation(s) in RCA: 6] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Currently available DXA (Dual energy X-ray Absorptiometry) scanners utilise bone mineral density (BMD) of Caucasian population to calculate T scores and categorise BMD. We studied the influence of various databases on classification of BMD in south-Indian postmenopausal women aged above 50 years. METHODOLOGY This was a cross-sectional study. Hologic DXA scanner was used to estimate BMD at lumbar spine (LS) and femoral neck (FN). T scores of ≤-2.5, -2.4 to -1, -0.9 to +1 were diagnostic of osteoporosis, osteopenia and normal respectively. Three reference databases(Italian, Korean and north Indian) were used to recalculate T scores. The agreement (K=kappa) between manufacturer provided database and the other databases was studied. The impact of different databases in diagnosing osteoporosis in subjects with FN fracture was assessed. RESULTS A total of 1956 postmenopausal women with mean (SD) age of 62 (4.3) years and 211 femoral neck(FN) fracture subjects with mean(SD) age of 68 (7.2) years were recruited. In subjects with fracture, osteoporosis at FN was found in 72% with Caucasian, 88% with North Indian, 56% with Italian, and 45% with Korean database. On comparing manufacturer provided database with the other population-specific reference, there was perfect agreement with north Indian (κ = 0.81 [FN], κ = 0.82 [LS]) and good agreement with the Italian database (κ = 0.78 [FN], κ = 0.74 [LS]). CONCLUSION North-Indian database identified most of the participants with FN fracture as having osteoporosis and had perfect agreement with the manufacturer's database. Follow up studies will further validate the impact of utilizing this database in clinical practice.
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Affiliation(s)
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Nihal Thomas
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Thomas Vizhalil Paul
- Department of Endocrinology, Christian Medical College, Vellore, Tamil Nadu, India
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