Association of blood neutrophil lymphocyte ratio in the patients with postmenopausal osteoporosis

Estrogen deficiency-mediated osteoimmunity in postmenopausal osteoporosis

Postmenopausal osteoporosis (PMO) is a common disease associated with aging, and estrogen deficiency is considered to be the main cause of PMO. Recently, however, osteoimmunology has been revealed to be closely related to PMO. On the one hand, estrogen deficiency directly affects the activity of bone cells (osteoblasts, osteoclasts, osteocytes). On the other hand, estrogen deficiency-mediated osteoimmunity also plays a crucial role in bone loss in PMO. In this review, we systematically describe the progress of the mechanisms of bone loss in PMO, estrogen deficiency-mediated osteoimmunity, the differences between PMO patients and postmenopausal populations without osteoporosis, and estrogen deficiency-mediated immune cells (T cells, B cells, macrophages, neutrophils, dendritic cells, and mast cells) activity. The comprehensive summary of this paper provides a clear knowledge context for future research on the mechanism of PMO bone loss.

Correlation study: Bone density and circulating inflammatory markers in postmenopausal patients

OBJECTIVE

This study aims to investigate the correlation between changes in bone mineral density (BMD) in postmenopausal women and circulating inflammatory markers.

METHODS

This retrospective study focused on postmenopausal women admitted to the orthopedic department of Suzhou Benq Medical Center from June 2022 to December 2023, following predetermined inclusion and exclusion criteria. We retrospectively collected data on initial blood routine test results and bone density measurements for all study subjects upon admission, including parameters such as white blood cell count (WBC), C-reactive protein, interleukin-6 (IL-6), and procalcitonin (PCT). Additionally, the systemic immune-inflammation index (SII) was calculated using neutrophil count, lymphocyte count, and platelet count. Statistical analyses using SPSS and GraphPad software were performed to assess the correlation between bone density and inflammatory markers.

RESULTS

Patients were classified into three groups based on BMD results, including 60 individuals in the osteoporosis (OP) group, 127 individuals in the osteopenia group, and 37 individuals in the Normal group, respectively. Principal component analysis analysis suggested that WBC, SII, and postmenopausal OP (PMOP) held significant feature values. Correlation analysis indicated a correlation between WBC (p = 0.021), IL-6 (p = 0.044), SII (p = 0.034), and PMOP. One-way ANOVA analysis revealed significant differences in IL-6 (p = 0.0179), SII (p = 0.0210), and PCT (p = 0.0200) among the three groups. Finally, ROC curve analysis demonstrated that SII (area under the curve = 0.716) has predictive value for PMOP.

CONCLUSION

This study identified a certain predictive value for PMOP through the assessment of inflammatory markers in peripheral blood using routine blood tests.

Unraveling the molecular and immunological landscape: Exploring signaling pathways in osteoporosis

Osteoporosis, characterized by compromised bone density and microarchitecture, represents a significant global health challenge, particularly in aging populations. This comprehensive review delves into the intricate signaling pathways implicated in the pathogenesis of osteoporosis, providing valuable insights into the pivotal role of signal transduction in maintaining bone homeostasis. The exploration encompasses cellular signaling pathways such as Wnt, Notch, JAK/STAT, NF-κB, and TGF-β, all of which play crucial roles in bone remodeling. The dysregulation of these pathways is a contributing factor to osteoporosis, necessitating a profound understanding of their complexities to unveil the molecular mechanisms underlying bone loss. The review highlights the pathological significance of disrupted signaling in osteoporosis, emphasizing how these deviations impact the functionality of osteoblasts and osteoclasts, ultimately resulting in heightened bone resorption and compromised bone formation. A nuanced analysis of the intricate crosstalk between these pathways is provided to underscore their relevance in the pathophysiology of osteoporosis. Furthermore, the study addresses some of the most crucial long non-coding RNAs (lncRNAs) associated with osteoporosis, adding an additional layer of academic depth to the exploration of immune system involvement in various types of osteoporosis. Finally, we propose that SKP1 can serve as a potential biomarker in osteoporosis.

Frailty phenotype as mediator between systemic inflammation and osteoporosis and fracture risks: A prospective study

BACKGROUND

Systemic inflammation and frailty have been implicated in osteoporosis (OP) and fracture risks; however, existing evidence remains limited and inconclusive. This study aimed to assess the associations of systemic inflammation and frailty phenotype with incident OP and fracture and to evaluate the mediating role of frailty phenotype.

METHODS

The present study analysed data from the UK Biobank, a comprehensive and representative dataset encompassing over 500 000 individuals from the general population. Baseline peripheral blood cell counts were employed to calculate the systemic inflammation markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammation index (SII). Frailty phenotype was assessed using five criteria, defined as frail (≥3 items met), pre-frail (1-2 items met) and non-frail (0 items met). OP and fracture events were confirmed through participants' health-related records. Multivariable linear and Cox regression models were utilized, along with mediation analysis.

RESULTS

Increased systemic inflammation was associated with increased risks of OP and fracture. The corresponding hazard ratios and 95% confidence intervals (CIs) for OP risk per standard deviation increase in the log-transformed NLR, PLR and SII were 1.113 (1.093-1.132), 1.098 (1.079-1.118) and 1.092 (1.073-1.111), and for fracture risk, they were 1.066 (1.051-1.082), 1.059 (1.044-1.075) and 1.073 (1.058-1.089), respectively. Compared with the non-frail individuals, the pre-frail and frail ones showed an elevated OP risk by 21.2% (95% CI: 16.5-26.2%) and 111.0% (95% CI: 98.1-124.8%), respectively, and an elevated fracture risk by 6.1% (95% CI: 2.8-9.5%) and 38.2% (95% CI: 30.7-46.2%), respectively. The systemic inflammation level demonstrated a positive association with frailty, with β (95% CI) of 0.034 (0.031-0.037), 0.026 (0.023-0.029) and 0.008 (0.005-0.011) in response to per standard deviation increment in log-transformed SII, NLR and PLR, respectively. The frailty phenotype mediated the association between systemic inflammation and OP/fracture risk. Subgroup and sensitivity analyses confirmed the robustness of these findings.

CONCLUSIONS

Systemic inflammation and frailty phenotype are independently linked to increased risks of OP and fracture. The frailty phenotype partially mediates the association between systemic inflammation and osteoporotic traits. These results highlight the significance of interventions targeting systemic inflammation and frailty in OP and fracture prevention and management.

Application of machine learning algorithms to identify people with low bone density

Background

Osteoporosis is becoming more common worldwide, imposing a substantial burden on individuals and society. The onset of osteoporosis is subtle, early detection is challenging, and population-wide screening is infeasible. Thus, there is a need to develop a method to identify those at high risk for osteoporosis.

Objective

This study aimed to develop a machine learning algorithm to effectively identify people with low bone density, using readily available demographic and blood biochemical data.

Methods

Using NHANES 2017-2020 data, participants over 50 years old with complete femoral neck BMD data were selected. This cohort was randomly divided into training (70%) and test (30%) sets. Lasso regression selected variables for inclusion in six machine learning models built on the training data: logistic regression (LR), support vector machine (SVM), gradient boosting machine (GBM), naive Bayes (NB), artificial neural network (ANN) and random forest (RF). NHANES data from the 2013-2014 cycle was used as an external validation set input into the models to verify their generalizability. Model discrimination was assessed via AUC, accuracy, sensitivity, specificity, precision and F1 score. Calibration curves evaluated goodness-of-fit. Decision curves determined clinical utility. The SHAP framework analyzed variable importance.

Results

A total of 3,545 participants were included in the internal validation set of this study, of whom 1870 had normal bone density and 1,675 had low bone density Lasso regression selected 19 variables. In the test set, AUC was 0.785 (LR), 0.780 (SVM), 0.775 (GBM), 0.729 (NB), 0.771 (ANN), and 0.768 (RF). The LR model has the best discrimination and a better calibration curve fit, the best clinical net benefit for the decision curve, and it also reflects good predictive power in the external validation dataset The top variables in the LR model were: age, BMI, gender, creatine phosphokinase, total cholesterol and alkaline phosphatase.

Conclusion

The machine learning model demonstrated effective classification of low BMD using blood biomarkers. This could aid clinical decision making for osteoporosis prevention and management.

Systemic immune-inflammatory indicators and bone mineral density in chronic kidney disease patients: A cross-sectional research from NHANES 2011 to 2018

BACKGROUND

The purpose of this study was to look at the relationship between the Systemic Immune Inflammatory Index (SII) and bone mineral density (BMD) in the pelvis, left upper and lower limbs, lumbar spine, thoracic spine, and trunk in a chronic kidney disease (CKD) population in the United States.

METHODS

The National Health and Nutrition Examination Survey (2011-2016) yielded 2302 people with CKD aged >18 years. CKD was defined as eGFR less than 90 ml/min/1.73 m2 or eGFR greater than 90 ml/min/1.73 m2 with urine ACR greater than 30 mg/L.SII was calculated as PC * (NC / LC) from platelet count (PC), neutrophil count (NC), and lymphocyte count (LC). Multiple logistic regression was used to examine the relationship between BMD and SII at different sites in CKD patients, smoothed curve-fitting and generalized weighting models were used to investigate non-linear relationships, and a two-tailed linear regression model was used to find potential inflection points in the model.

RESULTS

We discovered a negative correlation between SII and pelvic BMD among 2302 participants after controlling for gender, age, and race [β = -0.008; 95% confidence value -0.008; 95% confidence interval (CI) -0.014, -0.002]. Lower PEBMD was related to increasing SII (trend p = 0.01125). After additional correction, only pelvic BMD remained adversely linked with SII [value -0.006; 95% CI -0.012, -0.000, p = 0.03368]. Smoothed curve fitting revealed a consistent inverse relationship between SII and pelvic BMD. Further stratified analyses revealed a substantial positive negative connection between SII and pelvic BMD in individuals who did not have hypertension, diabetes, a BMI of more than 30 kg/m2, or stage 2 CKD. The connection between SII and PEBMD in people without diabetes revealed a strong inverted U-shaped curve.

CONCLUSION

In individuals with CKD in the United States, there was a negative connection between the systemic immunoinflammatory index (SII) and pelvic BMD. The SII might be a low-cost and simple test for CKD-related BMD loss.

Association of lymphocyte subsets and cytokines with bone metabolism: a retrospective, cross-sectional study

BACKGROUND

Previous research has shown that lymphocytes and cytokines can mediate bone metabolism. This study explored the clinical association and predictive ability of lymphocytes and cytokines levels for bone metabolism.

METHODS

A total of 162 patients were enrolled in this study. The levels of N-terminal propeptide of type I procollagen (P1NP), β-collagen degradation product (β-CTX), total T lymphocytes, immature T lymphocytes, suppressor/cytotoxic T lymphocytes, helper/inducer T lymphocytes, B lymphocytes, natural killer (NK) cells, Interferon-gamma (IFN-γ), tumour necrosis factor-alpha (TNF-α), IFN-α, interleukin-1 beta (IL-1β), IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, and IL12p70 were evaluated. The relationship between these lymphocyte subsets and cytokines with bone metabolic status was examined and their predictive ability for bone metabolic status was assessed.

RESULTS

The principal component analysis (PCA) and correlation analysis results varied on differences in lymphocyte subsets and cytokines in various bone metabolism states. Differential analysis revealed significant differences in the absolute counts of B lymphocytes (P < 0.05), level of IL-12p70 (P < 0.05), and IL-8 (P < 0.001) at different P1NP levels. Significant differences were observed in the absolute counts of total T lymphocytes (P < 0.05), B lymphocytes (P < 0.05), the level of IL-6 (P < 0.05), the percentage of B lymphocytes (P < 0.01), and NK cells (P < 0.05) at different β-CTX levels. Furthermore, the receiver operating characteristic (ROC) curve showed that the absolute count of B lymphocytes and levels of IL-12p70 and IL-8 could be used to evaluate bone formation states, while the absolute counts of T and B lymphocytes, level of IL-6, and percentages of NK cells and B lymphocytes could be used to evaluate bone resorption states.

CONCLUSION

The bone metabolism status changed based on the lymphocyte subsets and cytokine levels. Differentially expressed lymphocytes and cytokines could be used to distinguish bone metabolism status.

Tea consumption and risk of bone health: an updated systematic review and meta-analysis

INTRODUCTION

Current research evaluating the association between tea consumption and bone health still has inconsistent findings.

MATERIALS AND METHODS

The electronic databases of Embase, PubMed, Scopus, and Web of Science were systematically searched from inception until December 2022 to identify eligible studies. The calculation of summary relative risks (RRs) and 95% confidence intervals (CIs) was carried out using random-effects models. I2 statistics and Forest plots were used to assess the heterogeneity of RR values across studies.

RESULTS

The pooled relative risks for bone health-related outcomes of interest among tea drinkers, compared to non-drinkers, were 0.910 (95% confidence interval 0.845 to 0.980) for fractures, based on 20 studies, 0.332 (0.207-0.457) for BMD (13 studies), 0.800 (0.674-0.950) for osteoporosis (10 studies), and 1.006 (0.876-1.156) for osteopenia (5 studies). Subgroup analysis of locations showed that the pooled relative risks were 0.903 (0.844-0.966) for the hip, 0.735 (0.586-0.922) for the femur, 0.776 (0.610-0.988) for the lumbar, 0.980 (0.942-1.021) for the forearm and wrist, 0.804 (0.567-1.139) for the phalanges, and 0.612 (0.468-0.800) for Ward's triangle. One-stage dose-response analysis revealed that individuals who consumed less than 4.5 cups of tea per day had a lower risk of bone health-related outcomes than those who did not consume tea, with statistically significant results.

CONCLUSION

There is an association between tea consumption and a reduced risk of fractures, osteoporosis, hip, femur, and lumbar, as well as increased BMD.

Study of the link between hemotopoietic and skeletal systems in patients attending a referral center for osteoporosis

PURPOSE

To investigate the link between hematopoietic and skeletal tissues in patients with fragility fractures.

METHODS

We retrospectively analyzed the medical records of women older than 40 years who attended the Bone Disease Unit of "Sapienza" University of Rome for their first visit for osteoporosis from January 2020 to June 2022.

RESULTS

Fragility fractures were found in 61.8% of the sample. In particular, vertebral fractures in 35.5%, femoral fractures in 6.3%, Colles fractures in 16.5% and non-vertebral non-hip in 42.5%. Fractured patients were significantly older compared to non-fractured, had lower mean values of lumbar spine (p = 0.01), and femoral neck BMD (p = 0.007). A red blood cell distribution width (RDW) value higher than 15% was observed four times more in those with fractures compared to non-fractured patients (8.9% vs 2%, p = 0.01) and was associated with vertebral fracture after adjusting for age, BMI, menopause, nutritional status, smoking, osteoporosis and anemia (OR = 4.1, 95% CI 1.6-11.4, p = 0.003). Hematocrit was negatively associated with hip fracture also adjusting for age, BMI, menopause, nutritional status, smoking, osteoporosis (p = 0.025).

CONCLUSION

Our study demonstrates that RDW values were significantly associated with vertebral fracture and hematocrit with hip fracture. Since both parameters are included in the initial evaluation of patients with suspected bone fragility, our results should push doctors to look at these values with no incremental cost for national health services.

High systemic immune-inflammation index is relevant to osteoporosis among middle-aged and older people: A cross-sectional study

BACKGROUND

As one of novel inflammatory indexes proposed in recent years, systemic immune-inflammation index (SII) can comprehensively reflect the inflammatory and immune state of the body. This study aims to explore the relationship between SII and osteoporosis among middle-aged and older people.

MATERIALS AND METHODS

Our study includes 20,497 individuals from National Health and Nutrition Examination Survey (NHANES) 2005-2008, and target study population are confined to people aged 45 years and above. SII is calculated as platelet count × neutrophil count/lymphocyte count. Multivariate logistic regression analysis is used to explore the link between SII and osteoporosis, and receiver operating characteristics curve is used to screen optimal cut-off value of SII for indicating the occurrence of osteoporosis.

RESULTS

A total of 435 people with osteoporosis are screened among 4625 middle-aged and older people, and individuals in osteoporosis group have higher SII than those in nonosteoporosis group (p = .024). Logistic regression analysis indicates that with the enhancement of SII, prevalence of osteoporosis in each tertile category also increases (p < .001). This tendency is also not changed in univariate model (p < .001), as well as the adjustments for different parameters. Moreover, we also identify that SII of 530.09 is the optimal cut-off value for indicating the occurrence of osteoporosis among middle-aged and older people.

CONCLUSIONS

This present NHANES-based study noticed that higher SII is positively linked to osteoporosis among middle-aged and older people, and SII should not exceed 530.09 for them to obtain a potentially lower risk of osteoporosis.

The Inflammatory Contribution of B-Lymphocytes and Neutrophils in Progression to Osteoporosis

Osteoporosis is a bone disease characterized by structural deterioration and low bone mass, leading to fractures and significant health complications. In this review, we summarize the mechanisms by which B-lymphocytes and neutrophils contribute to the development of osteoporosis and potential therapeutics targeting these immune mediators to reduce the proinflammatory milieu. B-lymphocytes-typically appreciated for their canonical role in adaptive, humoral immunity-have emerged as critical regulators of bone remodeling. B-lymphocytes communicate with osteoclasts and osteoblasts through various cytokines, including IL-7, RANK, and OPG. In inflammatory conditions, B-lymphocytes promote osteoclast activation and differentiation. However, B-lymphocytes also possess immunomodulatory properties, with regulatory B-lymphocytes (Bregs) secreting TGF-β1 to restrain pathogenic osteoclastogenesis. Neutrophils, the body's most prevalent leukocyte, also contribute to the proinflammatory environment that leads to osteoporotic bone remodeling. In aged individuals, neutrophils display reduced chemotaxis, phagocytosis, and apoptosis. Understanding the delicate interplay between B-lymphocytes and neutrophils in the context of impaired bone metabolism is crucial for targeted therapies for osteoporosis.

Role of Mast-Cell-Derived RANKL in Ovariectomy-Induced Bone Loss in Mice

Mast cells may contribute to osteoporosis development, because patients with age-related or post-menopausal osteoporosis exhibit more mast cells in the bone marrow, and mastocytosis patients frequently suffer from osteopenia. We previously showed that mast cells crucially regulated osteoclastogenesis and bone loss in ovariectomized, estrogen-depleted mice in a preclinical model for post-menopausal osteoporosis and found that granular mast cell mediators were responsible for these estrogen-dependent effects. However, the role of the key regulator of osteoclastogenesis, namely, receptor activator of NFκB ligand (RANKL), which is secreted by mast cells, in osteoporosis development has, to date, not been defined. Here, we investigated whether mast-cell-derived RANKL participates in ovariectomy (OVX)-induced bone loss by using female mice with a conditional Rankl deletion. We found that this deletion in mast cells did not influence physiological bone turnover and failed to protect against OVX-induced bone resorption in vivo, although we demonstrated that RANKL secretion was significantly reduced in estrogen-treated mast cell cultures. Furthermore, Rankl deletion in mast cells did not influence the immune phenotype in non-ovariectomized or ovariectomized mice. Therefore, other osteoclastogenic factors released by mast cells might be responsible for the onset of OVX-induced bone loss.

α-Linolenic Acid Inhibits RANKL-Induced Osteoclastogenesis In Vitro and Prevents Inflammation In Vivo

Inflammation is an important risk factor for bone-destroying diseases. Our preliminary research found that Zanthoxylum bungeanum seed oil (ZBSO) is abundant in unsaturated fatty acids and could inhibit osteoclastogenesis in receptor activator of nuclear factor κB ligand (RANKL)-induced RAW264.7 cells. However, the key constituents in ZBSO in the prevention of osteoclastogenesis and its possible mechanism related to inflammation are still unclear. Therefore, in this study, oleic acid (OA), linoleic acid (LA), palmitoleic acid (PLA), and alpha-linolenic acid (ALA) in ZBSO, havingthe strongest effect on RANKL-induced osteoclastogenesis, were selected by a tartrate-resistant acid phosphatase (TRAP) staining method. Furthermore, the effects of the selected fatty acids on anti-inflammation and anti-osteoclastogenesis in vitro and in vivo were assessed using RT-qPCR. Among the four major unsaturated fatty acids we tested, ALA displayed the strongest inhibitory effect on osteoclastogenesis. The increased expression of free fatty acid receptor 4 (FFAR4) and β-arrestin2 (βarr2), as well as the decreased expression of nuclear factor-kappa B (NF-κB), tumor necrosis factor-α (TNF-α), nuclear factor of activated T-cells c1 (NFATc1), and tartrate-resistant acid phosphatase (TRAP) in RAW264.7 cells after ALA treatment were observed. Moreover, in ovariectomized osteoporotic rats with ALA preventive intervention, we found that the expression of TNF-α, interleukin-6 (IL-6), interleukin-1β (IL-1β), NFATc1, and TRAP were decreased, while with the ALA therapeutic intervention, downregulated expression of NF-κB, NFATc1, TRAP, and transforming growth factor beta-activated kinase 1 (TAK1) were noticed. These results indicate that ALA, as the major unsaturated fatty acid in ZBSO, could inhibit RANKL-induced osteoclastogenesis via the FFAR4/βarr2 signaling pathway and could prevent inflammation, suggesting that ZBSO may be a promising potential natural product of unsaturated fatty acids and a dietary supplement for the prevention of osteoclastogenesis and inflammatory diseases.

Neutrophil-lymphocyte ratio as a risk factor for osteoporotic vertebrae fractures and femoral neck fractures

Fracture is associated with osteopenia after osteoporosis. Neutrophil-lymphocyte ratio (NLR) is common in inflammatory diseases. NLR can be used as an effective clinical tool to assess postmenopausal osteoporosis. The aim of this study is to further explore the relationship between elevated NLR and the severity of osteoporotic vertebrae fractures and femoral neck fracture based on magnetic resonance imaging (MRI). A total of 80 patients with osteoporotic vertebrae fractures, osteoporotic femoral neck fracture in Baoding Second Central Hospital from 2017 to 2020 were selected as the research objects. This study included a series of pretreatment factors, mainly including white blood cell count, red blood cell count, hemoglobin, and the general condition of the patients. Statistical methods included Pearson chi-square test, Spearman correlation test, logistic regression analysis and receiver operator characteristic (ROC) curve. According to Pearson chi-square test, Spearman correlation test, univariate/multivariate logistic regression analysis, the severity of osteoporotic vertebrae fractures, osteoporotic femoral neck fracture was significantly correlated with NLR (P < .001). NLR (odds ratio [OR] = 13.229, 95% CI: 4.167-41.998, P < .001) was a significant independent risk factor for osteoporotic vertebrae fractures, osteoporotic femoral neck fracture. receiver operator characteristic (ROC) curve was used to detect the specificity and sensitivity. The level of NLR has an important influence on the severity of osteoporotic vertebrae fractures and femoral neck fracture. The higher the level of NLR, the more serious the osteoporotic vertebrae fractures and femoral neck fracture.

Effect of Lymphocyte Subsets on Bone Density in Senile Osteoporosis: A Retrospective Study

Background

Several studies have shown that lymphocyte subsets can mediate the occurrence of osteoporosis (OP); however, the predictive ability of lymphocyte subsets in senile OP has not been elucidated.

Purpose

To investigate the ability of lymphocyte subsets to predict senile osteoporosis (OP).

Methods and Materials

This study included 44 patients with senile OP and 44 without OP. Dual-energy X-ray absorptiometry (DEXA) was used to determine bone mineral density (BMD). Flow cytometry was used to analyze the absolute counts of the lymphocyte subsets and cytokine levels. Finally, the correlation between BMD and lymphocyte subset counts in the two groups was analyzed.

Results

There were no significant differences in age, sex, or weight between the OP and non-OP groups. The absolute counts of total T lymphocytes and CD8+ T lymphocytes in the OP group were significantly lower than those in the non-OP group. The levels of IFN-γ or TNF-α in the OP group were significantly higher or lower, respectively, than those in the non-OP group. PCA showed that age, BMI, total T lymphocytes, CD4+ T lymphocytes, CD8+ T lymphocytes, and B lymphocytes were the principal components of senile OP. The linear regression equation showed that BMD of the right femoral neck significantly decreased with a decline in CD8+ T lymphocyte counts.

Conclusion

BMD decreased with a decrease in CD8+ T lymphocytes. The mechanism by which lower lymphocyte subsets lead to lower BMD may be related to abnormal bone metabolism caused by immune aging. Therefore, we considered that CD8+ T lymphocytes could be used to predict the incidence of senile OP.

Systemic immune-inflammation index and bone mineral density in postmenopausal women: A cross-sectional study of the national health and nutrition examination survey (NHANES) 2007-2018

Background

This study aimed to investigate the association between the systemic immune-inflammation index (SII) and bone mineral density (BMD) and to determine the association between the SII and the risk of osteopenia/osteoporosis among postmenopausal women aged ≥50 years.

Methods

Postmenopausal women aged ≥50 years from the National Health and Nutrition Examination Survey were included. BMD testing was performed using dual-energy X-ray absorptiometry. The SII was calculated based on lymphocyte (LC), neutrophil (NC), and platelet (PC) counts. Moreover, the associations of BMD with SII and other inflammatory markers, including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), the product of platelet count and neutrophil count (PPN), PC, NC, and LC, were assessed using a multivariable weighted linear regression model. Additionally, the associations of low BMD/osteoporosis with SII and other inflammatory markers were assessed using multivariable weighted logistic regression.

Results

Finally, a total of 893 postmenopausal women with a weighted mean age of 60.90 ± 0.26 years were included finally. This study found that SII was negatively associated with total femur BMD and femoral neck BMD, and postmenopausal women in a higher SII quarter group showed low lumbar spine BMD than the lowest SII quarter group when SII was converted from a continuous variable to a categorical variable. Moreover, increased SII was associated with an increased risk of low BMD and osteoporosis. In addition, this study observed that other inflammatory markers, especially NLR and PPN, were negatively associated with BMD and positively associated with the risk of osteoporosis. Finally, the subgroup analysis showed that the associations between BMD and inflammatory markers were pronounced in postmenopausal women aged ≥65 years or those with normal BMI (<25 kg/m²).

Conclusion

SII may be a valuable and convenient inflammatory marker that could be applied to predict the risk of low BMD or osteoporosis among postmenopausal women aged ≥50. Moreover, postmenopausal women with a high level of SII or other inflammatory markers, such as NLR and PPN, should be aware of the potential risk of osteoporosis. However, given the inherent limitations of the present study, additional large-scale studies are required to investigate the role of SII in osteoporosis further.

Associations of Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Monocyte-to-Lymphocyte Ratio with Osteoporosis and Incident Vertebral Fracture in Postmenopausal Women with Rheumatoid Arthritis: A Single-Center Retrospective Cohort Study

Background and Objectives: We investigated whether nutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphoycte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) are associated with the presence of osteoporosis (OP) and vertebral fractures in patients with rheumatoid arthritis (RA). Materials and Methods: This retrospective cohort study included 413 postmenopausal patients with RA and 200 healthy controls who underwent dual-energy X-ray absorptiometry (DEXA) between January 2005 and December 2017. DEXA examination data were defined as the index date, and all laboratory values were measured within one month from the index date. OP was defined as a T-score < −2.5, and incident vertebral fractures were defined as the first occurrence of non-traumatic fractures after the index date. NLR, PLR, and MLR measures were dichotomized by a median split (low vs. high). Results: The median NLR, PLR, and MLR in RA patients were significantly higher than those in controls. The frequencies of OP of the lumbar spine, hip, and either site in postmenopausal patients with RA were 24.7%, 15.5%, and 32%, respectively, and were significantly higher than those in controls. After adjusting for confounding factors, a high baseline NLR was significantly associated with OP at either site (OR = 1.61, p = 0.041). In addition, high baseline NLR (OR = 2.11, p = 0.025) and PLR (OR = 2.3, p = 0.011) were related with the presence OP at hip. During the follow-up period, 53 (12.8%) patients with RA developed vertebral fractures incidentally. In multivariable Cox regression models, a high baseline NLR (HR = 4.72, p < 0.001), PLR (HR = 1.96, p = 0.024), and MLR (HR = 2.64, p = 0.002) were independently associated with a higher risk of incidental vertebral fractures. Conclusions: Our data suggest that NLR, PLR, and MLR can be used as potential markers of systemic bone loss among individuals with RA.

Expression of Receptor Activator of Nuclear – Kappa β Ligand in Patients with Metastatic Bone Disease

BACKGROUND: Bone metastasis is a complication that often occurs due to cancer in solid organs, and more often compared to primary bone tumors. Bone metastasis is associated with excessive osteolytic processes. AIM: This study was conducted to reveal the correlation between Receptor Activator of Nuclear factor kβ Ligand (RANKL) expression, lactate dehydrogenase (LDH), and neutrophil-lymphocyte ratio (NLR) level in patients with bone metastatic lesions. METHODS: This cross-sectional study was conducted in 15 subjects with bone metastatic lesions. The specimens were fresh bone tissues obtained by open biopsy. Expression of RANKL in mRNA level was detected quantitatively using reverse transcription-polymerase chain reaction. LDH and NLR were analyzed from the peripheral blood analysis. The correlation of RANKL expression with LDH and NLR was statistically analyzed. RESULTS: This study enrolled 15 subjects with bone metastasis disease based on the clinical, radiological, and histopathological results. The means of LDH, NLR, and RANKL expression were not significantly different. There was no significant association between the characteristics of metastatic lesion and RANKL expression. The correlation between LDH levels with RANKL expression was positive (p < 0.05), while the correlation between NLR and RANKL expression was negative (p < 0.05). CONCLUSION: RANKL expression was positively correlated with LDH and negatively correlated with the NLR. Both LDH and NLR can be used as predictive factors of RANKL expression in bone metastasis.

Immunoporosis: Role of immune system in the pathophysiology of different types of osteoporosis

Osteoporosis is a skeletal system disease characterized by low bone mass and altered bone microarchitecture, with an increased risk of fractures. Classical theories hold that osteoporosis is essentially a bone remodeling disorder caused by estrogen deficiency/aging (primary osteoporosis) or secondary to diseases/drugs (secondary osteoporosis). However, with the in-depth understanding of the intricate nexus between both bone and the immune system in recent decades, the novel field of "Immunoporosis" was proposed by Srivastava et al. (2018, 2022), which delineated and characterized the growing importance of immune cells in osteoporosis. This review aimed to summarize the response of the immune system (immune cells and inflammatory factors) in different types of osteoporosis. In postmenopausal osteoporosis, estrogen deficiency-mediated alteration of immune cells stimulates the activation of osteoclasts in varying degrees. In senile osteoporosis, aging contributes to continuous activation of the immune system at a low level which breaks immune balance, ultimately resulting in bone loss. Further in diabetic osteoporosis, insulin deficiency or resistance-induced hyperglycemia could lead to abnormal regulation of the immune cells, with excessive production of proinflammatory factors, resulting in osteoporosis. Thus, we reviewed the pathophysiology of osteoporosis from a novel insight-immunoporosis, which is expected to provide a specific therapeutic target for different types of osteoporosis.

Drinking tea before menopause is associated with higher bone mineral density in postmenopausal women

BACKGROUND

Though tea drinking years and menopause stages have been indicated to be related with bone mineral density (BMD), most human studies have not considered the impact of tea drinking beginning time. Whether drinking tea before or after menopause plays a role in BMD is still unclear. This study aims to analyze whether drinking tea before or after menopause influences BMD in Chinese postmenopausal women.

METHODS

A total of 1377 postmenopausal women under 80 years were enrolled from the baseline survey of the Lanxi Cohort Study. Participants were initially categorized into non-tea drinking, tea drinking beginning after menopause and tea drinking beginning before menopause groups. Tea drinking groups were subdivided according to tea drinking frequency, concentration and type. Multiple linear regression models were applied to evaluate associations between tea drinking before or after menopause and BMD and the impacts of tea drinking frequency, concentration and type on their associations in analyses including all participants. Interactions of tea drinking frequency, concentration and type with drinking tea before or after menopause were further analyzed.

RESULTS

After adjusting for confounding factors, women who began drinking tea before menopause had significantly higher total and regional BMD than non-tea drinking participants and participants who began drinking tea after menopause. Differences in spine BMD were more significant among those who drank tea ≥four times per week. In addition, significant associations between tea drinking and BMD were found among participants who began drinking tea before menopause in both models, irrespective of the concentration and type of tea. No significant associations were found in subgroups of participants who began drinking tea after menopause in either model.

CONCLUSIONS

The results indicate that drinking tea before menopause is related to higher BMD in Chinese postmenopausal women. The relationship is independent of tea drinking concentration and type.

Modifiable lifestyle factors associated with fragility hip fracture: a systematic review and meta-analysis

INTRODUCTION

Among the various hip fracture predictors explored to date, modifiable risk factors warrant special consideration, since they present promising targets for preventative measures. This systematic review and meta-analysis aims to assess various modifiable risk factors.

MATERIAL AND METHODS

We searched four online databases in September 2017. We included studies that reported on modifiable lifestyle risk factors for sustaining fragility hip fractures. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). The inclusion criteria consisted of (1) adult patients with osteoporotic hip fracture, (2) original study, (3) availability of full text articles in English, and (4) report of a modifiable lifestyle risk factor.

RESULTS

Thirty-five studies, containing 1,508,366 subjects in total, were included in this study. The modifiable risk factors that were significantly associated with an increased risk of hip fracture were the following: weight < 58 kg (128 lbs) (pooled OR 4.01, 95% CI 1.62-9.90), underweight body mass index (BMI) (< 18.5) (pooled OR 2.83, 95% CI 1.82-4.39), consumption of ≥ 3 cups of coffee daily (pooled OR 2.27, 95% CI 1.04-4.97), inactivity (pooled OR 2.14, 95% CI 1.21-3.77), weight loss (pooled OR 1.88, 95% CI 1.32-2.68), consumption of ≥ 27 g (approx. > 2 standard drinks) alcohol per day (pooled OR 1.54, 95% CI 1.12-2.13), and being a current smoker (pooled OR 1.50, 95% CI 1.22-1.85). Conversely, two factors were significantly associated with a decreased risk of hip fracture: obese BMI (> 30) (pooled OR 0.58, 95% CI 0.34-0.99) and habitual tea drinking (pooled OR 0.72, 95% CI 0.66-0.80).

CONCLUSION

Modifiable factors may be utilized clinically to provide more effective lifestyle interventions for at risk populations. We found that low weight and underweight BMI carried the highest risk, followed by high coffee consumption, inactivity, weight loss, and high daily alcohol consumption.

Effect of neutrophil-to-lymphocyte ratio on short-term prognosis of elderly patients with hip fracture

OBJECTIVE

To investigate the effect of neutrophil-to-lymphocyte ratio (NLR) on short-term prognosis in elderly patients with hip fracture.

METHODS

Altogether, 124 elderly patients with hip fractures who underwent surgery in our hospital were retrospectively studied, and they were divided into survival group (n=98) and death group (n=26) according to their 1-year survival. General data of both groups were collected and compared, and indicators with statistical differences in univariate analysis were further examined by logistic regression analysis. Venous blood samples were drawn from all patients 1 day after the surgery to detect and compare NLR, serum procalcitonin (PCT) and C-reactive protein (CRP) levels between both groups. ROC curve was used to analyze the clinical value of NLR in predicting the prognosis of patients. NLR cutoff value obtained by the ROC curve analysis was adopted to divide the patients into high and low ratio groups, and Kaplan-Meier (K-M) curves were used to assess the survival rate of patients in both groups.

RESULTS

There were significant differences in age, gender, marital status, medical history and American Society of Anesthesiologists (ASA) grades between both groups. Logistic regression analysis showed that advanced age (≥85 years), male gender, and higher ASA grades (III-IV) were risk factors for short-term poor prognosis in elderly patients with hip fracture. Compared with survival group, NLR, PCT and CRP levels were higher in death group. ROC curve showed that the AUC of NLR predicting patients' prognosis was 0.804 at a cutoff value of 6.939%. K-M curves showed that the overall survival was lower in high-ratio group than in low-ratio group.

CONCLUSION

Advanced age (overall survival was lower in high-ratio group than in low-ratio group), male gender, and higher ASA grades (III-IV) were risk factors for short-term poor prognosis in elderly patients with hip rifracture. NLR has some clinical value in predicting and evaluating the prognosis of patients.

NLR value and IL-18 level and their clinical significance in patients with deep vein thrombosis after receiving the surgery for spinal degeneration

OBJECTIVE

To investigate the value of the neutrophil-to-lymphocyte ratio (NLR) and Interleukin 18 (IL-18) level in patients with deep vein thrombosis after receiving surgery for spinal degeneration; and we explore their significance in clinical practice.

METHODS

This study was conducted in 296 patients who were treated in our hospital for spinal degeneration. After surgery, these patients were followed up for 1 month. After performing the color Doppler ultrasound examination, patients were divided into the thrombus group (n = 72) and the non-thrombus group (n = 224) based on the occurrence of deep vein thrombosis. Baseline data, NLR values and IL-18 levels before surgery, and at 1, 3, 5, and 7 days after surgery were compared between the two groups. Logistic regression analysis was implemented to analyze the risk factors for postoperative deep vein thrombosis. Patients in the thrombosis group were allocated to the mild, moderate, and severe group on the basis of the degree of thrombosis. NLR values and IL-18 levels at 3 days after surgery were compared among the three groups. The correlations between both NLR value and IL-18 level and the severity of deep vein thrombosis were analyzed with Pearson correlation. Receiver operating characteristic curve was used to assess the clinical value of NLR value and IL-18 level at 3 days after surgery in predicting postoperative deep vein thrombosis.

RESULTS

There were significant differences concerning age, the history of diabetes, and obesity between the two groups (all P<0.05). NLR values and IL-18 levels in both groups after surgery were increased when compared with before surgery (all P<0.01). In addition, NLR values and IL-18 levels reached a peak at 3 days after surgery. Compared with the non-thrombus group, NLR values and IL-18 levels in the thrombus group at 1, 3, 5, and 7 days after surgery were increased (all P<0.01). NLR value and IL-18 level in the thrombosis group at 3 days after surgery were increased with a worsened degree of thrombosis. In other words, both NLR value and IL-18 level were positively correlated with the degree of deep vein thrombosis. The results of logistic regression analysis displayed that age ≥60 years old, body mass index ≥23 kg/m², NLR value >4.34%, and IL-18 level >115.71 ng/mL were independent risk factors for postoperative deep vein thrombosis. The results of the ROC curve showed that the area under curves, which represent the formation of postoperative deep vein thrombosis, were above 0.7 when using NLR value and IL-18 level at 3 days after surgery (both P<0.001).

CONCLUSION

Compared with the non-thrombus group, NLR value and IL-18 level in the thrombosis group after receiving surgery for spinal degeneration are significantly increased. In addition, the more severe the thrombosis is, the higher the NLR value and IL-18 level at 3 days after surgery. Therefore, NLR value and IL-18 level at 3 days after surgery have certain clinical value in predicting postoperative deep vein thrombosis and prognosis.

Interaction between bone and immune cells: Implications for postmenopausal osteoporosis

Postmenopausal osteoporosis is a systemic disease characterized by the loss of bone mass and increased bone fracture risk largely resulting from significantly reduced levels of the hormone estrogen after menopause. Besides the direct negative effects of estrogen-deficiency on bone, indirect effects of altered immune status in postmenopausal women might contribute to ongoing bone destruction, as postmenopausal women often display a chronic low-grade inflammatory phenotype with altered cytokine expression and immune cell profile. In this context, it was previously shown that various immune cells interact with osteoblasts and osteoclasts either via direct cell-cell contact, or more likely via paracrine mechanisms. For example, specific subtypes of T lymphocytes express TNFα, which was shown to increase osteoblast apoptosis and to indirectly stimulate osteoclastogenesis via B cell-produced receptor-activator of NF-κB ligand (RANKL), thereby triggering bone loss during postmenopausal osteoporosis. T_h17 cells release interleukin-17 (IL-17), which directs mesenchymal stem cell differentiation towards the osteogenic lineage, but also indirectly increases osteoclast differentiation. B lymphocytes are a major regulator of osteoclast formation via granulocyte colony-stimulating factor secretion and the RANKL/osteoprotegerin system under estrogen-deficient conditions. Macrophages might act differently on bone cells dependent on their polarization profile and their secreted paracrine factors, which might have implications for the development of postmenopausal osteoporosis, because macrophage polarization is altered during disease progression. Likewise, neutrophils play an important role during bone homeostasis, but their over-activation under estrogen-deficient conditions contributes to osteoblast apoptosis via the release of reactive oxygen species and increased osteoclastogenesis via RANKL signaling. Furthermore, mast cells might be involved in the development of postmenopausal osteoporosis, because they store high levels of osteoclastic mediators, including IL-6 and RANKL, in their granules and their numbers are greatly increased in osteoporotic bone. Additionally, bone fracture healing is altered under estrogen-deficient conditions with the increased presence of pro-inflammatory cytokines, including IL-6 and Midkine, which might contribute to healing disturbances. Consequently, in addition to the direct negative influence of estrogen-deficiency on bone, immune cell alterations contribute to the pathogenesis of postmenopausal osteoporosis.

Blood lipid levels in patients with osteopenia and osteoporosis:a systematic review and meta-analysis

INTRODUCTION

Considering the controversial relationship between blood lipid levels and osteopenia and osteoporosis (OP), we performed this meta-analysis.

MATERIALS AND METHODS

Using specific keywords and related words, we searched PubMed, Embase, and Cochrane Library databases. The Newcastle-Ottawa Scale form was used to evaluate the quality of the literature. According to the inclusion and exclusion criteria, we systematically screened the literature to extract relevant information and data. ReVman 5.3 and Stata 13.0 software were used for statistical analysis. Results were expressed as the mean difference (MD) and 95% confidence interval (95% CI). The heterogeneity test was conducted according to I² and Q tests. Egger's test was used to quantitatively evaluate publication bias.

RESULTS

This analysis involved 12 studies (12,395 subjects). The quality of the literature was acceptable. Among subjects who were not taking lipid-lowering drugs, total cholesterol (TC) (MD = 0.11 mmol/L, 95%CI: - 0.03, 0.25; I² = 21%; P = 0.36), triglycerides (TG) (MD =  - 0.01 mmol/L, 95%CI: - 0.09, 0.07; I² = 6%; P = 0.34), and low-density lipoprotein cholesterol (LDL-C) (MD = 0.10 mmol/L, 95%CI: 0.00, 0.19; I² = 0%; P = 0.74) in the osteopenia were not significantly increased/decreased. There were no significant differences in LDL-C (MD = 0.02 mmol/L, 95%CI: - 0.09, 0.13; I² = 0%; P = 0.74) in postmenopausal women in osteopenia. TG (MD =  - 0.04 mmol/L, 95%CI: - 0.14,0.07; I² = 49%; P = 0.07) was unchanged in the osteoporosis (OP) group in subjects without taking lipid-lowering drugs. HDL-C was elevated in OP group (MD = 0.05 mmol/L, 95%CI: 0.03, 0.07; I² = 31%; P = 0.15) but not in osteopenia group (MD = 0.01 mmol/L, 95%CI: - 0.01, 0.02; I² = 38%; P = 0.14) in all subjects.

CONCLUSION

HDL-C was elevated in patients with OP.

A correlative studies between osteoporosis and blood cell composition: Implications for auxiliary diagnosis of osteoporosis

Osteoporosis is defined as a metabolic skeletal disease characterized by a decrease of the bone mass per unit volume, caused by a variety of reasons. Increasing evidence indicate that the host inflammatory response was correlated with the occurrence and development of osteoporosis, and it has been recognized that T lymphocytes and B lymphocytes play a critical role in pathogenesis of inflammatory bone disease. Between January 2018 and December 2018, retrospective analysis of 487 patients (exclusion of patients with recent infections and hematologic disorders whose leukocyte counts or classifications are markedly abnormal) who underwent bone mineral density (BMD) examinations in Huzhou Central Hospital. The patients were divided into normal bone density group, osteopenia group, and osteoporosis group according to the T score of BMD in the left femoral neck, respectively. Statistics of the lymphocyte ratio and the monocyte ratio in the blood routine examination results during the same period were performed so as to make a comparison of the differences among the groups. The correlation of the lymphocyte ratio and monocyte ratio with the T score of BMD in the left femoral neck was also analyzed. The difference between neutrocyte ratio lymphocyte ratio and the monocyte ratio was statistically significant in both males and females among the normal bone density group, osteopenia group and osteoporosis group (P < .01 or P < .05). Inflammation plays an important role in the progression of osteoporosis. By monitoring these three indicators in blood routine examination, early intervention for osteoporosis may become possible.

The Effectiveness and Safety of Acupoint Catgut Embedding for the Treatment of Postmenopausal Osteoporosis: A Systematic Review and Meta-Analysis

Purpose

To evaluate the effectiveness and safety of acupoint catgut embedding therapy (ACET) in postmenopausal osteoporosis (PMOP).

Methods

Review of some databases from their inception to June 2018 and randomized controlled trials (RCTs) in which ACET with PMOP were included. Two researchers extracted and evaluated the information independently. Cochrane Collaboration's tool and Jadad scale were used to evaluate the quality of the studies. RevMan V.5.3.3 software was used to carry out the meta-analysis while trial sequential analysis (TSA) performed with TSA 0.9 software.

Results

12 RCTs with 876 participants were included in this review. Meta-analysis showed that ACET alone was not superior to medication in effectiveness rate (RR= 1.11; 95% CI (0.89, 1.40); P=0.35) and E2 (SMD= 0.20; 95% CI (-0.17, 0.57); P=0.28; I ² =20%) while ACET combining medication was more effective on the effectiveness rate (RR= 1.32; 95% CI (1.20, 1.46); P<0.000 01) and E2 (SMD= 1.24; 95% CI (0.63, 1.84); P<0.0001). Additionally, ACET combining calcium could increase the bone mineral density (BMD) of the L2~4 vertebrae and femur-neck [WMD_L2~4 = 0.03; 95% CI (0.01, 0.05); P=0.003; and WMD_Femur-neck = 0.07; 95% CI (0.03, 0.10); P = 0.0006], reduce TCM syndrome score [WMD = -1.85; 95% CI (-2.13, -1.57); P<0.000 01], improve patient's quality of life [WMD_{three  months} = 6.90; 95% CI (3.90, 9.89); P<0.000 01; and WMD_{six  months} = 12.34; 95% CI (5.09, 19.60); P=0.0009], and relieve pain [WMD_VAS = -1.26; 95% CI (-1.66, -0.85); P<0.000 01; and WMD_{Pain  score} = -2.59; 95% CI (-4.76, -0.43); P= 0.02]. The TSA showed that the effectiveness of ACET for PMOP was demonstrated accurately.

Conclusions

ACET combining medication but not ACET alone is more effective than medication as comparison in the treatment of PMOP. As a novel treatment, ACET shows the potential of effectiveness and deserves further high quality of well-designed study.

The Relationship of Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio with Bone Mineral Density in Korean Postmenopausal Women

The neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are known to be markers of the systemic inflammatory response. However, the few studies that have been done on the relationship between the NLR and PLR and osteoporosis have yielded inconsistent results. Therefore, we assessed the relationship between the NLR and PLR and bone mineral density (BMD). This study was conducted with postmenopausal patients admitted to an orthopaedic hospital. Data including BMD, NLR, PLR and covariates were obtained from the subjects' medical records. In total, 407 postmenopausal patients were enrolled in this study. Analysis of covariance was performed to identify significant differences in BMD according to NLR and PLR. After adjusting for other covariates, a quartile of NLR was negatively associated with the mean value of lumbar BMD (p=0.040, p for trend=0.005) but not with the mean value of femur neck BMD. However, there were no significant associations among the PLR, the BMD of the lumbar and the femur neck. In conclusion, the quartile of NLR was negatively associated with the mean value of lumbar BMD in Korean postmenopausal patients.

Systemic immune-inflammation index acts as a novel diagnostic biomarker for postmenopausal osteoporosis and could predict the risk of osteoporotic fracture

Background

Postmenopausal osteoporosis (PMOP) is a bone metabolism disorder involving systematic inflammation activation. Blood routine examination is easily available in clinical practice and contains abundant information reflecting the systematic inflammation level. Thus, it is attractive to achieve early diagnosis of PMOP and predict osteoporotic fracture risk just based on the biomarkers in blood routine examination.

Methods

A multi‐centric prospective cohort study was designed and enrolled postmenopausal women from two independent institutions. All participants underwent the dual‐energy X‐ray absorptiometry (DEXA) scanning for diagnosing PMOP. Blood routine examination was conducted, and the key inflammatory biomarkers such as neutrophil‐to‐lymphocyte ratio (NLR) and systemic immune‐inflammation index (SII) were calculated. PMOP patients were followed up to observe osteoporotic fracture and identify the related risk predictors.

Results

A total of 92 participants out of 238 enrolled postmenopausal women were diagnosed with PMOP, with a prevalence of 38.66%. The main risk factors identified for PMOP included older age (OR = 2.06, 95% CI = 1.14‐3.72), longer menopause duration (OR = 3.14, 95% CI = 2.06‐4.79), higher NLR (OR = 2.11, 95% CI = 1.37‐3.25), and higher SII (OR = 3.02, 95% CI = 1.98‐4.61). Besides age and menopause duration, SII ≥834.89 was newly identified as a prominent risk factor for discriminating osteoporotic fracture risk in PMOP patients (HR = 3.66, 95% CI = 1.249‐10.71).

Conclusion

As an easy and economical biomarker calculated from blood routine examination, SII not only acts as a good risk predictor for PMOP diagnosis but also well discriminates the osteoporotic fracture risk, which deserves further investigation and application in clinical practice.

Platelet/lymphocyte ratio is an independent predictor for osteoporosis

Objectives:

To investigate the intercourse between the platelet/lymphocyte (P/L) and neutrophil/lymphocyte ratio (N/L), and vitamin D (Vit-D) levels in low bone mineral density (BMD) of women.

Methods:

Two hundred fifty-two postmenopausal female outpatients who were admitted to the obstetrics and gynecology and physical therapy clinics between July 2016 and December 2017 were retrospectively analyzed. The patients were grouped in relation to their T-score (normal [n=92], osteopenia [n=112], and PMO [n=48]). The serum levels of P/L, N/L, Vit-D, BMD and complete blood count of the patients were retrospectively examined.

Results:

The median P/L was significantly higher and Vit-D levels were significantly lower in the PMO group (130.75 [52.89-385] versus 123.05 [54-232.5], p=0.02 and 15.4 [4-34] versus 20.1 [4-47], p=0.003). While BMD and P/L were negatively correlated, a positive correlation between BMD and Vit-D was found. Vitamin D levels were negatively correlated with P/L (p<0.001) and N/L (p=0.04). Older age (≥65 years), Vit-D deficiency and P/L values >125.06 were found as independent prognostic factors for PMO in regression analysis.

Conclusion:

Higher P/L seems to be a quite simple marker to help predict postmenopausal PMO. As seen in our study, having low levels of Vit-D is crucial for PMO.

Identification of core genes and prediction of miRNAs associated with osteoporosis using a bioinformatics approach

Osteoporosis (OP) is an age-related disease, and osteoporotic fracture is one of the major causes of disability and mortality in elderly patients (>70 years old). As the pathogenesis and molecular mechanism of OP remain unclear, the identification of disease biomarkers is important for guiding research and providing therapeutic targets. In the present study, core genes and microRNAs (miRNAs) associated with OP were identified. Differentially expressed genes (DEGs) between human mesenchymal stem cell specimens from normal osseous tissues and OP tissues were detected using the GEO2R tool of the Gene Expression Omnibus database and Morpheus. Network topological parameters were determined using NetworkAnalyzer. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed using the Database for Annotation, Visualization and Integrated Discovery, and ClueGO. Cytoscape with the Search Tool for the Retrieval of Interacting Genes and Molecular Complex Detection plug-in was used to visualize protein-protein interactions (PPIs). Additionally, miRNA-gene regulatory modules were predicted using CyTargetLinker in order to guide future research. In total, 915 DEGs were identified, including 774 upregulated and 141 downregulated genes. Enriched GO terms and pathways were determined, including 'nervous system development', 'regulation of molecular function', 'glutamatergic synapse pathway' and 'pathways in cancer'. The node degrees of DEGs followed power-law distributions. A PPI network with 541 nodes and 1,431 edges was obtained. Overall, 3 important modules were identified from the PPI network. The following 10 genes were identified as core genes based on high degrees of connectivity: Albumin, PH domain leucine-rich repeat-containing protein phosphatase 2 (PHLPP2), DNA topoisomerase 2-α, kininogen 1 (KNG1), interleukin 2 (IL2), leucine-rich repeats and guanylate kinase domain containing, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit γ (PIK3CG), leptin, transferrin and RNA polymerase II subunit A (POLR2A). Additionally, 15 miRNA-target interactions were obtained using CyTargetLinker. Overall, 7 miRNAs co-regulated IL2, 3 regulated PHLPP2, 3 regulated KNG1, 1 regulated PIK3CG and 1 modulated POLR2A. These results indicate potential biomarkers in the pathogenesis of OP and therapeutic targets.

Step-up and step-down treatments for optimal asthma control in children and adolescents

OBJECTIVE

To review therapeutic options for stepwise management of pediatric asthma in the context of this population's unique needs such as potential effects of asthma, treatments, or both on growth and psychosocial development, and caregiver involvement.

DATA SOURCES AND STUDY SELECTION

We conducted PubMed searches to identify relevant articles then reviewed resultant articles, guidelines for asthma management in children, and articles from personal files.

RESULTS

Stepwise management of asthma, similar to adults, is recommended for children in current global and US guidelines. Treatment may be stepped up or stepped down temporarily or long-term based on response over time. Inhaled corticosteroids remain the recommended treatment for persistent childhood asthma and any potential small effects on growth are considered relatively minor compared with their benefit. Controller medication options for patients <18 years old are limited, especially for Global Initiative for Asthma Steps 2-5. The long-acting antimuscarinic antagonist tiotropium (Steps 4/5, patients aged ≥12 years) and in certain circumstances (Step 5), anti-immunoglobulin E (aged ≥6 years) and interleukin-5 antibodies (aged ≥12 years) are newer treatment options. Tiotropium is indicated in the United States and Europe for patients ≥6 years old. Stepping down treatment, which is recommended but infrequently practiced, can maintain symptom control and minimize adverse events while substantially reducing costs. Patient education and better monitoring remain important for self-management and optimum outcomes.

CONCLUSION

A need exists to target individual treatment goals for children with asthma by using step-up and step-down approaches to maximize treatment benefits and minimize potential adverse effects.

Evaluation of bone mineral density (BMD) and indicators of bone turnover in patients with hemophilia

A decrease in bone mass is observed in hemophilic patients. The aim of this study was to evaluate bone mineral density (BMD), parathyroid hormone (PTH), 25-hydroxy vitamin D (vitamin D), and a bone formation and resorption marker, procollagen type I N-terminal propeptide (PINP) and urinary N-terminal telopeptide (uNTX) respectively, in hemophilic patients and healthy controls. Laboratory parameters related to the pathogenesis of bone loss such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were also evaluated. Thirty-five men over 18 years of age, with severe hemophilia (A and B) and receiving secondary prophylaxis, were included in the study. The same number of age-, sex-, and ethnicity-matched healthy controls were evaluated. Anthropometric, biochemical, and hormonal parameters were determined in both groups. No significant difference in anthropometric parameters was found between the two groups. The BMD was low in 34% of hemophilic patients. Vitamin D, calcium, and free testosterone levels were significantly lower (p < 0.001, p = 0.011, p < 0.001, respectively), while PTH, PINP, and activated partial thromboplastin time (aPTT) levels were significantly higher (p < 0.014, p = 0.043, p < 0.001, respectively), in hemophilic patients compared to controls. There was no significant difference between the two groups in NLR, PLR, phosphorus, thyroid-stimulating hormone, and uNTX level. The reduction of bone mass in hemophilic patients may be evaluated using the markers of bone formation and resorption, enabling early detection and timely treatment.

Long-Term Intake of Green Tea Extract Causes Mal-Conformation of Trabecular Bone Microarchitecture in Growing Rats

The purpose of this study was to examine the effects of green tea extract (GTE) intake on bone structural and physiological properties, such as bone mass, trabecular bone microarchitecture, cortical bone geometry, and bone mechanical strength, in growing rats. Four-week-old male Wistar rats were divided into the following four groups: standard diet feeding for 85 days (S-CON) or 170 days (L-CON), and GTE diet feeding for 85 days (S-GTE) or 170 days (L-GTE). At the end of the experiment, in addition to measurement of circulating bone formation/resorption markers, bone mass, trabecular bone microarchitecture, and cortical bone geometry were analyzed in the left femur, and bone mechanical strength of the right femur was measured. There was no difference in all bone parameters between the S-CON and S-GTE groups. On the other hand, the L-GTE group showed the decrease in some trabecular bone mass/microarchitecture parameters and no change in cortical bone mass/geometry parameters compared with the L-CON group, and consequently the reduction in bone weight corrected by body weight. There was no difference in bone formation/resorption markers and bone mechanical strength between the S-CON and S-GTE groups and also between the L-CON and L-GTE groups. However, serum leptin levels were significantly lower in the L-GTE group than in the L-CON group. Thus, the long-term GTE intake had negative effects on bone, especially trabecular bone loss and microarchitecture mal-conformation, in growing rats.