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Wang S, Xie J, Zhai D, Wang Z, Qi H, Deng M. Association between ultra-processed food and osteoporosis: a cross-sectional study based on the NHANES database. Nutr Metab (Lond) 2024; 21:69. [PMID: 39180053 PMCID: PMC11342598 DOI: 10.1186/s12986-024-00843-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 08/08/2024] [Indexed: 08/26/2024] Open
Abstract
AIM Nutritional characteristics and additives in ultra-processed foods (UPF) are directly related to bone health. Physical activity as a modifiable lifestyle intervention also plays a possible role in bone mineral density (BMD), but effect of physical activity on association between UPF and osteoporosis is not fully understood. Herein, this study aims to explore the association of UPF with osteoporosis, and assess the potential mediating effects of some related factors on this pathway. METHODS Data of adults were extracted from the National Health and Nutrition Examination Survey (NHANES) database in this cross-sectional study. Associations of unprocessed/minimally processed food (MPF), processed culinary ingredient (PCI), processed foods (PF) and UPF with femur neck BMD, total femur BMD and osteoporosis were investigated using linear regression and weighted univariate and multivariate logistic regression analyses respectively. Subgroup analyses of age, gender, physical activity, poverty income ratio (PIR), hypertension, diabetes mellitus (DM), cardiovascular disease (CVD), and dyslipidemia were performed. The potential mediating and interaction effects of physical activity and related factors on association of UPF with osteoporosis were also assessed. The evaluation indexes were β, odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Among 10,678 eligible persons, 454 had osteoporosis. After adjusting for covariates, elevated UPF intake was associated with decreased demur neck and total femur BMD (β=-0.003). A higher UPF intake level (> 57.51%) was linked to higher odds of osteoporosis (OR = 1.789). These relationships were also significant in different subgroups. Physical activity had a potential mediating effect on the association between UPF and osteoporosis (OR = 0.47, mediating proportion = 21.54%). CONCLUSION UPF intake levels were associated with BMD and osteoporosis. Physical activity had an interaction effect with UPF, and had a potential mediating effect on relationship between UPF and osteoporosis.
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Affiliation(s)
- Songfeng Wang
- Department of Oncology, The First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, P.R. China
| | - Jiasi Xie
- Department of Oncology, The First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, P.R. China
| | - Dandan Zhai
- Department of Oncology, The First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, P.R. China
| | - Zhou Wang
- Department of Oncology, The First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, P.R. China
| | - Huixuan Qi
- Department of Oncology, The First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, P.R. China
| | - Muhong Deng
- Department of Oncology, The First Medical Center of Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Medical School, No. 28 Fuxing Road, Haidian District, Beijing, 100853, P.R. China.
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Zhou Q, Chen X, Chen Q, Hao L. Independent and combined associations of dietary antioxidant intake with bone mineral density and risk of osteoporosis among elderly population in United States. J Orthop Sci 2024; 29:1064-1072. [PMID: 37537112 DOI: 10.1016/j.jos.2023.07.014] [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: 01/30/2023] [Revised: 07/14/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The influence of dietary antioxidant intake on the occurrence and progression of osteoporosis may be significant. However, to date, evidence on the link between combined effect of dietary antioxidants on bone mineral density (BMD) level and risk of osteoporosis is limited. We aimed to assess the independent and combined association of dietary antioxidant intake with BMD level and risk of osteoporosis among elderly population in United States through analysis of data in the National Health and Nutrition Examination Survey. METHODS The dietary antioxidant intake was assessed based on six antioxidants, including vitamin A, vitamin C, vitamin E, zinc, selenium, and total carotenoid. A composite dietary antioxidant index (CDAI) was used to evaluate the combined exposure of dietary antioxidant intake. RESULTS A total of 5618 participants were included. Higher dietary vitamin A, vitamin C, vitamin E, zinc, selenium, and total carotenoid, were positively associated with BMD level. Compared with participants in the first quartile, those in the higher quartile of vitamin E (Q4: OR 0.652; 95% CI 0.463-0.918), zinc (Q4: OR 0.581; 95% CI 0.408-0.826), and selenium (Q3: OR 0.673; 95% CI 0.503-0.899) were associated with decreased risk of overall osteoporosis. Furthermore, compared to those in the first quartile, participants in the highest quartile of CDAI were associated with increased total femur (β 0.019; 95% CI 0.007-0.032), femur neck (β 0.020; 95% CI 0.009-0.032), trochanter (β 0.012; 95% CI 0.001-0.023), and intertrochanter BMD level (β 0.022; 95% CI 0.007-0.037); participants in the highest quartile of CDAI were associated with decreased risk of overall osteoporosis (OR 0.536; 95% CI 0.376-0.763). Furthermore, the associations of CDAI with the BMD level and osteoporosis risk were more significant among female participants. CONCLUSION Our study provides evidence that a combination of dietary antioxidants intake was associated increased BMD level and decreased osteoporosis risk.
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Affiliation(s)
- Qing Zhou
- Central Laboratory, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Xi Chen
- Central Laboratory, The People's Hospital of Baoan Shenzhen, The Second Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Qiuyan Chen
- Science and Education Department, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, China
| | - Lu Hao
- Science and Education Department, Shenzhen Baoan Shiyan People's Hospital, Shenzhen, China.
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Wei R, Zhang Y, Huang M, Piao H, Gu Z, Zhu C. Associations between bone mineral density and abdominal aortic calcification: Results of a nationwide survey. Nutr Metab Cardiovasc Dis 2024; 34:1488-1495. [PMID: 38494366 DOI: 10.1016/j.numecd.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 11/21/2023] [Accepted: 01/29/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND AIMS Vascular calcification has been linked to bone mineral density (BMD). This study aimed to investigate the association between BMD and abdominal aortic calcification (AAC). METHODS AND RESULTS Data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) were utilized. Participants lacking BMD and AAC score data were excluded. BMD at the femoral neck was measured using dual-energy X-ray absorptiometry. AAC scores were assessed using the Kauppila scoring system, with AAC defined as a score greater than zero, and severe AAC defined as a score greater than six. Weighted multivariable regression analysis and subgroup analysis were conducted to examine the independent relationship between BMD and AAC score, AAC, and severe AAC. A total of 2965 participants were included. After adjusting for multiple covariates, BMD showed a negative association with higher AAC scores (β = -0.17, 95% CI -0.29, -0.05, p = 0.0066). The odds of having AAC and severe AAC decreased by 9% and 16%, respectively, for every one-unit increase in BMD (AAC: odds ratio [OR] = 0.91, 95% CI 0.82, 1.00, p = 0.0431; severe AAC: OR = 0.84, 95% CI 0.71, 0.99, p = 0.0334). CONCLUSION Low BMD is associated with higher AAC scores and an increased risk of AAC and severe AAC. Considering the detrimental impact of low BMD on cardiovascular health, individuals with AAC should be evaluated for osteopenia and osteoporosis in clinical settings.
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Affiliation(s)
- Ran Wei
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China
| | - Yixin Zhang
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China
| | - Maoxun Huang
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China
| | - Hulin Piao
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China
| | - Zhaoxuan Gu
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China
| | - Cuilin Zhu
- Cardiovascular Surgery Department of the Second Hospital of Jilin University, Jilin Province, China.
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Yao Z, Ayoub A, Srinivasan V, Wu J, Tang C, Duan R, Milosavljevic A, Ebetino F, Frontier A, Boyce B. Hydroxychloroquine and a low activity bisphosphonate conjugate prevent and reverse ovariectomy-induced bone loss in mice through dual antiresorptive and anabolic effects. RESEARCH SQUARE 2024:rs.3.rs-4237258. [PMID: 38746138 PMCID: PMC11092802 DOI: 10.21203/rs.3.rs-4237258/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Osteoporosis is incurable because there are no dual antiresorptive and anabolic therapeutic agents that can be administered long-term. The most widely used antiresorptive agents, bisphosphonates (BPs), also inhibit bone formation and thus have limited effect in preventing osteoporotic fracture. Hydroxychloroquine (HCQ), which is used to treat rheumatoid arthritis, prevents the lysosomal degradation of TNF receptor-associated factor 3 (TRAF3), an NF-κB adaptor protein that limits bone resorption and maintains bone formation. We attempted to covalently link HCQ to a hydroxyalklyl BP (HABP) with anticipated low antiresorptive activity, to target delivery of HCQ to bone to test if this targeting increases its efficacy to prevent TRAF3 degradation in the bone microenvironment and thus reduce bone resorption and increase bone formation, while reducing its systemic side effects. Unexpectedly, HABP-HCQ was found to exist as a salt in aqueous solution, composed of a protonated HCQ cation and a deprotonated HABP anion. Nevertheless, it inhibited osteoclastogenesis, stimulated osteoblast differentiation, and increased TRAF3 protein levels in vitro. HABP-HCQ significantly inhibited both osteoclast formation and bone marrow fibrosis in mice given multiple daily PTH injections. In contrast, HCQ inhibited fibrosis, but not osteoclast formation, while the HABP alone inhibited osteoclast formation, but not fibrosis, in the mice. HABP-HCQ, but not HCQ, prevented trabecular bone loss following ovariectomy in mice and, importantly, increased bone volume in ovariectomized mice with established bone loss because HABP-HCQ increased bone formation and decreased bone resorption parameters simultaneously. In contrast, HCQ increased bone formation, but did not decrease bone resorption parameters, while HABP also restored the bone lost in ovariectomized mice, but it inhibited parameters of both bone resorption and formation. Our findings suggest that the combination of HABP and HCQ could have dual antiresorptive and anabolic effects to prevent and treat osteoporosis.
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Affiliation(s)
| | | | | | - Jun Wu
- University of Rochester Medical Center
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Xu R, Chen Y, Yao Z, Wu W, Cui J, Wang R, Diao Y, Jin C, Hong Z, Li X. Application of machine learning algorithms to identify people with low bone density. Front Public Health 2024; 12:1347219. [PMID: 38726233 PMCID: PMC11080984 DOI: 10.3389/fpubh.2024.1347219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/29/2024] [Indexed: 05/12/2024] Open
Abstract
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.
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Affiliation(s)
- Rongxuan Xu
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Yongxing Chen
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Zhihan Yao
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Wei Wu
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Jiaxue Cui
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Ruiqi Wang
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Yizhuo Diao
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Chenxin Jin
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
| | - Zhijun Hong
- The Health Management Center, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Xiaofeng Li
- Department of Epidemiology and Health Statistics, Dalian Medical University, Dalian, China
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Roberts T, Sambhariya V, Ly C, Ho A, Pientka WF. The Effect of Age and Sex on Early Postoperative Outcomes after Surgical Treatment of Distal Radius Fractures. J Hand Surg Asian Pac Vol 2024; 29:125-133. [PMID: 38494162 DOI: 10.1142/s2424835524500140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Background: We aim to evaluate the impact of advanced age and sex on postoperative complications and radiographic outcomes after open reduction with internal fixation of distal radius fractures (DRF). Methods: We conducted a retrospective chart review, including all patients who underwent open reduction with internal fixation of a DRF between 2012 and 2018 at a single level 1 trauma centre. We recorded patient age, sex, fracture classification (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA]), time from injury to surgical date, surgical duration, diabetes status, tobacco use, illicit drug use, history of osteoporosis, use of adjuvants, fixation type, postoperative radiographic restoration of normal parameters and early complications including loss of reduction within 30 days postoperatively. Advanced age was defined as age greater than 60 years. Results: A total of 521 patients underwent operative treatment - 264 males and 257 females. Males were twice as likely (23.5% vs. 10.1%; p < 0.0001) to sustain a type C3 fracture and be treated with a wrist spanning plate (5.3% vs. 0; p < 0.0001). A larger percentage of elderly patients undergoing operative treatment of DRF were female (20.2% vs. 5.7%; p < 0.0001) and females were more likely to carry a pre-injury diagnosis of osteoporosis (9.3% vs. 0%; p < 0.0001). And 100% of the elderly patients received were treated with a volar plate. The overall early loss of reduction was 7.5%. The overall complication rate was 8.2%. No differences in early postoperative complications were identified between sexes or age groups. Neither female sex nor advanced age was found to have increased risk of postoperative complications or early loss of reduction. Similar postoperative radiographic parameter measurements were obtained across groups as well. Conclusions: Our results support the idea that operative treatment of unstable DRF in elderly patients and women is a reasonable treatment option without significant increases in early postoperative complications. Level of Evidence: Level III (Therapeutic III).
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Affiliation(s)
- Tyler Roberts
- Department of Orthopaedic Surgery, JPS Health Network, Fort Worth, TX, USA
| | - Varun Sambhariya
- Department of Orthopaedic Surgery, JPS Health Network, Fort Worth, TX, USA
| | - Colin Ly
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Alison Ho
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - William F Pientka
- Department of Orthopaedic Surgery, JPS Health Network, Fort Worth, TX, USA
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Xuan X, Sun R, Peng C, Liu L, Huang T, Huang C. The nonlinear association between triglyceride glucose-body mass index and femoral neck BMD in nondiabetic elderly men: NHANES 2005-March 2020. PLoS One 2024; 19:e0296935. [PMID: 38261591 PMCID: PMC10805317 DOI: 10.1371/journal.pone.0296935] [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: 11/08/2022] [Accepted: 12/20/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The triglyceride glucose-body mass index (TyG-BMI) has been considered a surrogate marker for assessing insulin resistance. We aimed to correlate the TyG-BMI, triglyceride glucose combined with body mass index, with femoral neck bone mineral density (FN BMD) in non-diabetic elderly men. METHODS Using data from the National Health and Nutrition Examination Survey (NHANES) database, totally, 1182 eligible men aged ≥ 50 years without diabetes were included in the current study. Smoothed curves were obtained by a two-piecewise linear regression model and the threshold effects were explored by using a smoothing function. RESULTS TyG-BMI was positive related with and FN BMD with or without adjustment for confounders. However, no typical dose-dependent positive association between TyG-BMI and FN BMD was observed across the TyG-BMI tertiles, indicating a non-linear association. Further analysis by the weighted two-piecewise linear regression model and recursive algorithm suggested that per SD increase in TyG-BMI increased FN BMD by 0.266 gm/cm2 when TyG-BMI lower than 168.20. However, when TyG-BMI is higher than 168.20, FN BMD only increased 0.046 gm/cm2 for per SD increase of TyG-BMI after fully adjustment (OR = 11.258, 95%CI: 6.034, 16.481). Moreover, subgroup analyses showed that higher TyG-BMI levels were related to elevated FN BMD in all groups, suggesting the consistency of the positive association within these stratas. CONCLUSIONS This study demonstrated that TyG-BMI is positively associated with FN BMD in a nonlinear fashion among elderly men without diabetes, which may be a reliable marker for the early identification of individuals with lower FN BMD.
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Affiliation(s)
- Xiuping Xuan
- Department of Endocrinology, The First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, Guangxi, China
| | - Rong Sun
- Department of Ophthalmology, Taihe Hospital, Hubei University of Medical, Shiyan, 442000, Hubei, China
| | - Caibi Peng
- Bishan Maternity and Child Hospital of Chongqing, Bishan, Chongqing, 402760, China
| | - Lijuan Liu
- Department of Endocrinology, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Bishan, Chongqing, 402760, China
| | - Tiantian Huang
- Department of Endocrinology, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Bishan, Chongqing, 402760, China
| | - Chenghu Huang
- Department of Endocrinology, Bishan Hospital of Chongqing, Bishan Hospital of Chongqing Medical University, Bishan, Chongqing, 402760, China
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Vásquez E, Alam MT, Murillo R. Race and ethnic differences in physical activity, osteopenia, and osteoporosis: results from NHANES 2009-2010, 2013-2014, 2017-2018. Arch Osteoporos 2023; 19:7. [PMID: 38150070 DOI: 10.1007/s11657-023-01356-1] [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: 04/18/2023] [Accepted: 11/19/2023] [Indexed: 12/28/2023]
Abstract
This study aimed to determine current physical activity trends association with bone density in a racial and ethnically diverse sample of older adults. We found that those engaged in no and some physical activity had lower femoral BMD when compared to those that met the physical activity recommendation. PURPOSE Most older adults do not engage in the recommended levels of physical activity to improve health, and there are racial and ethnic differences in physical activity participation. This study aims to evaluate whether meeting the physical activity recommendation is related to osteopenia and osteoporosis in a racially and ethnically diverse sample of older adults. METHODS Femoral neck bone mineral density (BMD) data from the National Health and Nutrition Examination Survey (NHANES 2009-2010, 2013-2014, 2017-2018) was obtained from 5252adults 60-80 years old. Self-reported physical activity was categorized into met recommendation, some physical activity, and no physical activity. We used linear regression models to examine the association between physical activity and BMD for each race and ethnic group adjusting for sociodemographics and other selected variables. RESULTS Non-Latino Blacks (NLB) and Latinos reported the lowest prevalence of meeting the physical activity recommendation, compared with Non-Latino Whites (NLW) (40.0%, 44.0%, and 51.4%, respectively; p < 0.0001). Further, NLB and Latinos had a lower prevalence of osteoporosis when compared to NLW (5.4%, 7.3%, and 9.1% respectively; p < 0.0001). There was a 0.03 g/cm2 difference in BMD between those who met the physical activity recommendation when compared to the no physical activity group; however, this decreased after adjusting for selected covariates. CONCLUSION Considering the prevalence and burden of osteopenia and osteoporosis, and projected increases in the racial and ethnic diversity of the older population, more research is needed to further understand the association between meeting the physical activity recommendation and bone health among racial and ethnic diverse older adults.
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Affiliation(s)
- Elizabeth Vásquez
- School of Public Health, Department of Epidemiology and Biostatistics, University at Albany State University of New York, One University Place, Room 125, Rensselaer, NY, 12144, USA.
| | | | - Rosenda Murillo
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
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Maldonado LY, Bosques L, Cromer SJ, Azar SS, Yu EW, Burnett-Bowie SAM. Racial and Ethnic Disparities in Metabolic Bone Disease. Endocrinol Metab Clin North Am 2023; 52:629-641. [PMID: 37865478 DOI: 10.1016/j.ecl.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Racial and ethnic disparities exist in the prevalence and management of osteoporosis, metastatic cancer, and sickle cell disease. Despite being the most common metabolic bone disease, osteoporosis remains underscreened and undertreated among Black women. Skeletal-related events in metastatic cancer include bone pain, pathologic fractures, and spinal cord compression. Disparities in screening for and treating skeletal-related events disproportionately affect Black patients. Metabolic bone disease contributes significantly to morbidity in sickle cell disease; however, clinical guidelines for screening and treatment do not currently exist. Clinical care recommendations are provided to raise awareness, close health care gaps, and guide future research efforts.
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Affiliation(s)
- Lauren Y Maldonado
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bigelow 730, Boston, MA 02114, USA; Department of Pediatrics, MassGeneral Hospital for Children and Harvard Medical School, 175 Cambridge Street, Boston, MA 02114, USA
| | - Linette Bosques
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bigelow 730, Boston, MA 02114, USA
| | - Sara J Cromer
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA
| | - Sharl S Azar
- Hematology and Medical Oncology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Yawkey 9-536, Boston, MA 02114, USA
| | - Elaine W Yu
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA
| | - Sherri-Ann M Burnett-Bowie
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA.
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Barik S, Kumar V. Male Osteoporosis and Frailty. Indian J Orthop 2023; 57:237-244. [PMID: 38107814 PMCID: PMC10721747 DOI: 10.1007/s43465-023-01027-w] [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: 08/29/2023] [Accepted: 10/12/2023] [Indexed: 12/19/2023]
Abstract
It is estimated that 50% women and 20% of men over the age of 50 years will have an osteoporosis-related fracture in their remaining life. Although, Osteoporosis is generally thought to be a disease affecting females, more than a third of hip fractures occur in males due to reduced bone strength. Along with Osteoporosis, the other pathological process which occurs simultaneously is Sarcopenia. It is defined as age-related atrophy of skeletal muscle mass that reduces muscle strength, function, and quality of life. This chapter discusses the various aspects of the disease process in the males including its classification, clinical features, diagnosis and treatment.
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Affiliation(s)
- Sitanshu Barik
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
| | - Vishal Kumar
- Department of Orthopedics, All India Institute of Medical Sciences, Deoghar, India
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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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Sun X, Du T. Trends in weight change patterns across life course among US adults, 1988-2018: population-based study. BMC Public Health 2023; 23:2168. [PMID: 37932673 PMCID: PMC10626664 DOI: 10.1186/s12889-023-17137-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND To examine trends in weight change patterns from young adulthood through midlife to late adulthood and their sex and racial/ethnic disparities among US adults from 1988 to 2018. METHODS A total of 48,969 participants from the National Health and Nutrition Examination Survey 1988-1994 and 2001-2018 were included. RESULTS The age-adjusted prevalence of stable non-obesity between young adulthood and midlife declined significantly from 84.1% (95 CI, 82.9-85.3%) in 1988-1994 to 68.7% (67.1-70.2%) in 2013-2018, and between midlife and late adulthood from 71.2% (69.2-73.1%) to 52.4% (50.5-54.2%). The magnitude of increase in the prevalence of weight gain from young adulthood to midlife (from 10.8% [9.9-11.6%] in 1988-1994 to 21.2% [20-22.3%] in 2013-2018; P < 0.001 for trend) was greater than that from midlife to late adulthood (from 14.1% [12.9-15.3%] to 17.2% [16.2-18.1%]; P = 0.002 for trend). The magnitude of increase in the prevalence of stable obesity from young adulthood to midlife (from 3.9% [3.1-4.8%] in 1988-1994 to 9.2% [8.2-10.3%] in 2013-2018; P < 0.001 for trend) was smaller than that from midlife to late adulthood (from 11.2% [10.1-12.2%] to 24.8% [23.3-26.3%]; P < 0.001 for trend). The declining trends in the prevalence of stable non-obesity and increasing trends in the prevalence of weight gain and stable obesity from young adulthood through midlife to late adulthood were also observed for all sex and race/ethnicity subgroups. The magnitude of decrease in the prevalence of stable non-obesity, and the magnitude of increase in the prevalence of weight gain from young adulthood through midlife to late adulthood were greater in men than in women (all P for interaction < 0.01). Weight gain patterns for those aged ≥ 65 years were substantially different from the younger age groups. CONCLUSIONS More young people born in later years are encountering obesity and accumulate greater obesity exposure across their lives than young people born in earlier years.
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Affiliation(s)
- Xingxing Sun
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Tingting Du
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, Hubei, China.
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Ilic I, Ristic B, Stojadinovic I, Ilic M. Epidemiology of Hip Fractures Due to Falls. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1528. [PMID: 37763647 PMCID: PMC10533163 DOI: 10.3390/medicina59091528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The epidemiological pattern of the hip fracture burden attributable to falls in Central European countries is still insufficiently known. The aim of this study was to assess the regional and national trends of hip fractures due to falls in Central Europe from 1990 to 2019. Materials and Methods: Using the Global Burden of Disease (GBD) 2019 study, this descriptive epidemiological study presents trends in incidence of and Years Lived with Disability (YLDs) from hip fractures due to falls in the region of Central Europe. All estimates (age- and sex-specific rates, and age-standardized rates) were expressed per 100,000. A joinpoint regression analysis was used to assess trends: the average annual percent change (AAPC) with a corresponding 95% confidence interval (95% CI) was calculated. Results: Among all new cases of hip fracture in the population as a whole in Central Europe in 2019, 3.9% in males and 7.0% in females were attributable to falls, while the share of hip fractures due to falls in the population aged 70 and over was 16.9% in males and 20.0% in females. About 400,000 new cases of hip fracture due to falls occurred in the Central European region in 2019 (220,000 among males and 160,000 among females), resulting in 55,000 YLDs (32,000 in females and 22,000 in males). About one-third of all new cases (59,326 in males and 72,790 in females) and YLDs (8585 in males, and 10,622 in females) of hip fractures due to falls were recorded in Poland. From 1990 to 2019, the age-standardized incidence rates of hip fracture due to falls showed a decreasing tendency in females (AAPC = -1.1%), and an increasing tendency in males (AAPC = 0.1%). Both in males and females, YLDs rates of hip fracture due to falls in the Central European region decreased (AAPC = -1.6% and AAPC = -2.4%, respectively). Conclusions: Hip fracture due to falls represents an important health issue in the Central European region, although incidences and YLDs declined in the most recent decades. However, further efforts to reduce the burden of hip fractures attributed to falls are needed.
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Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Branko Ristic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Traumatology, Clinic for Orthopedics and Traumatology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Ivan Stojadinovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
- Department of Spinal Surgery, Clinic for Orthopedics and Traumatology, University Clinical Center Kragujevac, 34000 Kragujevac, Serbia
| | - Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia
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Bao Y, Xu Y, Li Z, Wu Q. Racial and ethnic difference in the risk of fractures in the United States: a systematic review and meta-analysis. Sci Rep 2023; 13:9481. [PMID: 37301857 PMCID: PMC10257681 DOI: 10.1038/s41598-023-32776-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 04/02/2023] [Indexed: 06/12/2023] Open
Abstract
This systematic review and meta-analysis examined the association between race and ethnicity and fracture risk in the United States. We identified relevant studies by searching PubMed and EMBASE for studies published from the databases' inception date to December 23, 2022. Only observational studies conducted in the US population that reported the effect size of racial-ethnic minority groups versus white people were included. Two investigators independently conducted literature searches, study selection, risk of bias assessment, and data abstraction; discrepancies were resolved by consensus or consultation of a third investigator. Twenty-five studies met the inclusion criteria, and the random-effects model was used to calculate the pooled effect size due to heterogeneity between the studies. Using white people as the reference group, we found that people of other races and ethnic groups had a significantly lower fracture risk. In Black people, the pooled relative risk (RR) was 0.46 (95% confidence interval (CI), 0.43-0.48, p < 0.0001). In Hispanics, the pooled RR was 0.66 (95% CI, 0.55-0.79, p < 0.0001). In Asian Americans, the pooled RR was 0.55 (95% CI, 0.45-0.66, p < 0.0001). In American Indians, the pooled RR was 0.80 (95% CI, 0.41-1.58, p = 0.3436). Subgroup analysis by sex in Black people revealed the strength of association was greater in men (RR = 0.57, 95% CI = 0.51-0.63, p < 0.0001) than in women (RR = 0.43, 95% CI = 0.39-0.47, p < 0.0001). Our findings suggest that people of other races and ethnic groups have a lower fracture risk than white people.
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Affiliation(s)
- Yueyang Bao
- Nevada Institute of Personalized Medicine, College of Sciences, University of Nevada, Las Vegas, NV, USA
- Department of Biology, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Yingke Xu
- Nevada Institute of Personalized Medicine, College of Sciences, University of Nevada, Las Vegas, NV, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Zhuowei Li
- Nevada Institute of Personalized Medicine, College of Sciences, University of Nevada, Las Vegas, NV, USA
| | - Qing Wu
- Department of Biomedical Informatics, Center for Biostatistics, The Ohio State University, Columbus, OH, USA.
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15
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Agarwal S, Germosen C, Bucovsky M, Colon I, Kil N, Walker M. Skeletal Microstructure in Caribbean Hispanic Women. JBMR Plus 2023; 7:e10725. [PMID: 37197315 PMCID: PMC10184017 DOI: 10.1002/jbm4.10725] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Hispanic individuals are underrepresented in skeletal research. Bone mineral density (BMD) and fracture data are conflicting. We investigated skeletal health in elderly Caribbean Hispanic (HW), non-Hispanic white (NHW), and non-Hispanic black (NHB) women in a population-based study in New York City. We utilized high-resolution peripheral quantitative CT (HRpQCT), dual-energy X-ray absorptiometry (DXA), and finite element analysis (FEA). Of 442, 48.4% were HW, 21.3% NHW, and 30.3% NHB. Adjusted analyses are shown. Compared to NHW, HW had 8.5% (p < 0.01) lower spine areal BMD (aBMD) and 5.1% lower trabecular bone score (TBS). The frequency of morphometric vertebral fractures did not differ between HW and NHW. By HRpQCT, HW had 2.9% higher cortical (Ct) volumetric BMD (vBMD), 7.9% greater Ct area (Ct.Ar) and 9.4% greater Ct thickness (Ct.Th) at the radius compared to NHW. Results were similar at the tibia but trabecular microstructure tended to be worse. Ultimately, failure load (FL) did not differ between HW and NHW at either site. aBMD was 3.8% to 11.1% lower at the spine, femoral neck, and radius in HW compared to NHB (all p < 0.001) and vertebral fractures were twice as common. Compared to NHB, HW had 7.7% to 10.3% lower Ct.Ar at both the radius and tibia as well as 8.4% lower total vBMD, 6.3% lower trabecular number, and 10.3% lower Ct.Th at the tibia associated with 18.2% and 12.5% lower FL at both sites, respectively. In conclusion, HW had lower spine aBMD and TBS versus NHW women, whereas microstructural differences at the radius and tibia were small and not associated with differences in FL. In contrast, HW had lower aBMD, as well as deteriorated radial and tibial microstructure associated with worse FL compared to NHB women. Our results provide insight into racial/ethnic differences in skeletal health, adding to data that may be used to improve osteoporosis screening and treatment in HW. © 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)
- Sanchita Agarwal
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Carmen Germosen
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Mariana Bucovsky
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Ivelisse Colon
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Nayoung Kil
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
| | - Marcella Walker
- Division of EndocrinologyColumbia University Irving Medical CenterNew YorkNYUSA
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Zhuo M, Chen Z, Zhong ML, Lei F, Qin JJ, Liu S, Liu YM, Sun T, Zhang XJ, Zhu L, Cai J, Ye JM, Yang E. Association of insulin resistance with bone mineral density in a nationwide health check-up population in China. Bone 2023; 170:116703. [PMID: 36781092 DOI: 10.1016/j.bone.2023.116703] [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: 05/13/2022] [Revised: 11/23/2022] [Accepted: 02/08/2023] [Indexed: 02/13/2023]
Abstract
INTRODUCTION Insulin resistance (IR) is closely associated with cardio-metabolic diseases. However, the impact of IR on bone mass remains obscure. The present study is to evaluate the association between the triglyceride-glucose (TyG) indicated IR and bone mass in a nationwide health check-up population in China. METHODS We conducted a retrospective cross-sectional study including 788,247 participants and a longitudinal cohort study in 8770 participants who had repeated measurements of TyG index and bone mass in at least a 2-year follow-up period. The restricted cubic splines and logistic models were used to analyze the association between IR and bone mass in the cross-sectional study. The Cox model was applied to evaluate the relationship between baseline IR and the subsequent incidence of low bone mass and osteoporosis in the longitudinal study. RESULTS In the cross-sectional study, the TyG index had positive correlations with low bone mass, osteoporosis, or both after adjusting for confounding factors (all P < 0.001). In the longitudinal cohort study, the baseline TyG index was significantly associated with the incidence of low bone mass, osteoporosis, or both during the follow-up period, with hazard ratios (HRs) of 1.56 (95 % confidence interval [CI]: 1.25, 1.93, P < 0.05), 1.66 (95%CI: 1.06, 2.59, P < 0.05), and 1.55 (95%CI: 1.27, 1.88, P < 0.05) after adjusting for confounding factors, respectively. CONCLUSIONS These results suggest that IR indicated by TyG is significantly associated with an increased risk of low bone mass and osteoporosis. Therefore, bone mass monitoring and early prevention strategies may be needed in individuals with IR to prevent the occurrence of low bone mass and osteoporosis.
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Affiliation(s)
- Ming Zhuo
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Ze Chen
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Mao-Lin Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Fang Lei
- Institute of Model Animal, Wuhan University, Wuhan, China; School of Basic Medical Science, Wuhan University, Wuhan, China
| | - Juan-Juan Qin
- Institute of Model Animal, Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shuhua Liu
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Ye-Mao Liu
- Institute of Model Animal, Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tao Sun
- Institute of Model Animal, Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiao-Jing Zhang
- Institute of Model Animal, Wuhan University, Wuhan, China; School of Basic Medical Science, Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Lihua Zhu
- Institute of Model Animal, Wuhan University, Wuhan, China; Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jingjing Cai
- Institute of Model Animal, Wuhan University, Wuhan, China; Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Jun-Ming Ye
- Department of Anesthesiology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
| | - Erping Yang
- Department of Orthopedic, Huanggang Central Hospital of Yangtze University, Huanggang, China.
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17
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Hassanabadi N, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D, Morin SN. Variation in bone mineral density and fractures over 20 years among Canadians: a comparison of the Canadian Multicenter Osteoporosis Study and the Canadian Longitudinal Study on Aging. Osteoporos Int 2023; 34:357-367. [PMID: 36449036 PMCID: PMC9852141 DOI: 10.1007/s00198-022-06623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
UNLABELLED International variations in osteoporosis and fracture rates have been reported, with temporal trends differing between populations. We observed higher BMD and lower fracture prevalence in a recently recruited cohort compared to that of a cohort recruited 20 years ago, even after adjusting for multiple covariates. PURPOSE We explored sex-specific differences in femoral neck bone mineral density (FN-BMD) and in prevalent major osteoporotic fractures (MOF) using two Canadian cohorts recruited 20 years apart. METHODS We included men and women aged 50-85 years from the Canadian Multicentre Osteoporosis Study (CaMos, N = 6,479; 1995-1997) and the Canadian Longitudinal Study on Aging (CLSA, N = 19,534; 2012-2015). We created regression models to compare FN-BMD and fracture risk between cohorts, adjusting for important covariates. Among participants with prevalent MOF, we compared anti-osteoporosis medication use. RESULTS Mean (SD) age in CaMos (65.4 years [8.6]) was higher than in CLSA (63.8 years [9.1]). CaMos participants had lower mean body mass index and higher prevalence of smoking (p < 0.001). Adjusted linear regression models (estimates [95%CI]) demonstrated lower FN-BMD in CaMos women (- 0.017 g/cm2 [- 0.021; - 0.014]) and men (- 0.006 g/cm2 [- 0.011; 0.000]), while adjusted odds ratios (95%CI) for prevalent MOF were higher in CaMos women (1.99 [1.71; 2.30]) and men (2.33 [1.82; 3.00]) compared to CLSA. In women with prevalent MOF, menopausal hormone therapy use was similar in both cohorts (43.3% vs 37.9%, p = 0.076), but supplements (32.0% vs 48.3%, p < 0.001) and bisphosphonate use (5.8% vs 17.3%, p < 0.001) were lower in CaMos. The proportion of men with MOF who received bisphosphonates was below 10% in both cohorts. CONCLUSION Higher BMD and lower fracture prevalence were noted in the more recently recruited CLSA cohort compared to CaMos, even after adjusting for multiple covariates. We noted an increase in bisphosphonate use in the recent cohort, but it remained very low in men.
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Affiliation(s)
- Nazila Hassanabadi
- Department of Medicine, McGill University, Montreal, 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
| | | | - Angela M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Elham Rahme
- Department of Medicine, McGill University, Montreal, 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
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - David Goltzman
- Department of Medicine, McGill University, Montreal, 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
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, 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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Kukafka R, Eysenbach G, Kim H, Lee S, Kong S, Kim JW, Choi J. Interpretable Deep-Learning Approaches for Osteoporosis Risk Screening and Individualized Feature Analysis Using Large Population-Based Data: Model Development and Performance Evaluation. J Med Internet Res 2023; 25:e40179. [PMID: 36482780 PMCID: PMC9883743 DOI: 10.2196/40179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/16/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Osteoporosis is one of the diseases that requires early screening and detection for its management. Common clinical tools and machine-learning (ML) models for screening osteoporosis have been developed, but they show limitations such as low accuracy. Moreover, these methods are confined to limited risk factors and lack individualized explanation. OBJECTIVE The aim of this study was to develop an interpretable deep-learning (DL) model for osteoporosis risk screening with clinical features. Clinical interpretation with individual explanations of feature contributions is provided using an explainable artificial intelligence (XAI) technique. METHODS We used two separate data sets: the National Health and Nutrition Examination Survey data sets from the United States (NHANES) and South Korea (KNHANES) with 8274 and 8680 respondents, respectively. The study population was classified according to the T-score of bone mineral density at the femoral neck or total femur. A DL model for osteoporosis diagnosis was trained on the data sets and significant risk factors were investigated with local interpretable model-agnostic explanations (LIME). The performance of the DL model was compared with that of ML models and conventional clinical tools. Additionally, contribution ranking of risk factors and individualized explanation of feature contribution were examined. RESULTS Our DL model showed area under the curve (AUC) values of 0.851 (95% CI 0.844-0.858) and 0.922 (95% CI 0.916-0.928) for the femoral neck and total femur bone mineral density, respectively, using the NHANES data set. The corresponding AUC values for the KNHANES data set were 0.827 (95% CI 0.821-0.833) and 0.912 (95% CI 0.898-0.927), respectively. Through the LIME method, significant features were induced, and each feature's integrated contribution and interpretation for individual risk were determined. CONCLUSIONS The developed DL model significantly outperforms conventional ML models and clinical tools. Our XAI model produces high-ranked features along with the integrated contributions of each feature, which facilitates the interpretation of individual risk. In summary, our interpretable model for osteoporosis risk screening outperformed state-of-the-art methods.
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Affiliation(s)
| | | | - Hyeyeon Kim
- Department of Family Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sanghwa Lee
- Department of Family Medicine, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sunghye Kong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin-Woo Kim
- Department of Oral and Maxillofacial Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Jongeun Choi
- School of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
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Kirilova E, Kirilov N, Bischoff F, Vladeva S, Nikolov N, Nikolov M, Batalov Z, Batalov A, Kinov P, Kovachev V, Kovachev M, Todorov S. Prevalence of low bone mineral density at axial sites and fracture risk in Bulgarian population. Orthop Rev (Pavia) 2022; 14:57622. [PMID: 36589513 PMCID: PMC9796993 DOI: 10.52965/001c.57622] [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] [Indexed: 12/27/2022] Open
Abstract
Background Osteoporosis is a common chronic disease characterized by low bone mineral density (BMD) and microarchitectural deterioration of the bone, which are associated with increased risk of fragility fractures. Currently the most popular tool is the fracture risk assessment model FRAX to calculate the 10-year probability of major osteoporotic fractures (MOF) and hip fractures (HF). Objective To investigate the prevalence of low BMD at axial sites and fracture risk in Bulgarian population. Methods We retrospectively analyzed dual energy X-ray absorptiometry (DXA) scan results of 12 478 subjects. Scan results included BMD and T-score assessments of lumbar spine and femoral neck. FRAX major osteoprotic fracture (MOF) and FRAX hip fracture (HF) were assessed in subjects between 40 and 90 years using BMD values. Results Of total 12478 subjects, 12119 were women and 359 were men. The mean age of the subjects was 61 years (yrs.) ± 10 yrs. The overall prevalence of low BMD at the lumbar spine was 6084/9336 subjects (65.2%). 3502/9336 subjects (37.5%) were considered as osteopenic and 2582/9336 subjects (27.7%) were considered as osteoporotic. The overall prevalence of low BMD at the femoral neck was 2036/3140 (64.8%). 1641/3140 subjects (52.3%) were classified as osteopenic and 395/3 140 subjects (12.6%) were classified as osteoporotic. The mean values of FRAX MOF and FRAX HF increased significantly with increasing the age interval. Conclusion This study is the largest epidemiological research in Bulgaria up to date about the prevalence of low BMD at axial sites.
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Affiliation(s)
- Elena Kirilova
- Department of RheumatologyUniversity hospital “UMBAL Dr. Georgi Stranski”-Pleven
| | - Nikola Kirilov
- Department of Orthopedics and TraumatologyUniversity hospital “UMBAL Dr. Georgi Stranski”-Pleven
| | | | | | - Nikolay Nikolov
- Department of RheumatologyUniversity hospital “UMBAL Dr. Georgi Stranski”-Pleven
| | - Martin Nikolov
- Department of RheumatologyUniversity hospital “UMBAL Dr. Georgi Stranski”-Pleven
| | - Zguro Batalov
- Department of Internal Diseases, Plovdiv, BulgariaUniversity Hospital ‘Kaspela’, Rheumatology Clinic, Plovdiv, Bulgaria, Medical University of Plovdiv
| | - Anastas Batalov
- Department of Internal Diseases, Plovdiv, BulgariaUniversity Hospital ‘Kaspela’, Rheumatology Clinic, Plovdiv, Bulgaria, Medical University of Plovdiv
| | - Plamen Kinov
- Department of Orthopedics and TraumatologyUniversity Hospital Queen Giovanna - ISUL
| | - Vihar Kovachev
- Department of Orthopedics and TraumatologyUniversity hospital “UMBAL Dr. Georgi Stranski”-Pleven
| | - Mancho Kovachev
- Department of Orthopedics and TraumatologyUniversity hospital “UMBAL Dr. Georgi Stranski”-Pleven
| | - Svilen Todorov
- Department of Orthopedics and TraumatologyUniversity hospital “UMBAL Dr. Georgi Stranski”-Pleven
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20
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Orces CH. Trends in osteoporosis medication use in US postmenopausal women: analysis of the National Health and Nutrition Examination Survey 1999-2000 through 2017-2018. Menopause 2022; 29:1279-1284. [PMID: 36067395 DOI: 10.1097/gme.0000000000002063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to examine trends in the use of osteoporosis medications in postmenopausal women between 1999-2000 and 2017-2018. METHODS National Health and Nutrition Examination Survey data were analyzed to describe trends in the use of osteoporosis medications in US women 50 years and older. Joinpoint regression software was used to detect points at which significant changes in the direction and magnitude of the trends occurred over time. Logistic regression models adjusted for potential confounders were assembled to determine the independent association between time period (2007-2008 vs 2017-2018) and osteoporosis medication use. RESULTS Of 13,826 postmenopausal women, about 7% reported taking osteoporosis medications. Joinpoint regression demonstrated that the prevalence of women taking osteoporosis medications significantly decreased by -23.3% on average (95% confidence interval [CI], -23.3% to -37.7%) per survey cycle between 2007-2008 and 2017-2018. Similarly, bisphosphonate use decreased by -22.6% on average (95% CI, -38.8% to -2.1%) from 2007 to 2008 onward. Logistic regression demonstrated that, after adjustment for potential confounders including bone mineral density and self-reported hip or spine fractures, postmenopausal women were 61% and 56% less likely to use any osteoporosis medications and bisphosphonates in 2017 to 2018 compared with their counterparts in 2007 to 2008, respectively. CONCLUSIONS The use of osteoporosis medications in postmenopausal US women has significantly decreased since 2007 to 2008 onward. This finding was mostly attributed to a low prescription rate of bisphosphonate drugs. Moreover, the treatment of osteoporosis in postmenopausal women was suboptimal and decreased over time.
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Artificial intelligence used to diagnose osteoporosis from risk factors in clinical data and proposing sports protocols. Sci Rep 2022; 12:18330. [PMID: 36316387 PMCID: PMC9622877 DOI: 10.1038/s41598-022-23184-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Osteoporosis (OP) is characterized by diminished bone mass and deteriorating bone structure that increases the chance of fractures in the spine, hips, and wrists. In this paper, a novel data processing method of artificial intelligence (AI) is used for evaluating, predicting, and classifying OP risk factors in clinical data of men and women separately. Additionally, artificial intelligence was used to suggest the most appropriate sports programs for treatment. Data was obtained from dual-energy x-ray absorption scanning center of Ayatollah Kashani, Milad, and Khatam al-Anbia hospitals in Tehran, Iran. The subjects included 1224 men and women. Models were developed using decision tree, random forest (RF), k-nearest neighbor, support vector machine, gradient boosting (GB), Extra trees, Ada Boost (AB), and artificial neural network multilayer perceptron analysis to predict osteoporosis and to recommend sports programs. Data was divided into training (80%) and test dataset (20%). The results were obtained on a 20% test dataset. Area under receiver operating characteristic curve (AUROC) was used to compare the performance of the models. To predict healthy individuals, osteopenia and osteoporosis, the FR algorithm with AUROC 0.91 performed best in men and the GB algorithm with AUROC 0.95 performed best in women compared to other classification algorithms. Prediction of RF algorithm in women and men with AUROC 0.96 and 0.99, respectively, showed the highest performance in diagnosing the type of exercise for healthy individuals and those with osteopenia and OP. Eight AI algorithms were developed and compared to accurately predict osteoporosis risk factors and classify individuals into three categories: healthy, osteopenia, and OP. In addition, the AI algorithms were developed to recommend the most appropriate sports programs as part of treatment. Applying the AI algorithms in a clinical setting could help primary care providers classify patients with osteoporosis and improve treatment by recommending appropriate exercise programs.
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22
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Uhlinova J, Kuudeberg A, Metsküla K, Lember M, Rosenberg M. Significant associations between bone mineral density and vascular calcification in patients with different stages of chronic kidney disease. BMC Nephrol 2022; 23:327. [PMID: 36199013 PMCID: PMC9533531 DOI: 10.1186/s12882-022-02955-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Chronic kidney disease—mineral and bone disorders (CKD-MBD) is characterised by generalised vascular calcification (VC) and impaired bone health. We aimed to investigate the relationship between VC and bone mineral density (BMD) in CKD patients. Methods We performed a cross-sectional study of patients with different stages of CKD. For assessment of VC of abdominal aorta lateral lumbar X-rays (Kauppila score), the ankle-brachial index (ABI) and echocardiography were used. Total body densitometry provided BMD. Results Ninety patients (41% male, median age 64 years (range 29–87)) were included, of whom 41.1% had a Kauppila score > 1. Evidence of peripheral VC as measured by ABI was detected in 23.3% of cases. Lesions of the heart valves were found in 46.7% of patients. There was a significant association between high ABI and lesions of the heart valves. In the multivariate regression model to analyse the independent determinants of abdominal aorta calcification (AAC) and ABI, the BMD of the femoral neck was identified as significant for both (p = 0.001, p = 0.001). The total spine BMD was found to be significant for AAC (p = 0.001), and the BMD of spine L1-L4 and the ribs were found to be significant for ABI (p = 0.01, p = 0.002 respectively). In factorial regression analysis, where BMD was independent determinant, valvular calcification was significant for BMD of femur, femoral neck and total BMD. Age and tALP were inversely correlated with the BMD of femur and femoral neck. Conclusions Our work highlighted clinically important relationships between VC and bone mineral density (BMD) in CKD patients. We detected inverse relationships between AAC, high ABI and BMD. Secondly, BMD at certain bone sites (femur, femoral neck) and total BMD were associated with important lesions of heart valves. Thirdly, a significant association between a high ABI and lesions of the heart valves. We believe that the results of our study will help in the planning of future research and in current clinical practice for the early diagnosis, further monitoring and management of CKD-MBD. Additionally, these results may have treatment implications on use of different CKD-MBD medications.
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Affiliation(s)
- Jana Uhlinova
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Puusepa str. 8, 50406, Tartu, Estonia. .,Department of Internal Medicine, Tartu University Hospital, Tartu, Estonia.
| | - Anne Kuudeberg
- Department of Anatomy, Institute of Pathological Anatomy and Forensic Medicine, University of Tartu, Tartu, Estonia
| | - Kaja Metsküla
- Department of Immunology, Institute of Biomedicine and Translation Medicine, University of Tartu, Tartu, Estonia
| | - Margus Lember
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Puusepa str. 8, 50406, Tartu, Estonia.,Department of Internal Medicine, Tartu University Hospital, Tartu, Estonia
| | - Mai Rosenberg
- Department of Internal Medicine, Institute of Clinical Medicine, University of Tartu, Puusepa str. 8, 50406, Tartu, Estonia.,Department of Internal Medicine, Tartu University Hospital, Tartu, Estonia
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23
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Juan A, Frontera G, Cacheda AP, Ibáñez M, Narváez J, Marí B, Nolla JM. Bone health and predictors of 15-year mortality in a physically active population. REUMATOLOGIA CLINICA 2022; 18:459-463. [PMID: 36210614 DOI: 10.1016/j.reumae.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To analyse determinants of mortality at 15 years in a population over 60 years of age and physically active. METHODS This is a prospective longitudinal study. After 15 years of participating in an active ageing programme, participants were contacted by telephone to verify their state of health and to determine whether in that time they had had any fractures. RESULTS 561 individuals over 60 years of age were included, 82% of whom were women. Only differences in densitometric data, FRAX values and history of previous fracture at baseline characteristics were found between the group that died at 15 years and the group that remained alive. The only variables that were related to mortality risk were the basal data of the densitometric t-score (OR = .50, P < .001) and history of fracture in any location (OR = 2.44, P < .033). CONCLUSIONS The value of bone mineral density could be considered as a useful biomarker to calculate the risk of mortality in people over 60 years old with a physically active lifestyle.
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Affiliation(s)
- Antonio Juan
- Servicio de Reumatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain.
| | - Guillem Frontera
- Unidad de Investigación, Hospital Universitari de Son Espases, Palma de Mallorca, Spain
| | - Ana Paula Cacheda
- Servicio de Reumatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Mónica Ibáñez
- Servicio de Reumatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Javier Narváez
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Bartolomé Marí
- Unidad de Medicina de Deporte, Institut de Serveis Socials i Esportius, Consell de Mallorca, Palma de Mallorca, Spain
| | - Joan Miquel Nolla
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
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24
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Shen G, Liu X, Lei W, Duan R, Yao Z. Plumbagin is a NF-κB-inducing kinase inhibitor with dual anabolic and antiresorptive effects that prevents menopausal-related osteoporosis in mice. J Biol Chem 2022; 298:101767. [PMID: 35235833 PMCID: PMC8958545 DOI: 10.1016/j.jbc.2022.101767] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 12/03/2022] Open
Abstract
Osteoporosis is caused by enhanced bone resorption and relatively reduced bone formation. There is an unmet need to develop new agents with both antiresorptive and anabolic effects to treat osteoporosis, although drugs with either effect alone are available. A small molecular compound, plumbagin, was reported to inhibit receptor activator of nuclear factor kappa-B ligand-induced osteoclast (OC) differentiation by inhibiting IκBα phosphorylation-mediated canonical NF-κB activation. However, the key transcriptional factor RelA/p65 in canonical NF-κB pathway functions to promote OC precursor survival but not terminal OC differentiation. Here, we found that plumbagin inhibited the activity of NF-κB inducing kinase, the key molecule that controls noncanonical NF-κB signaling, in an ATP/ADP-based kinase assay. Consistent with this, plumbagin inhibited processing of NF-κB2 p100 to p52 in the progenitor cells of both OCs and osteoblasts (OBs). Interestingly, plumbagin not only inhibited OC but also stimulated OB differentiation in vitro. Importantly, plumbagin prevented trabecular bone loss in ovariectomized mice. This was associated with decreased OC surfaces on trabecular surface and increased parameters of OBs, including OB surface on trabecular surface, bone formation rate, and level of serum osteocalcin, compared to vehicle-treated mice. In summary, we conclude that plumbagin is a NF-κB-inducing kinase inhibitor with dual anabolic and antiresorptive effects on bone and could represent a new class of agent for the prevention and treatment of osteoporosis.
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Affiliation(s)
- Gengyang Shen
- Department of Pathology and Laboratory Medicine, and Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA
| | - Xin Liu
- Department of Pathology and Laboratory Medicine, and Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA
| | - Wei Lei
- Department of Pathology and Laboratory Medicine, and Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA
| | - Rong Duan
- Department of Pathology and Laboratory Medicine, and Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA
| | - Zhenqiang Yao
- Department of Pathology and Laboratory Medicine, and Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York, USA.
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25
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Wang F, Zheng L, Theopold J, Schleifenbaum S, Heyde CE, Osterhoff G. Methods for bone quality assessment in human bone tissue: a systematic review. J Orthop Surg Res 2022; 17:174. [PMID: 35313901 PMCID: PMC8935787 DOI: 10.1186/s13018-022-03041-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/02/2022] [Indexed: 02/07/2023] Open
Abstract
Background For biomechanical investigations on bone or bone implants, bone quality represents an important potential bias. Several techniques for assessing bone quality have been described in the literature. This study aims to systematically summarize the methods currently available for assessing bone quality in human bone tissue, and to discuss the advantages and limitations of these techniques. Methods A systematic review of the literature was carried out by searching the PubMed and Web of Science databases from January 2000 to April 2021. References will be screened and evaluated for eligibility by two independent reviewers as per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies must apply to bone quality assessment with imaging techniques, mechanical testing modalities, and compositional characterization. The terms used for the systematic search were: “(bone quality”. Ti,ab.) AND “(human bone specimens)”. Results The systematic review identified 502 relevant articles in total. Sixty-eight articles met the inclusion criteria. Among them, forty-seven articles investigated several imaging modalities, including radiography, dual-energy X-ray absorptiometry (DEXA), CT-based techniques, and MRI-based methods. Nineteen articles dealt with mechanical testing approaches, including traditional testing modalities and novel indentation techniques. Nine articles reported the correlation between bone quality and compositional characterization, such as degree of bone mineralization (DBM) and organic composition. A total of 2898 human cadaveric bone specimens were included. Conclusions Advanced techniques are playing an increasingly important role due to their multiple advantages, focusing on the assessment of bone morphology and microarchitecture. Non-invasive imaging modalities and mechanical testing techniques, as well as the assessment of bone composition, need to complement each other to provide comprehensive and ideal information on the bone quality of human bone specimens. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-03041-4.
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Affiliation(s)
- Fangxing Wang
- ZESBO - Center for Research On Musculoskeletal Systems, Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany. .,Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany.
| | - Leyu Zheng
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
| | - Jan Theopold
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
| | - Stefan Schleifenbaum
- ZESBO - Center for Research On Musculoskeletal Systems, Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Semmelweisstraße 14, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopedic Surgery, Traumatology and Plastic Surgery, Leipzig University, Liebigstraße 20 Haus 4, 04103, Leipzig, Germany
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26
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Johannesdottir F, Putman MS, Burnett-Bowie SAM, Finkelstein JS, Yu EW, Bouxsein ML. Age-Related Changes in Bone Density, Microarchitecture, and Strength in Postmenopausal Black and White Women: The SWAN Longitudinal HR-pQCT Study. J Bone Miner Res 2022; 37:41-51. [PMID: 34647644 PMCID: PMC8770571 DOI: 10.1002/jbmr.4460] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 01/28/2023]
Abstract
Higher fracture risk in White versus Black women is partly explained by lower BMD and worse bone microarchitecture in White women. However, whether rates of decline in bone density, microarchitecture and strength differ between postmenopausal Black and White women is unknown. Further, factors that influence rates of age-related bone microarchitecture deterioration remain ill-defined. Thus, over 6.7 years, longitudinal changes were measured in peripheral volumetric bone mineral density (vBMD), microarchitecture, and strength at the distal radius and tibia using HR-pQCT in postmenopausal Black (n = 80) and White (n = 137) women participating in the Study of Women's Health Across the Nation. It was assessed whether age-related changes in vBMD and microarchitecture were influenced by body weight, body composition, and/or weight change. It was found that at the radius, where White women appeared to have slightly greater rates of loss in total vBMD, cortical bone volume, and porosity than Black women, those differences were attenuated after adjusting for clinical covariates. At the tibia, Black and White women had similar rates of bone loss. Independent of race and other clinical covariates, women with the lowest baseline body weight experienced the greatest decline in total and trabecular vBMD at the radius. Furthermore, women who lost weight over the follow-up period had higher rates of bone loss, particularly at the tibia, compared with those who maintained or gained weight. Higher baseline total body fat mass was also protective of bone loss at both the radius and tibia. In conclusion, these findings indicate that lower fracture risk among postmenopausal Black women is not caused by slower rates of bone deterioration, and highlight the importance for postmenopausal women to avoid lower body weight and excessive weight loss to avert rapid bone loss and subsequent fractures. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Fjola Johannesdottir
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Melissa S Putman
- Harvard Medical School, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA.,Endocrine Division, Boston Children's Hospital, Boston, MA, USA
| | - Sherri-Ann M Burnett-Bowie
- Harvard Medical School, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Joel S Finkelstein
- Harvard Medical School, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Elaine W Yu
- Harvard Medical School, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Mary L Bouxsein
- Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Endocrine Unit, Massachusetts General Hospital, Boston, MA, USA
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27
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Zhou HL, Wei MH, Di DS, Zhang RY, Zhang JL, Yuan TT, Liu Q, Zhou TT, Huang Q, Wang Q. Association between SEMA3A signaling pathway genes and BMD/OP risk: An epidemiological and experimental study. Front Endocrinol (Lausanne) 2022; 13:1014431. [PMID: 36425469 PMCID: PMC9679019 DOI: 10.3389/fendo.2022.1014431] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/24/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study aimed to explore the associations of genetic variants in the semaphorin 3A (SEMA3A) signaling pathway genes, including SEMA3A, NRP1, PLXNA1, PLXNA2 and PLXNA3 with osteoporosis (OP) risk and bone mineral density (BMD) in a Chinese Han older adult population. STUDY DESIGN AND METHOD A two-stage design was adopted. Total of 47.8kb regions in the 5 genes were sequenced using targeted next-generation sequencing (NGS) technology in the discovery stage, and the discovered OP-related single nucleotide polymorphisms (SNPs) were further genotyped using improved multiple linkage detection reaction technique in the validation stage. Methods of ALP/TRAP staining, real-time fluorescent quantitative PCR, and cell proliferation and apoptosis assays were performed with MC3T3-E1 and RAW 264.7 cell lines to clarify biological effects of observed functional variants in cell lines responsible for bone mass remodeling. RESULTS Total of 400 postmenopausal women (211 OP cases) were involved in the discovery stage, where 6 common and 4 rare genetic variants were found to be associated with OP risk. In the validation stage among another 859 participants (417 women, 270 OP cases), the PLXNA2 rs2274446 T allele was associated with reduced OP risk and increased femoral neck (FN) BMD compared to the C allele. Moreover, significant associations of NRP1 rs2070296 with FN BMD/OP risk and of NRP1 rs180868035 with lumbar spine and FN BMDs were also observed in the combination dataset analysis. Compared to the osteoblasts/osteoclasts transfected with the wild-type NRP1 rs180868035, those transfected with the mutant-type had reduced mRNA expression of osteoblastic genes (i.e., ALP, RUNX2, SP7 and OCN), while elevated mRNA expression of osteoclastic genes (i.e., TRAP, NFATc1 and CTSK). Furthermore, mutant NRP1 rs180868035 transfection inhibited osteoblast proliferation and osteoclast apoptosis, while promoted osteoclast proliferation and osteoblast apoptosis in corresponding cell lines. CONCLUSION Genetic variants located in NRP1 and PLXNA2 genes were associated with OP risk and BMD. The NRP1 rs180868035 affects bone metabolism by influencing osteoblasts and osteoclasts differentiation, proliferation and apoptosis.
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Affiliation(s)
- Hao-long Zhou
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mu-hong Wei
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dong-sheng Di
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ru-yi Zhang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian-li Zhang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting-ting Yuan
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Liu
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting-ting Zhou
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Huang
- Department of Rehabilitation Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Qin Huang, ; Qi Wang,
| | - Qi Wang
- Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Qin Huang, ; Qi Wang,
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28
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Yi X, Liu X, Kenney HM, Duan R, Lin X, Schwarz E, Yao Z. TNF-Polarized Macrophages Produce Insulin-like 6 Peptide to Stimulate Bone Formation in Rheumatoid Arthritis in Mice. J Bone Miner Res 2021; 36:2426-2439. [PMID: 34585777 PMCID: PMC8688308 DOI: 10.1002/jbmr.4447] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/01/2021] [Accepted: 09/22/2021] [Indexed: 01/05/2023]
Abstract
The risk of osteoporosis is increased in rheumatoid arthritis (RA). Anti-tumor necrosis factor (TNF) therapy has markedly improved the outcomes of RA patients but does not improve osteoporosis in some reports. This could be a combined result of disease severity and other therapeutic agents, such as glucocorticoids that accelerate osteoporosis progression. We evaluated the effects of anti-TNF therapy on osteoporosis in an animal model of RA and explored the possible mechanisms involved. Six-week-old TNF transgenic (TNF-Tg) mice with early stage erosive arthritis were treated with TNF antibody (Ab) or control immunoglobulin (IgG) weekly for 4 weeks. We found that TNF Ab completely blocked the development of erosive arthritis in TNF-Tg mice, but only slightly increased vertebral bone mass, associated with reduction in parameters of both bone resorption and formation. Similarly, TNF Ab slightly increased trabecular bone mass in tibias of 8-month-old TNF-Tg mice with advanced erosive arthritis. Interestingly, TNFα increased osteoblast differentiation from mouse bone marrow stromal cells (BMSCs) containing large number of macrophages but not from pure mesenchymal progenitor cells (MPCs). TNFα-polarized macrophages (TPMs) did not express iNos and Arginase 1, typical markers of inflammatory and resident macrophages. Interestingly, TPMs stimulated osteoblast differentiation, unlike resident and inflammatory macrophages polarized by IL-4 and interferon-λ, respectively. RNA-seq analysis indicated that TPMs produced several anabolic factors, including Jagged1 and insulin like 6 (INSL6). Importantly, inhibition of either Jagged1 or INSL6 blocked TNFα-induced osteoblast differentiation. Furthermore, INSL6 Ab significantly decreased the expansion of TNF-induced MPCs in BMSCs, and anti-TNF Ab reduced INSL6 expression by macrophages in vitro and in TNF-Tg mice in vivo. We conclude that TPMs produce INSL6 to stimulate bone formation and anti-TNF Ab blocks not only enhanced bone resorption but also the anabolic effect of TPMs on bone, limiting its effect to increase bone mass in this model of RA. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Xiangjiao Yi
- Department of Pathology and Laboratory Medicine, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Xin Liu
- Department of Pathology and Laboratory Medicine, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - H Mark Kenney
- Department of Pathology and Laboratory Medicine, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Rong Duan
- Department of Pathology and Laboratory Medicine, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Xi Lin
- Department of Pathology and Laboratory Medicine, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Edward Schwarz
- Department of Pathology and Laboratory Medicine, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA.,Department of Orthopedic Surgery, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
| | - Zhenqiang Yao
- Department of Pathology and Laboratory Medicine, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, USA
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Assessing the roles of demographic, social, economic, environmental, health-related, and political factors on risk of osteoporosis diagnosis among older adults. Arch Osteoporos 2021; 16:177. [PMID: 34817704 PMCID: PMC8722370 DOI: 10.1007/s11657-021-01042-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 11/14/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Chronic stress from social/environmental pressures has been proposed to affect bone health through increased inflammation. We demonstrate that inflammation from prolonged stress does not cause changes to bone health through inflammation but instead impacts access to health care, social inequalities, and overall health, which in turn impact bone health. PURPOSE The study provides a comprehensive assessment of how determinants of health across demographic, psychological, mobility-related, health, environmental, and economic domains are associated with the diagnosis of osteoporosis and tests three hypotheses: (1) a diverse set of variables across domains will predict osteoporosis, (2) chronic inflammation as a result of stress (represented by high-sensitivity C-reactive protein) will not be associated with osteoporosis, and (3) the model developed will have high accuracy in predicting osteoporosis. METHODS Logistic regression and Cox proportional hazards models of osteoporosis diagnosis were estimated using data from 14,792 and 13,169 participants (depending on model) in the 2012-2016 waves of the Health and Retirement Study, including the Biomarker Study, the Contextual Data Resource, and validated measures of childhood socioeconomic status. Predictive accuracy was assessed using k-Nearest Neighbors Discriminant Analysis. RESULTS Demographic, environmental, and health-related factors were associated with osteoporosis diagnosis, and predictive accuracy of the models was good. High-sensitivity C-reactive protein was not associated with osteoporosis diagnosis. CONCLUSION Social determinants identified indicate access to health care, inequalities in the greater social environment (e.g., access to resources), and overall health (i.e., underlying medical conditions) are key components for developing osteoporosis and indicate underlying health inequities in this sample. There is a need to further address the interplay between primary health care and social determinants of health.
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30
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Graziano EJ, Vaughn BP, Wang Q, Chow LS, Campbell JP. Microscopic Colitis Is Not an Independent Risk Factor for Low Bone Density. Dig Dis Sci 2021; 66:3542-3547. [PMID: 33063187 DOI: 10.1007/s10620-020-06651-2] [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: 06/29/2020] [Accepted: 10/01/2020] [Indexed: 12/09/2022]
Abstract
BACKGROUND Microscopic colitis (MC) is a subtype of inflammatory bowel disease (IBD) with overlapping risk factors for low bone density (LBD). While LBD is a known complication of IBD, its association with MC is not well-established. AIMS Assess the prevalence of LBD in MC compared to control populations, and evaluate if MC predicts LBD when controlling for confounders. METHODS Retrospective, observational case control study of adult patients with pathologically confirmed MC from 2005 to 2015. Bone density measurements were abstracted from dual-energy X-ray absorptiometry (DEXA) reports, and bone density was classified using T-score: normal (T ≥ - 1.0), osteopenia (- 1.0 > T > -2.5) or osteoporosis (T ≤ - 2.5). Demographics, disease, medication history and LBD risk factors were obtained from chart review. Prevalence of LBD was compared to national and local controls. A matched control cohort to MC patients without prior diagnosis of LBD was analyzed with logistic regression to assess the relationship of MC to LBD. RESULTS One hundred and eighteen patients with MC were identified. Osteopenia in women with MC was more prevalent compared to national controls (67% vs. 49%, p = 0.0004), and LBD was more prevalent in MC patients compared to local controls (82% vs. 55%, p < 0.0001). In MC patients without prior diagnosis of LBD matched to controls, there was a higher prevalence of osteopenia (53.2% vs. 36.7%, p = 0.04). However, after controlling for confounders, MC was not associated with LBD (OR 0.83, 95% CI 0.22, 3.16, p = 0.8). CONCLUSIONS While LBD was more prevalent in MC patients compared to control populations, with adjustment for key confounders (including BMI, steroids, smoking, vitamin D and calcium use), MC was not an independent predictor of LBD.
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Affiliation(s)
- Elliot J Graziano
- Department of Internal Medicine, University of Minnesota, 420 Delaware Street SE MMC 284, Minneapolis, MN, 55455, USA.
| | - Byron P Vaughn
- Inflammatory Bowel Disease Program, Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
| | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Lisa S Chow
- Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN, USA
| | - James P Campbell
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, MN, USA
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Noel SE, Santos MP, Wright NC. Racial and Ethnic Disparities in Bone Health and Outcomes in the United States. J Bone Miner Res 2021; 36:1881-1905. [PMID: 34338355 PMCID: PMC8607440 DOI: 10.1002/jbmr.4417] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022]
Abstract
Osteoporosis is a bone disease classified by deterioration of bone microarchitecture and decreased bone strength, thereby increasing subsequent risk of fracture. In the United States, approximately 54 million adults aged 50 years and older have osteoporosis or are at risk due to low bone mass. Osteoporosis has long been viewed as a chronic health condition affecting primarily non-Hispanic white (NHW) women; however, emerging evidence indicates racial and ethnic disparities in bone outcomes and osteoporosis management. The primary objective of this review is to describe disparities in bone mineral density (BMD), prevalence of osteoporosis and fracture, as well as in screening and treatment of osteoporosis among non-Hispanic black (NHB), Hispanic, and Asian adults compared with NHW adults living on the US mainland. The following areas were reviewed: BMD, osteoporosis prevalence, fracture prevalence and incidence, postfracture outcomes, DXA screening, and osteoporosis treatments. Although there are limited studies on bone and fracture outcomes within Asian and Hispanic populations, findings suggest that there are differences in bone outcomes across NHW, NHB, Asian, and Hispanic populations. Further, NHB, Asian, and Hispanic populations may experience suboptimal osteoporosis management and postfracture care, although additional population-based studies are needed. There is also evidence that variation in BMD and osteoporosis exists within major racial and ethnic groups, highlighting the need for research in individual groups by origin or background. Although there is a clear need to prioritize future quantitative and qualitative research in these populations, initial strategies for addressing bone health disparities are discussed. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Sabrina E Noel
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Michelly P Santos
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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Juan A, Frontera G, Cacheda AP, Ibáñez M, Narváez J, Marí B, Nolla JM. Bone Health and Predictors of 15-Year Mortality in a Physically Active Population. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00185-6. [PMID: 34507875 DOI: 10.1016/j.reuma.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/22/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To analyse determinants of mortality at 15years in a population over 60years of age and physically active. METHODS This is a prospective longitudinal study. After 15years of participating in an active aging programme, participants were contacted by telephone to verify their state of health and to determine whether in that time they had had any fractures. RESULTS A total of 561 individuals over 60years of age were included, 82% of whom were women. Only differences in densitometric data, FRAX values and history of previous fracture at baseline characteristics were found between the group that died at 15years and the group that remained alive. The only variables that were related to mortality risk were the basal data of the densitometric T-score (OR=.50, P<.001) and history of fracture in any location (OR=2.44, P<.033). CONCLUSIONS The value of bone mineral density could be considered as a useful biomarker to calculate the risk of mortality in people over 60years old with a physically active lifestyle.
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Affiliation(s)
- Antonio Juan
- Servicio de Reumatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, España.
| | - Guillem Frontera
- Unidad de Investigación, Hospital Universitari de Son Espases, Palma de Mallorca, España
| | - Ana Paula Cacheda
- Servicio de Reumatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, España
| | - Mónica Ibáñez
- Servicio de Reumatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, España
| | - Javier Narváez
- Servicio de Reumatología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España; IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Bartolomé Marí
- Unidad de Medicina de Deporte, Institut de Serveis Socials i Esportius, Consell de Mallorca, Palma de Mallorca, España
| | - Joan Miquel Nolla
- Servicio de Reumatología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España; IDIBELL, Hospitalet de Llobregat, Barcelona, España
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Ou Yang WY, Lai CC, Tsou MT, Hwang LC. Development of Machine Learning Models for Prediction of Osteoporosis from Clinical Health Examination Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147635. [PMID: 34300086 PMCID: PMC8305021 DOI: 10.3390/ijerph18147635] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/11/2021] [Accepted: 07/15/2021] [Indexed: 01/04/2023]
Abstract
Osteoporosis is treatable but often overlooked in clinical practice. We aimed to construct prediction models with machine learning algorithms to serve as screening tools for osteoporosis in adults over fifty years old. Additionally, we also compared the performance of newly developed models with traditional prediction models. Data were acquired from community-dwelling participants enrolled in health checkup programs at a medical center in Taiwan. A total of 3053 men and 2929 women were included. Models were constructed for men and women separately with artificial neural network (ANN), support vector machine (SVM), random forest (RF), k-nearest neighbor (KNN), and logistic regression (LoR) to predict the presence of osteoporosis. Area under receiver operating characteristic curve (AUROC) was used to compare the performance of the models. We achieved AUROC of 0.837, 0.840, 0.843, 0.821, 0.827 in men, and 0.781, 0.807, 0.811, 0.767, 0.772 in women, for ANN, SVM, RF, KNN, and LoR models, respectively. The ANN, SVM, RF, and LoR models in men, and the ANN, SVM, and RF models in women performed significantly better than the traditional Osteoporosis Self-Assessment Tool for Asians (OSTA) model. We have demonstrated that machine learning algorithms improve the performance of screening for osteoporosis. By incorporating the models in clinical practice, patients could potentially benefit from earlier diagnosis and treatment of osteoporosis.
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Affiliation(s)
- Wen-Yu Ou Yang
- Department of Neurology, Taipei Veterans General Hospital, Taipei City 11217, Taiwan;
| | - Cheng-Chien Lai
- Department of Medicine, Taipei Veterans General Hospital, Taipei City 11217, Taiwan;
| | - Meng-Ting Tsou
- Department of Family Medicine, Mackay Memorial Hospital, Taipei City 10491, Taiwan;
- Mackay Junior College of Medicine, Nursing and Management, Taipei City 11260, Taiwan
| | - Lee-Ching Hwang
- Department of Family Medicine, Mackay Memorial Hospital, Taipei City 10491, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Correspondence:
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Abstract
Aging athletes face unique, increased adversities related to increased mobility and age-related spine issues, such as spinal stenosis, osteoporosis complicated by fragility fractures, and degenerative disk disease. This article covers various spine pathologies that aging athletes experience and ideal treatment of this population to allow safe return to activity.
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Affiliation(s)
- Pramod N Kamalapathy
- Department of Orthopaedics, University of Virginia, 400 Ray Hunt C. Drive, Charlottesville, VA 22903, USA
| | - Hamid Hassanzadeh
- Department of Orthopaedics, University of Virginia, 400 Ray Hunt C. Drive, Charlottesville, VA 22903, USA.
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Krez A, Agarwal S, Bucovsky M, McMahon DJ, Hu Y, Bessler M, Schrope B, Carrelli A, Clare S, Guo XDE, Silverberg SJ, Stein EM. Long-term Bone Loss and Deterioration of Microarchitecture After Gastric Bypass in African American and Latina Women. J Clin Endocrinol Metab 2021; 106:e1868-e1879. [PMID: 33098299 PMCID: PMC8502471 DOI: 10.1210/clinem/dgaa654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/14/2020] [Indexed: 01/06/2023]
Abstract
CONTEXT The prevalence of obesity is burgeoning among African American and Latina women; however, few studies investigating the skeletal effects of bariatric surgery have focused on these groups. OBJECTIVE To investigate long-term skeletal changes following Roux-en-Y gastric bypass (RYGB) in African American and Latina women. DESIGN Four-year prospective cohort study. PATIENTS African American and Latina women presenting for RYGB (n = 17, mean age 44, body mass index 44 kg/m2) were followed annually for 4 years postoperatively. MAIN OUTCOME MEASURES Dual-energy x-ray absorptiometry (DXA) measured areal bone mineral density (aBMD) at the spine, hip, and forearm, and body composition. High-resolution peripheral quantitative computed tomography measured volumetric bone mineral density (vBMD) and microarchitecture. Individual trabecula segmentation-based morphological analysis assessed trabecular morphology and connectivity. RESULTS Baseline DXA Z-Scores were normal. Weight decreased ~30% at Year 1, then stabilized. Parathyroid hormone (PTH) increased by 50% and 25-hydroxyvitamin D was stable. By Year 4, aBMD had declined at all sites, most substantially in the hip. There was significant, progressive loss of cortical and trabecular vBMD, deterioration of microarchitecture, and increased cortical porosity at both the radius and tibia over 4 years. There was loss of trabecular plates, loss of axially aligned trabeculae, and decreased trabecular connectivity. Whole bone stiffness and failure load declined. Risk factors for bone loss included greater weight loss, rise in PTH, and older age. CONCLUSIONS African American and Latina women had substantial and progressive bone loss, deterioration of microarchitecture, and trabecular morphology following RYGB. Further studies are critical to understand the long-term skeletal consequences of bariatric surgery in this population.
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Affiliation(s)
- Alexandra Krez
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
| | - Sanchita Agarwal
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mariana Bucovsky
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Donald J McMahon
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Yizhong Hu
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Marc Bessler
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Beth Schrope
- Department of Surgery, Columbia University College of Physicians and Surgeons, New York, NY
| | - Angela Carrelli
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Shannon Clare
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
| | - Xiang-Dong Edward Guo
- Bone Bioengineering Laboratory, Department of Biomedical Engineering, Columbia University, New York, New York
| | - Shonni J Silverberg
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
| | - Emily M Stein
- Endocrinology and Metabolic Bone Disease Service, Hospital for Special Surgery, New York, New York
- Correspondence and Reprint Requests: Emily M. Stein, MD, MS, Director of Research, Metabolic Bone Service, Hospital for Special Surgery, Associate Professor of Medicine, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021. E-mail:
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Rinonapoli G, Ruggiero C, Meccariello L, Bisaccia M, Ceccarini P, Caraffa A. Osteoporosis in Men: A Review of an Underestimated Bone Condition. Int J Mol Sci 2021; 22:2105. [PMID: 33672656 PMCID: PMC7924179 DOI: 10.3390/ijms22042105] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/17/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023] Open
Abstract
Osteoporosis is called the 'silent disease' because, although it does not give significant symptoms when it is not complicated, can cause fragility fractures, with serious consequences and death. Furthermore, the consequences of osteoporosis have been calculated to weigh heavily on the costs of health systems in all the countries. Osteoporosis is considered a female disease. Actually, the hormonal changes that occur after menopause certainly determine a significant increase in osteoporosis and the risk of fractures in women. However, while there is no doubt that women are more exposed to osteoporosis and fragility fractures, the literature clearly indicates that physicians tend to underestimate the osteoporosis in men. The review of the literature done by the authors shows that osteoporosis and fragility fractures have a high incidence also in men; and, furthermore, the risk of fatal complications in hip fractured men is higher than that for women. The authors report the evidence of the literature on male osteoporosis, dwelling on epidemiology, causes of osteoporosis in men, diagnosis, and treatment. The analysis of the literature shows that male osteoporosis is underscreened, underdiagnosed, and undertreated, both in primary and secondary prevention of fragility fractures.
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Affiliation(s)
- Giuseppe Rinonapoli
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Carmelinda Ruggiero
- Orthogeriatric Service, Geriatric Unit, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy;
| | - Luigi Meccariello
- Department of Orthopaedics and Traumatology, AORN San Pio “Gaetano Rummo Hospital”, via R.Delcogliano, 82100 Benevento (BN), Italy;
| | - Michele Bisaccia
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Paolo Ceccarini
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
| | - Auro Caraffa
- Orthopaedic and Traumatology Department, University of Perugia, Ospedale S.Maria della Misericordia, S. Andrea delle Fratte, 06156 Perugia, Italy; (M.B.); (P.C.); (A.C.)
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Zheng XY, Zhou Z, Gao Y, Chen Y, Li R, Zhou M, Zhu D. Racial differences and factors associated with low femoral neck bone mineral density: an analysis of NHANES 2005-2014 data. Arch Osteoporos 2021; 16:9. [PMID: 33409707 DOI: 10.1007/s11657-020-00850-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/02/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Using national representative data, we found the prevalence of and risk factors associated with low BMD differed by race and ethnicity. PURPOSE Race/ethnicity is an important determinant of osteoporosis risk. The study aims were to (1) estimate the racial and ethnic differences in the prevalence of low BMD, (2) identify factors associated with low BMD by race and ethnic group, and (3) evaluate if the association between sleep duration and low BMD is modified by age, sex, gender, and/or race/ethnicity. METHODS Using data from the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2014, totally, 7992 participants aged ≥ 50 years were included as the primary cohort. Three race/ethnic groups were included: non-Hispanic Whites, Hispanics, and non-Hispanic Blacks. Low BMD was defined by femoral neck BMD T-scores less than - 1, as measured by DXA scan. Univariate and multivariate analyses were performed to determine associations between participants' demographics, comorbidities, lifestyle characteristics, and prevalent low BMD. RESULTS Prevalence of low BMD was 50.8% among non-Hispanic Whites, 23.7% among non-Hispanic Blacks, and 44.0% among Hispanics. After adjusting for confounders, advanced age, female gender, and fracture history were significantly associated with increased odds of low BMD in all three race/ethnic groups. Family history of osteoporosis, ever used glucocorticoids daily, and vitamin D deficiency or insufficiency were associated with increased odds of low BMD only among non-Hispanic Whites. Cardiovascular disease (CVD) history and diabetes were associated with low BMD only among non-Hispanic Blacks. Short sleep duration was not associated with low BMD in all ethnic groups, but was significantly associated with low BMD in older adults (> 65 years) and females. CONCLUSIONS Prevalence of low BMD among three race/ethnic groups in the USA is determined, with race/ethnic disparities in several risk factors associated with low BMD identified. By contrast, advanced age, female gender, and fracture history are associated with increased odds of low BMD across all race/ethnic groups. The association between sleep duration and low BMD is modified by age and sex. Together, these findings may help clinicians and healthcare providers formulate better care for individual's bone health.
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Affiliation(s)
- Xiao-Yun Zheng
- Department of Senior Official Ward, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Beijing, 100029, China.
| | - Zhi Zhou
- Department of Senior Official Ward, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Beijing, 100029, China
| | - Yan Gao
- Department of Senior Official Ward, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Beijing, 100029, China
| | - Yi Chen
- Department of Senior Official Ward, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Beijing, 100029, China
| | - Rui Li
- Department of Senior Official Ward, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Beijing, 100029, China
| | - Mo Zhou
- Department of Senior Official Ward, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Beijing, 100029, China
| | - Dan Zhu
- Department of Senior Official Ward, China-Japan Friendship Hospital, 2 Yinghua Dongjie, Beijing, 100029, China
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Zhai T, Chen Q, Xu J, Jia X, Xia P. Prevalence and Trends in Low Bone Density, Osteopenia and Osteoporosis in U.S. Adults With Non-Alcoholic Fatty Liver Disease, 2005-2014. Front Endocrinol (Lausanne) 2021; 12:825448. [PMID: 35126317 PMCID: PMC8807487 DOI: 10.3389/fendo.2021.825448] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) is suggested to be associated with bone mineral density (BMD) alterations; however, this has not been ascertained. The current study aimed to investigate the changes in BMD and the prevalence of osteopenia/osteoporosis in US adults with or without NAFLD and to evaluate their association. METHODS The study was conducted based on data collected from the U.S. National Health and Nutrition Examination Survey (NHANES) during the period 2005-2014. A total of 13 837 and 6 177 participants aged > 20 years were eligible for conducting the Hepatic Steatosis Index (HSI) and the US Fatty Liver Index (USFLI) analysis, respectively. RESULTS From 2005-2014, a downward trend in femoral neck BMD was observed in subjects with NAFLD aged ≥ 40. After adjustment for potential confounders, an upward shift occurred in the prevalence of osteopenia/osteoporosis at the femoral neck in adults aged ≥ 40, particularly in women ≥ 60 years old and men below the age of 60. Moreover, a negative association was found between BMD and NAFLD markers (USFLI, HSI), whereas NAFLD with advanced fibrosis was positively associated with the prevalence of spine fractures. CONCLUSIONS There was a trend toward lower BMD and higher prevalence of osteopenia/osteoporosis at the femoral neck in US adults with NAFLD aged ≥ 40 years during the period of 2005-2014. NAFLD with advanced fibrosis was positively associated with a higher risk of spine fracture. More research is required to fully investigate the mechanism and consequence of poor bone health in NAFLD patients and consider optimum management of osteopenia/osteoporosis for this population.
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Affiliation(s)
- Tianyu Zhai
- Department of Endocrinology and Metabolism, Zhongshan Hospital, and Fudan Institute for Metabolic Diseases, Fudan University, Shanghai, China
| | - Qi Chen
- Department of Endocrinology and Metabolism, Zhongshan Hospital, and Fudan Institute for Metabolic Diseases, Fudan University, Shanghai, China
| | - Jing Xu
- Department of Endocrinology and Metabolism, Zhongshan Hospital, and Fudan Institute for Metabolic Diseases, Fudan University, Shanghai, China
| | - Xi Jia
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Pu Xia
- Department of Endocrinology and Metabolism, Zhongshan Hospital, and Fudan Institute for Metabolic Diseases, Fudan University, Shanghai, China
- *Correspondence: Pu Xia,
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Zemel BS, Wasserman H, Kelly A, Fan B, Shepherd J, Lappe J, Gilsanz V, Oberfield S, Winer KK, Kalkwarf HJ. Intermachine differences in DXA measurements vary by skeletal site, and impact the assessment of low bone density in children. Bone 2020; 141:115581. [PMID: 32795677 PMCID: PMC7680379 DOI: 10.1016/j.bone.2020.115581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Bone mineral content (BMC) and areal-bone mineral density (aBMD) measurements of the lumbar spine (LS) and whole body less head (WBLH) by dual energy X-ray absorptiometry (DXA) are recommended for bone health assessment in children. Intermachine differences were not considered previously in formulating these recommendations. METHODOLOGY DXA measurements of the LS, WBLH, total hip, femoral neck and distal 1/3 radius from the Bone Mineral Density in Childhood Study were examined. Healthy children, ages 6 to 16 years, from five clinical centers participated. The same spine, whole body, and femur phantoms were measured on each Center's DXA machine. Percentage of individuals with low BMC or aBMD (Z-score < -1.5) was determined. Clinical center differences were evaluated by analysis of covariance adjusting for height and BMI Z-score, calcium intake, physical activity, Tanner stage and bone age. Logistic regression assessed odds of low BMC or aBMD across clinical centers. RESULTS Significant differences among Clinical Centers (p < 0.05) were evident in adjusted mean BMC and aBMD Z-scores (n = 1503) for all skeletal sites. WBLH BMC and aBMD Z-scores had the greatest range across centers (-0.13 to 0.24, and -0.17 to 0.56, respectively). The percentage of children with Z-scores less than -1.5 varied among Clinical Centers from 1.9 [95%CI 0.8, 4.5] to 8.1 [95%CI 5.7, 11.3] for WBLH BMC, 1.1 [95%CI 0.4, 3.5] to 6.3 [95%CI 3.8, 10.1] for WBLH aBMD, and from 4.4 [95%CI 2.8, 7.0] to 12.6 [95%CI 9.3, 16.9] for distal 1/3 radius aBMD. For each skeletal site except total hip aBMD and femoral neck BMC, at least one center had significantly lower odds of low bone density. CONCLUSIONS By design, our reference ranges capture intermachine variability. Most clinical centers don't know where their machine falls within the range of intermachine variability, and this may affect diagnosis of children evaluated for conditions that threaten bone health. Total hip scans showed the least, and whole body scans showed the most intermachine variability. Pediatric bone health assessment recommendations should recognize intermachine differences and address this important issue.
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Affiliation(s)
- Babette S Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, United States of America; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America.
| | - Halley Wasserman
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, United States of America
| | - Andrea Kelly
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America; Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, United States of America
| | - Bo Fan
- Department of Radiology, University of California San Francisco, San Francisco, United States of America
| | - John Shepherd
- University of Hawaii Cancer Center, University of Hawaii (Manoa), United States of America
| | - Joan Lappe
- Division of Endocrinology, Department of Medicine, Creighton University, Omaha, United States of America
| | - Vicente Gilsanz
- Departments of Orthopaedic Surgery and Radiology, Children's Hospital Los Angeles, Los Angeles, CA, United States of America
| | - Sharon Oberfield
- Division of Pediatric Endocrinology, Diabetes, and Metabolism, Department of Pediatrics, Columbia University Medical Center, New York, United States of America
| | - Karen K Winer
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, United States of America
| | - Heidi J Kalkwarf
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, United States of America; Department of Pediatrics, University of Cincinnati College of Medicine, United States of America
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Ho-Pham LT, Doan MC, Van LH, Nguyen TV. Development of a model for identification of individuals with high risk of osteoporosis. Arch Osteoporos 2020; 15:111. [PMID: 32699999 DOI: 10.1007/s11657-020-00788-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/07/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED Many developing countries, including Vietnam, lack DXA resources for the diagnosis of osteoporosis, which poses difficulties in the treatment and prevention of osteoporosis at the individual level. We have developed and validated a prediction model for individualized assessment of osteoporosis based on age and body weight for men and women. PURPOSE To estimate the prevalence of osteoporosis and to develop and validate a prediction model for estimating the absolute risk of osteoporosis in the Vietnamese population. METHODS The study involved 1477 women and 669 men aged 50 years and older, who were recruited from the general population in Ho Chi Minh City (Vietnam). Bone mineral density (BMD) at the femoral neck, total hip, and lumbar spine was measured by DXA (Hologic Horizon). The diagnosis of osteoporosis was based on BMD T-score (T-score ≤ - 2.5) at the femoral neck or lumbar spine which was derived from a published reference range for the Vietnamese population. The logistic regression model was used to develop the prediction model for men and women separately. The bootstrap method was used to evaluate the model performance using 3 indices: the area under the receiver's operating characteristic curve (AUC), Brier score, and R-squared values. RESULTS The prevalence of osteoporosis at any site was 28.3% in women and 15.5% in men. The best predictors of osteoporosis risk were age and body weight. Using these indices, a cut-off of 0.195 for women yielded an AUC of 0.825, Brier score = 0.112, and it explained 33.8% of total variance in risk of osteoporosis between individuals. Similarly, in men, the internal validation with a cut-off of 0.09 yielded good accuracy, with AUC = 0.858, Brier score = 0.040, and R-squared = 30.3%. CONCLUSION We have developed and validated a prediction model for individualized assessment of osteoporosis. In settings without DXA, this model can serve as a useful screening tool to identify high-risk individuals for DXA scan.
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Affiliation(s)
- Lan T Ho-Pham
- Bone and Muscle Research Group, Ton Duc Thang University, No. 19 Nguyen Huu Tho Street, Tan Phong Ward, District 7, Ho Chi Minh City, 700000, Vietnam. .,Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
| | - Minh C Doan
- Bone and Muscle Research Group, Ton Duc Thang University, No. 19 Nguyen Huu Tho Street, Tan Phong Ward, District 7, Ho Chi Minh City, 700000, Vietnam.,Department of Internal Medicine, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Long H Van
- Bone and Muscle Research Group, Ton Duc Thang University, No. 19 Nguyen Huu Tho Street, Tan Phong Ward, District 7, Ho Chi Minh City, 700000, Vietnam.,Faculty of Applied Sciences, Ton Duc Thang University, Ho Chi Minh City, Vietnam
| | - Tuan V Nguyen
- Bone and Muscle Research Group, Ton Duc Thang University, No. 19 Nguyen Huu Tho Street, Tan Phong Ward, District 7, Ho Chi Minh City, 700000, Vietnam.,School of Biomedical Engineering, University of Technology Sydney, Ultimo, Australia.,Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
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Colicino E, Pedretti NF, Busgang SA, Gennings C. Per- and poly-fluoroalkyl substances and bone mineral density: Results from the Bayesian weighted quantile sum regression. Environ Epidemiol 2020; 4:e092. [PMID: 32613152 PMCID: PMC7289141 DOI: 10.1097/ee9.0000000000000092] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/04/2020] [Indexed: 01/09/2023] Open
Abstract
Per- and poly-fluoroalkyl substances (PFAS) are chemicals, detected in 95% of Americans, that induce osteotoxicity and modulate hormones, thereby influencing bone health. Previous studies found associations between individual PFAS and bone mineral density in adults but did not analyze their combined effects. OBJECTIVE To extend weighted quantile sum (WQS) regression to a Bayesian framework (Bayesian extension of the WQS regression [BWQS]) and determine the association between a mixture of serum PFAS and mineral density in lumbar spine, total, and neck femur in 499 adults from the 2013 to 2014 National Health and Nutrition Examination Survey (NHANES). METHODS We used BWQS to assess the combined association of eight PFAS, as a mixture, with bone mineral density in adults. As secondary analyses, we focused on vulnerable populations (men over 50 years and postmenopausal women). Analyses were adjusted for sociodemographic factors. Sensitivity analyses included bone mineral density associations with individual compounds and results from WQS regressions. RESULTS The mean age was 55 years old (SD = 1) with average spine, total, and neck femur mineral densities of 1.01 (SD = 0.01), 0.95 (SD = 0.01), and 0.78 (SD = 0.01) gm/cm2, respectively. PFAS mixture levels showed no evidence of association with mineral density (spine: β = -0.004; 95% credible interval [CrI] = -0.04, 0.04; total femur: β = 0.002; 95% CrI = -0.04, 0.05; femur neck: β = 0.005; 95%CrI = -0.03, 0.04) in the overall population. Results were also null in vulnerable populations. Findings were consistent across sensitivity analyses. CONCLUSIONS We introduced a Bayesian extension of WQS and found no evidence of the association between PFAS mixture and bone mineral density.
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Affiliation(s)
- Elena Colicino
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicolo Foppa Pedretti
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Stefanie A. Busgang
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chris Gennings
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York
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42
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Juan A, Frontera G, Cacheda AP, Ros I, Narváez J, Marí B, Nolla JM. Epidemiology of osteoporosis and its determinants in physically active Majorcan elderly. Mediterr J Rheumatol 2020; 31:42-49. [PMID: 32411932 PMCID: PMC7219640 DOI: 10.31138/mjr.31.1.42] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objective: To estimate the prevalence and distribution of determinants of osteoporosis (OP) in a population of physically active Majorcans over 60. Methods: Health survey in which consecutive women and men above 60 years old visiting sports facilities during a two-month period were recruited. All underwent a densitometry of the lumbar spine (LS) and femoral neck (FN). Osteoporosis was defined according to the World Health Organization densitometric criteria (T-score <2.5 SD in the LS or FN, and osteopenia if the result was between −2.5 and −1 SD). As osteoporosis shows substantial differences between genders, the study of its determinants was conducted independently for men and women. Results: The sample included 731 subjects (86% female), with an average age of 70 (SD 5) among men and 65 (8) among women. The overall prevalence of osteoporosis was 35.7% in the LS, 8.9% in the FN and 39.4% in the LS and/or FN. The analysis by gender showed a higher prevalence of osteoporosis in women than in men (43.8 % vs. 11.1%). The presence of osteoporosis increased with age in men and women (7.8% for 61–75 years old vs 22.7% > 75 years old for men and 48.5% for 61–75 years old vs 62.7% > 75 for women). Conclusions: Densitometric osteoporosis is frequent among physically active elderly population, and higher than expected in a largely sunlight-exposed area.
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Affiliation(s)
- Antonio Juan
- Servicio de Reumatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Guillem Frontera
- Unidad de Investigación, Hospital Universitari de Son Espases, Palma de Mallorca, Spain
| | - Ana Paula Cacheda
- Servicio de Reumatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Inmaculada Ros
- Servicio de Reumatología, Hospital Universitari Son Llàtzer, Palma de Mallorca, Spain
| | - Javier Narváez
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,IDIBELL, L'Hospitalet de Llobregat, Spain
| | | | - Joan Miquel Nolla
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,IDIBELL, L'Hospitalet de Llobregat, Spain
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Duan P, Zhang J, Chen J, Liu Z, Guo P, Li X, Li L, Zhang Q. Oolong tea drinking boosts calcaneus bone mineral density in postmenopausal women: a population-based study in southern China. Arch Osteoporos 2020; 15:49. [PMID: 32189157 DOI: 10.1007/s11657-020-00723-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 02/28/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Observational studies have shown that tea consumption has a potentially beneficial effect on bone health. However, few studies have assessed the effects of types of tea consumed on bone health. We aimed to investigate whether drinking oolong tea is associated with increased calcaneus bone mineral density (BMD) in postmenopausal women. METHODS From an epidemiological survey in Shantou, 476 postmenopausal women aged 40 to 88 years were enrolled in the study. All women were questioned about their demographic features, lifestyle, health status, types of tea consumed, habit of tea consumption, and habitual dietary intake by use of a structured questionnaire. Estimated areal BMD was measured by calcaneal quantitative ultrasound (QUS). RESULTS As compared with non-tea drinkers, oolong tea drinkers had higher calcaneus BMD (β 34.70 [95% CI 10.38, 59.03]). In addition, calcaneus BMD was significantly increased for those drinking 1-5 cups/day (β 27.43 [95% CI 3.70, 51.16]) but not > 5 cups/day. We observed no linear increase in calcaneus BMD with increasing years of tea consumption and local polynomial regression fitting showed a parabola-shaped association between years of tea consumption and calcaneus BMD. However, symptoms of osteoporosis did not differ by types of tea consumed. CONCLUSION Long-term moderate oolong tea consumption may have beneficial effects on bone health in postmenopausal women in Shantou of southern China.
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Affiliation(s)
- Pengfei Duan
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Jiahong Zhang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Jialian Chen
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Zhixi Liu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Xiaolian Li
- Department of Orthopedics, the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Linfen Li
- Institution of Drug Clinical Trial, the Second Affiliated Hospital of Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Qingying Zhang
- Department of Preventive Medicine, Shantou University Medical College, Shantou, 515041, Guangdong, China.
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou, 515041, China.
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Levitt DE, Yeh AY, Prendergast MJ, Budnar, Jr. RG, Adler KA, Cook G, Molina PE, Simon L. Chronic Alcohol Dysregulates Skeletal Muscle Myogenic Gene Expression after Hind Limb Immobilization in Female Rats. Biomolecules 2020; 10:E441. [PMID: 32178412 PMCID: PMC7175129 DOI: 10.3390/biom10030441] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/07/2020] [Accepted: 03/10/2020] [Indexed: 12/20/2022] Open
Abstract
Alcohol use and aging are risk factors for falls requiring immobilization and leading to skeletal muscle atrophy. Skeletal muscle regeneration is integral to post-immobilization recovery. This study aimed to elucidate the effects of alcohol and ovarian hormone loss on the expression of genes implicated in muscle regeneration. Three-month-old female rats received an ovariectomy or a sham surgery, consumed an alcohol-containing or control diet for 10 weeks, were subjected to unilateral hind limb immobilization for seven days, and finally were allowed a three (3d)- or 14 (14d)-day recovery. Immobilization decreased the quadriceps weight at 3d and 14d, and alcohol decreased the quadriceps weight at 14d in the nonimmobilized hind limb (NI). At 3d, alcohol decreased gene expression of myoblast determination protein (MyoD) in the immobilized hind limb (IMM) and myocyte enhancer factor (Mef)2C and tumor necrosis factor (TNF)α in NI, and ovariectomy increased MyoD and decreased TNFα expression in NI. At 14d, alcohol increased the gene expression of Mef2C, MyoD, TNFα, and transforming growth factor (TFG)β in IMM and decreased monocyte chemoattractant protein (MCP)1 expression in NI; ovariectomy increased TNFα expression in NI, and alcohol and ovariectomy together increased Mef2C expression in NI. Despite increased TGFβ expression, there was no concomitant alcohol-mediated increase in collagen in IMM at 14d. Overall, these data indicate that alcohol dysregulated the post-immobilization alteration in the expression of genes implicated in regeneration. Whether alcohol-mediated molecular changes correspond with post-immobilization functional alterations remains to be determined.
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Affiliation(s)
| | | | | | | | | | | | | | - Liz Simon
- Department of Physiology, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA; (D.E.L.); (A.Y.Y.); (M.J.P.); (R.G.B.J.); (K.A.A.); (G.C.); (P.E.M.)
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45
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Determinants of vitamin D supplementation among older adults and its effect on 25(OH)D levels according to bone mineral density status. NUTR HOSP 2020; 37:28-36. [PMID: 31960687 DOI: 10.20960/nh.02917] [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] [Indexed: 11/02/2022] Open
Abstract
Introduction Background: although supplementation with vitamin D has been reported as a main determinant of 25-hydroxyvitamin D status [25(OH)D] levels, there are limited data in regard to the factors associated with vitamin D supplementation in older adults. Aims: to examine the characteristics of participants associated with vitamin D supplement use and its effect on 25(OH)D concentrations according to bone mineral density (BMD). Methods: the present analysis was based on data from participants aged 60 years and older in the National Health and Nutrition Examination Survey. Logistic regression models were created to examine the demographic, lifestyle, and health characteristics associated with vitamin D supplementation. Moreover, general linear models were assembled to assess the effect of vitamin D supplement doses on 25(OH)D concentrations according to BMD status. Results: of 5,204 participants, 45.3% reported taking vitamin D supplements, at least 400 IU per day. Overall, women, non-Hispanic whites, college education, former smokers, physical activity, and > 2 comorbidities were variables significantly associated with increased odds of taking vitamin D supplements. Notably, among subjects with osteoporosis, those taking vitamin D supplements between 400 and 800 IU per day had on average 20.7 nmol/L higher 25(OH)D concentrations compared with their non-user counterparts. Conclusions: demographic and healthy lifestyle characteristics are the main determinants of vitamin D supplement use among older adults. Moreover, even among subjects with low bone mass, vitamin D supplements between 400 and 800 IU per day are adequate to reach sufficient 25(OH)D concentrations.
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46
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Oh HJ, Yoon BH, Ha YC, Suh DC, Lee SM, Koo KH, Lee YK. The change of bone mineral density and bone metabolism after gastrectomy for gastric cancer: a meta-analysis. Osteoporos Int 2020; 31:267-275. [PMID: 31776636 DOI: 10.1007/s00198-019-05220-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 11/01/2019] [Indexed: 12/24/2022]
Abstract
UNLABELLED Bone mineral density (BMD) is significantly decreased after gastrectomy in patients with gastric cancer. Calcium malabsorption, secondary hyperparathyroidism, and dominant bone resorption appear to contribute to bone loss in these patients. Patients should undergo early surveillance and nutritional or pharmacologic intensive interventions for bone health. PURPOSE Survivorship care, including bone health, has become an important issue in gastric cancer. We performed a meta-analysis of the available observational studies to determine whether and how osteoporosis risk is increased after gastrectomy in patients with gastric cancer. METHODS A total of 1204 patients (802 men) from 19 cohort studies were included. We evaluated the prevalence of osteoporosis in postgastrectomy patients, comparing the incidence according to the type of gastrectomy and sex. Additionally, we evaluated changes in bone mineral density (BMD) and bone metabolism-related markers pre- to postoperatively and between patients who underwent gastrectomy and matched controls. Proportion meta-analysis was performed and pooled odds ratios (ORs) were calculated. RESULTS The pooled incidence estimate was 36% [95% confidence interval (CI), 32-40]. The incidence of osteoporosis was significantly higher in women than in men (OR = 1.90, p < 0.001) but was similar between partial and total gastrectomy groups (OR = 0.983, p = 0.939). BMD was significantly decreased, and calcium, phosphorous, and parathyroid hormone levels were significantly increased in patients after gastrectomy compared to those before gastrectomy. BMD and calcium and 25OH-vitamin D levels were significantly decreased, and parathyroid hormone and 1,25OH-vitamin D levels were significantly increased in the gastrectomy group compared to that in the control group. CONCLUSION We found that BMD is significantly decreased after gastrectomy in patients with gastric cancer. Vitamin D deficiency and secondary hyperparathyroidism are suggested to be common mechanism underlying BMD impairment. After resection, patients should undergo long-term nutritional and bone health surveillance, in addition to their oncological follow-up.
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Affiliation(s)
- H J Oh
- Division of Gastroenterology, Department of Internal Medicine, Center for Cancer Prevention and Detection, National Cancer Center, Goyang-si, Republic of Korea
| | - B-H Yoon
- Department of Orthopaedic Surgery, Inje University College of Medicine, Seoul Paik Hospital, Seoul, Republic of Korea
| | - Y-C Ha
- Department of Orthopaedic Surgery, College of Medicine, Chung-Ang University, Seoul, Republic of Korea
| | - D-C Suh
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - S-M Lee
- College of Pharmacy, Daegu Catholic University , 13-13 Hayang-ro, Hayang-eup, Gyeongsan-si,Gyeongbuk, 38430, Republic of Korea.
| | - K-H Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Republic of Korea
- Department of Orthopedic Surgery, Seoul National University College of Medicine, 166 Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Republic of Korea
| | - Y-K Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, 463-707, Republic of Korea.
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Kralick AE, Zemel BS. Evolutionary Perspectives on the Developing Skeleton and Implications for Lifelong Health. Front Endocrinol (Lausanne) 2020; 11:99. [PMID: 32194504 PMCID: PMC7064470 DOI: 10.3389/fendo.2020.00099] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis is a significant cause of morbidity and mortality in contemporary populations. This common disease of aging results from a state of bone fragility that occurs with low bone mass and loss of bone quality. Osteoporosis is thought to have origins in childhood. During growth and development, there are rapid gains in bone dimensions, mass, and strength. Peak bone mass is attained in young adulthood, well after the cessation of linear growth, and is a major determinant of osteoporosis later in life. Here we discuss the evolutionary implications of osteoporosis as a disease with developmental origins that is shaped by the interaction among genes, behavior, health status, and the environment during the attainment of peak bone mass. Studies of contemporary populations show that growth, body composition, sexual maturation, physical activity, nutritional status, and dietary intake are determinants of childhood bone accretion, and provide context for interpreting bone strength and osteoporosis in skeletal populations. Studies of skeletal populations demonstrate the role of subsistence strategies, social context, and occupation in the development of skeletal strength. Comparisons of contemporary living populations and archeological skeletal populations suggest declines in bone density and strength that have been occurring since the Pleistocene. Aspects of western lifestyles carry implications for optimal peak bone mass attainment and lifelong skeletal health, from increased longevity to circumstances during development such as obesity and sedentism. In light of these considerations, osteoporosis is a disease of contemporary human evolution and evolutionary perspectives provide a key lens for interpreting the changing global patterns of osteoporosis in human health.
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Affiliation(s)
- Alexandra E. Kralick
- Department of Anthropology, University of Pennsylvania, Philadelphia, PA, United States
| | - Babette S. Zemel
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- *Correspondence: Babette S. Zemel
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48
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Lee EJ, Huang CC, Tai SH, Lai CH. Comparison of an intravertebral reduction device and percutaneous vertebroplasty for anatomical reduction with single-level vertebral compression fractures. FORMOSAN JOURNAL OF SURGERY 2020. [DOI: 10.4103/fjs.fjs_5_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wu Q, Xu Y, Lin G. Trends and Disparities in Self-Reported and Measured Osteoporosis among US Adults, 2007-2014. J Clin Med 2019; 8:jcm8122052. [PMID: 31766617 PMCID: PMC6947633 DOI: 10.3390/jcm8122052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 11/25/2022] Open
Abstract
(1) Background: Studies examining osteoporosis trends among US adults by different socioeconomic status (SES) are limited. The prevalence of self-reported osteoporosis in the US is rarely reported. (2) Methods: Data from the National Health and Nutritional Examination Survey (NHANES) between 2007–2008 and 2013–2014 cycles were analyzed. Age-adjusted prevalence of self-reported and that of measured osteoporosis were calculated overall and by sex, race/ethnicity, education attainment, and SES. (3) Results: The prevalence of self-reported osteoporosis was higher than that of measured osteoporosis in all three survey cycles for women, and in 2007–2008 and 2009–2010 for men. Participants with high school/GED or higher educational attainment had an increased prevalence of measured osteoporosis during the study period. Among all SES groups, participants with low family income (PIR < 1.3) had the highest prevalence of measured osteoporosis, and the prevalence increased from 49.3 per 1000 population to 71.8 per 1000 population during the study period. (4) Conclusions: The prevalence of self-reported osteoporosis was higher than that of measured osteoporosis in US adults between 2007 and 2014. The age-adjusted prevalence of measured osteoporosis increased in participants with the educational attainment of high school/GED or above, and individuals with low family income.
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Affiliation(s)
- Qing Wu
- Nevada Institute of Personalized Medicine, University of Nevada, Las Vegas, NV 89154, USA;
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA;
- Correspondence: ; Tel.: +1-702-895-1439
| | - Yingke Xu
- Nevada Institute of Personalized Medicine, University of Nevada, Las Vegas, NV 89154, USA;
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA;
| | - Ge Lin
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89154, USA;
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50
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Madimenos FC, Liebert MA, Cepon‐Robins TJ, Urlacher SS, Josh Snodgrass J, Sugiyama LS, Stieglitz J. Disparities in bone density across contemporary Amazonian forager‐horticulturalists: Cross‐population comparison of the Tsimane and Shuar. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 171:50-64. [DOI: 10.1002/ajpa.23949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/26/2019] [Accepted: 10/07/2019] [Indexed: 01/12/2023]
Affiliation(s)
- Felicia C. Madimenos
- Department of Anthropology Queens College (CUNY) Flushing New York
- New York Consortium on Evolutionary Primatology (NYCEP) New York New York
| | - Melissa A. Liebert
- Department of Anthropology Northern Arizona University Flagstaff Arizona
| | | | | | | | - Lawrence S. Sugiyama
- Department of Anthropology University of Oregon Eugene
- Institute of Cognitive and Decision Sciences University of Oregon Eugene Oregon
| | - Jonathan Stieglitz
- Université Toulouse 1 Capitole Toulouse France
- Institute for Advanced Study in Toulouse Toulouse France
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