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Pan Y, Deng L. Generalized case-cohort and inference for Cox’s model with parameter constraints. COMMUN STAT-SIMUL C 2022. [DOI: 10.1080/03610918.2020.1714661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Yingli Pan
- Hubei Key Laboratory of Applied Mathematics, Faculty of Mathematics and Statistics, Hubei University, Wuhan, China
| | - Lifeng Deng
- College of Mathematics and Systems Science, Shandong University of Science and Technology, Qingdao, Shandong, China
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Abstract
Osteoporosis is becoming an increasingly important public health issue, and effective treatments to prevent fragility fractures are available. Osteoporosis imaging is of critical importance in identifying individuals at risk for fractures who would require pharmacotherapy to reduce fracture risk and also in monitoring response to treatment. Dual x-ray absorptiometry is currently the state-of-the-art technique to measure bone mineral density and to diagnose osteoporosis according to the World Health Organization guidelines. Motivated by a 2000 National Institutes of Health consensus conference, substantial research efforts have focused on assessing bone quality by using advanced imaging techniques. Among these techniques aimed at better characterizing fracture risk and treatment effects, high-resolution peripheral quantitative computed tomography (CT) currently plays a central role, and a large number of recent studies have used this technique to study trabecular and cortical bone architecture. Other techniques to analyze bone quality include multidetector CT, magnetic resonance imaging, and quantitative ultrasonography. In addition to quantitative imaging techniques measuring bone density and quality, imaging needs to be used to diagnose prevalent osteoporotic fractures, such as spine fractures on chest radiographs and sagittal multidetector CT reconstructions. Radiologists need to be sensitized to the fact that the presence of fragility fractures will alter patient care, and these fractures need to be described in the report. This review article covers state-of-the-art imaging techniques to measure bone mineral density, describes novel techniques to study bone quality, and focuses on how standard imaging techniques should be used to diagnose prevalent osteoporotic fractures.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA 94143, USA.
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3
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Abstract
Osteoporosis is becoming an increasingly important public health issue, and effective treatments to prevent fragility fractures are available. Osteoporosis imaging is of critical importance in identifying individuals at risk for fractures who would require pharmacotherapy to reduce fracture risk and also in monitoring response to treatment. Dual x-ray absorptiometry is currently the state-of-the-art technique to measure bone mineral density and to diagnose osteoporosis according to the World Health Organization guidelines. Motivated by a 2000 National Institutes of Health consensus conference, substantial research efforts have focused on assessing bone quality by using advanced imaging techniques. Among these techniques aimed at better characterizing fracture risk and treatment effects, high-resolution peripheral quantitative computed tomography (CT) currently plays a central role, and a large number of recent studies have used this technique to study trabecular and cortical bone architecture. Other techniques to analyze bone quality include multidetector CT, magnetic resonance imaging, and quantitative ultrasonography. In addition to quantitative imaging techniques measuring bone density and quality, imaging needs to be used to diagnose prevalent osteoporotic fractures, such as spine fractures on chest radiographs and sagittal multidetector CT reconstructions. Radiologists need to be sensitized to the fact that the presence of fragility fractures will alter patient care, and these fractures need to be described in the report. This review article covers state-of-the-art imaging techniques to measure bone mineral density, describes novel techniques to study bone quality, and focuses on how standard imaging techniques should be used to diagnose prevalent osteoporotic fractures.
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Affiliation(s)
- Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA 94143, USA.
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Ji GR, Yao M, Sun CY, Li ZH, Han Z. BsmI, TaqI, ApaI and FokI polymorphisms in the vitamin D receptor (VDR) gene and risk of fracture in Caucasians: a meta-analysis. Bone 2010; 47:681-6. [PMID: 20601302 DOI: 10.1016/j.bone.2010.06.024] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Revised: 06/19/2010] [Accepted: 06/21/2010] [Indexed: 11/26/2022]
Abstract
CONTEXT Vitamin D receptor (VDR) gene polymorphisms have been strongly associated with bone mineral density in some studies. However, in a recent meta-analysis, no relationship of the VDR BsmI or TaqI polymorphism and fracture risk was found in the meta-analysis of published data. OBJECTIVE AND DESIGN Our meta-analysis studied whether a relationship exists between BsmI, TaqI, ApaI and FokI polymorphisms in the VDR gene and risk of fracture. DATA SOURCES Relevant studies were identified from the following electronic databases: MEDLINE, EMBASE and Current Contents before January 2010. DATA SYNTHESIS This meta-analysis included 17 studies with a total of 21 eligible comparisons, which included 2112 fracture cases and 4521 controls. All of these studies reported on Caucasians. The combined results based on all studies showed that fracture cases had a significantly lower frequency of bb genotype of BsmI [odds ratio (OR) = 0.87, 95% confidence interval (CI)=0.76, 0.98]. When stratifying by fracture type, we found that (1) hip fracture cases had a significantly lower frequency of bb genotype of BsmI (OR=0.82, 95% CI=0.70, 0.97); (2) hip fracture cases had a significantly lower frequency of Tt genotype of TaqI (OR=0.65, 95% CI=0.43, 0.97); (3) hip fracture cases had a significantly higher frequency of tt genotype of TaqI (OR=1.74, 95% CI=1.05, 2.91); (4) vertebral fracture cases had a significantly higher frequency of Aa genotype of ApaI (OR=1.63, 95% CI=1.03, 2.59). No significant difference was found in any genotype of FokI. CONCLUSION Our meta-analysis suggests that there is a modest but statistically significant association between the BsmI bb genotypes and fracture.
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Affiliation(s)
- Guang-Rong Ji
- Department of Orthopedic, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, Heilongjiang Province, China.
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Tranah GJ, Taylor BC, Lui LY, Zmuda JM, Cauley JA, Ensrud KE, Hillier TA, Hochberg MC, Li J, Rhees BK, Erlich HA, Sternlicht MD, Peltz G, Cummings SR. Genetic variation in candidate osteoporosis genes, bone mineral density, and fracture risk: the study of osteoporotic fractures. Calcif Tissue Int 2008; 83:155-66. [PMID: 18787887 PMCID: PMC2699257 DOI: 10.1007/s00223-008-9165-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 07/19/2008] [Indexed: 10/21/2022]
Abstract
Candidate osteoporosis gene variants were examined for associations with fracture risk and bone mineral density (BMD). A total of 9,704 white women were recruited at four U.S. clinical centers and enrolled into the Study of Osteoporotic Fractures, a longitudinal cohort study. Genotyping of 31 polymorphisms from 18 candidate osteoporosis genes was performed in 6,752 women. Incident radiographic fractures were identified at the third and eighth examinations compared with the baseline examination. BMD was measured at the total hip by dual-energy X-ray absorptiometry. Analyses were adjusted for age, clinic site, and self-reported ethnicity. During a mean follow-up of 14.5 years, a total of 849 hip, 658 vertebral, and 2,496 nonhip/nonvertebral fractures occurred in 6,752 women. Women carrying the ALOX15_G48924T T/T genotype had a higher rate of hip fracture (hazard ratio [HR] = 1.33;95% confidence interval [95% CI] = 1.00-1.77) compared with the G/G genotype. Compared with those carrying the PRL_T228C T/T genotype, women with either the C/C (HR = 0.80; 95% CI = 0.67-0.95) or C/T (HR = 0.81; 95% CI = 0.68-0.97) genotype had a lower rate of nonvertebral/nonhip fractures. Women carrying the BMP2_A125611G G/G genotype had a higher rate of vertebral fracture (odds ratio [OR] = 1.51; 95% CI = 1.03-2.23) compared with the A/A genotype. Women with the ESR1_C1335G G/G genotype had a higher rate of vertebral fracture (OR = 1.64; 95% CI = 1.07-2.50) compared with the C/C genotype. Compared with those with the MMP2_C595T C/C genotype, women with the C/T (OR = 0.79; 95% CI = 0.65-0.96) or T/T (OR = 0.44; 95% CI = 0.27-0.72) genotype had a lower rate of vertebral fracture. In conclusion, polymorphisms in several candidate genes were associated with hip, vertebral, and nonhip/nonvertebral fractures but not with total hip BMD in this large population based cohort study.
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Affiliation(s)
- Gregory J. Tranah
- CPMC Research Institute, San Francisco, CA 94120, USA e-mail:
- California Pacific Medical Center Research Institute, San Francisco Coordinating Center UCSF, 185 Berry Street, Lobby 4, Suite 5700, San Francisco, CA 94107-1728, USA
| | - Brent C. Taylor
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Li-Yung Lui
- CPMC Research Institute, San Francisco, CA 94120, USA e-mail:
| | - Joseph M. Zmuda
- Department of Epidemiology, University of Pittsburgh, Pittsburg, PA 15261, USA
| | - Jane A. Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburg, PA 15261, USA
| | - Kristine E. Ensrud
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN 55455, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA
| | - Teresa A. Hillier
- Kaiser Permanente Center for Health Research Northwest/Hawaii, Portland, OR 97227, USA
| | - Marc C. Hochberg
- Department of Medicine and Epidemiology and Preventative Medicine, University of Maryland School of Medicine University, Baltimore, MD 21201, USA
| | - Jia Li
- Department of Human Genetics, Roche Molecular Systems, Alameda, CA 94501-1145, USA
| | - Brian K. Rhees
- Department of Human Genetics, Roche Molecular Systems, Alameda, CA 94501-1145, USA
| | - Henry A. Erlich
- Department of Human Genetics, Roche Molecular Systems, Alameda, CA 94501-1145, USA
| | - Mark D. Sternlicht
- Department of Anatomy, University of California, San Francisco, CA 94107, USA
| | - Gary Peltz
- Department of Genetics and Genomics, Roche Palo Alto, Palo Alto, CA 94304, USA
| | - Steven R. Cummings
- CPMC Research Institute, San Francisco, CA 94120, USA e-mail:
- Department of Epidemiology, University of California, San Francisco, CA 94107, USA
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Lei SF, Jiang H, Deng FY, Deng HW. Searching for genes underlying susceptibility to osteoporotic fracture: current progress and future prospect. Osteoporos Int 2007; 18:1157-75. [PMID: 17534537 DOI: 10.1007/s00198-007-0402-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2006] [Accepted: 04/11/2007] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Osteoporotic fracture (OF) is a public health problem. It is a common practice in the genetics of osteoporosis that bone mineral density (BMD) was studied as a major surrogate phenotype in gene search for risk of OF (ROF) because of their high phenotypic correlation. However, some studies indicate that the genetic correlation between BMD and ROF is very low. This implies that most genes found important for BMD may not be relevant to ROF. Ideally, employing OF per se as a direct study phenotype can directly find the relevant genes underlying ROF. EVIDENCE Here, we summarized some evidence supporting ROF under moderate genetic control, and the current progress of molecular genetic studies employing OF as the direct study phenotype, then give our consideration on the future prospects in the genetics of ROF.
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Affiliation(s)
- S-F Lei
- Laboratory of Molecular and Statistical Genetics, College of Life Sciences, Hunan Normal University, Changsha, Hunan, 410081, People's Republic of China
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Moffett SP, Zmuda JM, Cauley JA, Ensrud KE, Hillier TA, Hochberg MC, Li J, Cayabyab S, Lee JM, Peltz G, Cummings SR. Association of the VDR translation start site polymorphism and fracture risk in older women. J Bone Miner Res 2007; 22:730-6. [PMID: 17280526 DOI: 10.1359/jbmr.070201] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED We evaluated the association between the VDR translation start site polymorphism and osteoporotic phenotypes among 6698 older white women. Women with the C/C genotype had lower wrist BMD and an increased risk of wrist and all non-spine/low-trauma fractures. The high frequency of this variant confers a population attributable risk that is similar to several established risk factors for fracture. INTRODUCTION The vitamin D receptor (VDR) is a nuclear receptor that regulates bone formation, bone resorption, and calcium homeostasis. A common C to T polymorphism in exon 2 of the VDR gene introduces a new translation start site and a protein that differs in length by three amino acids (T = 427aa, C = 424aa; rs10735810). MATERIALS AND METHODS We conducted genetic association analyses of this polymorphism, BMD, and fracture outcomes in a prospective cohort of 6698 white American women >or=65 years of age. Incident fractures were confirmed by physician adjudication of radiology reports. There were 2532 incident nontraumatic/nonvertebral fractures during 13.6 yr of follow-up including 509 wrist and 703 hip fractures. RESULTS Women with the C/C genotype had somewhat lower distal radius BMD compared with those with the T/T genotype (CC=0.358 g/cm(2), CT=0.361 g/cm(2), TT=0.369 g/cm(2), p=0.003). The C/C genotype was also associated with increased risk of non-spine, low traumatic fractures (HR: 1.18; 95% CI: 1.04, 1.33) and wrist fractures (HR: 1.33; 95% CI: 1.01, 1.75) compared with the T/T genotype in age-adjusted models. Further adjustments for distal radius BMD only slightly attenuated these associations. The VDR polymorphism was not associated with hip fracture. The population attributable risk (PAR) of the C/C genotype for incident fractures was 6.1%. The PAR for established risk factors for fracture were: low femoral neck BMD (PAR=16.3%), maternal history of fracture (PAR=5.1%), low body weight (PAR=5.3%), corticosteroid use (PAR=1.3%), and smoking (PAR=1.6%). Similar PAR results were observed for wrist fractures. CONCLUSIONS The common and potentially functional VDR translation start site polymorphism confers a modestly increased relative risk of fracture among older white women. However, the high frequency of this variant confers a population attributable risk that is similar to or greater than several established risk factors for fracture.
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Affiliation(s)
- Susan P Moffett
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA.
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8
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Briggs AM, Greig AM, Wark JD. The vertebral fracture cascade in osteoporosis: a review of aetiopathogenesis. Osteoporos Int 2007; 18:575-84. [PMID: 17206492 DOI: 10.1007/s00198-006-0304-x] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2006] [Accepted: 11/28/2006] [Indexed: 10/23/2022]
Abstract
Once an initial vertebral fracture is sustained, the risk of subsequent vertebral fracture increases significantly. This phenomenon has been termed the "vertebral fracture cascade". Mechanisms underlying this fracture cascade are inadequately understood, creating uncertainty in the clinical environment regarding prevention of further fractures. The cascade cannot be explained by low bone mass alone, suggesting that factors independent of this parameter contribute to its aetiopathogenesis. This review explores physiologic properties that may help to explain the vertebral fracture cascade. Differences in bone properties, including bone mineral density and bone quality, between individuals with and those without osteoporotic vertebral fractures are discussed. Evidence suggests that non-bone parameters differ between individuals with and those without osteoporotic vertebral fractures. Spinal properties, including vertebral macroarchitecture, intervertebral disc integrity, spinal curvature and spinal loading are compared in these groups of individuals. Cross-sectional studies also indicate that neurophysiologic properties, particularly trunk control and balance, are affected by the presence of a vertebral fracture. This review provides a synthesis of the literature to highlight the multi-factorial aetiopathogenesis of the vertebral fracture cascade. With a more comprehensive understanding of the mechanisms underlying this clinical problem, more effective preventative strategies may be developed to offset the fracture cascade.
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Affiliation(s)
- A M Briggs
- Centre for Health, Exercise and Sports Medicine, School of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia.
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9
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Abstract
Over the past 10 years, many advances have been made in understanding the mechanisms by which genetic factors regulate susceptibility to osteoporosis. It has become clear from studies in man and experimental animals that different genes regulate BMD at different skeletal sites and in men and women. Linkage studies have identified several chromosomal regions that regulate BMD, but only a few causative genes have been discovered so far using this approach. In contrast, significant advances have been made in identifying the genes that cause monogenic bone diseases, and polymorphic variation is some of these genes has been found to contribute to the genetic regulation of BMD in the normal population. Other genes that have been investigated as possible candidates for susceptibility to osteoporosis because of their role in bone biology, such as vitamin D, have yielded mixed results. Many candidate gene association studies have been underpowered, and meta-analysis has been used to try to confirm or refute potential associations and gain a better estimate of their true effect size in the population. Most of the genetic variants that confer susceptibility to osteoporosis remain to be discovered. It is likely that new techniques such as whole-genome association will provide new insights into the genetic determinants of osteoporosis and will help to identify genes of modest effect size. From a clinical standpoint, genetic variants that are found to predispose to osteoporosis will advance our understanding of the pathophysiology of the disease. They could be developed as diagnostic genetic tests or form molecular targets for design of new drugs for the prevention and treatment of osteoporosis and other bone diseases.
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Affiliation(s)
- Omar M E Albagha
- Rheumatology Section, Molecular Medicine Centre, University of Edinburgh School of Molecular and Clinical Medicine, Western General Hospital, Edinburgh, EH4 2XU, United Kingdom.
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Abstract
There is compelling evidence to suggest that both the development of bone to peak bone mass at maturity and subsequent loss depend on the interaction between genetic, hormonal, environmental and nutritional factors. The major part (≤80%) of the age-specific variation in bone turnover and bone density is genetically determined. However, the notion of genetic determinant is of little value unless the specific genes that are involved can be identified. Most work in this area of osteoporosis research has focused on the candidate gene approach, which has identified several candidate genes for osteoporosis, including genes encoding the vitamin D receptor (VDR), oestrogen receptors (α and β), apolipoprotein E, collagen type I α 1 and methylenetetrahydrofolate reductase, amongst many others. However, in general, findings from numerous studies of the association between such genes and various bone variables have been inconsistent. In addition to possible gene—gene interactions it is likely that there are interactions between these genes and certain environmental factors, especially nutrition, that may mediate expression of bone-related phenotypes. While these potential interactions add a level of complexity to our understanding of these apparent genetic effects on bone, identification of a role for genetic factors without knowledge of their interaction with nutrients can do little to advance prevention and treatment of osteoporosis. This information is especially important because, unlike genotype, diet and nutrition can be modified. The aim of the present review is to critically evaluate current knowledge relating to candidate genes for osteoporosis, with particular emphasis on their interaction with nutrients and dietary factors in determining bone health.
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Affiliation(s)
- Siobhán Cusack
- Department of Food and Nutritional Sciences, University College, Cork, Republic of Ireland
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11
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Ferrari S. Single gene mutations and variations affecting bone turnover and strength: a selective 2006 update. ACTA ACUST UNITED AC 2006. [DOI: 10.1138/20060240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Fang Y, Rivadeneira F, van Meurs JBJ, Pols HAP, Ioannidis JPA, Uitterlinden AG. Vitamin D receptor gene BsmI and TaqI polymorphisms and fracture risk: a meta-analysis. Bone 2006; 39:938-45. [PMID: 16769262 DOI: 10.1016/j.bone.2006.04.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Revised: 04/12/2006] [Accepted: 04/13/2006] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Fracture is the major clinical outcome of osteoporosis. The vitamin D receptor (VDR) gene is thought to be a candidate gene for osteoporosis. Many genetic studies have suggested an association of VDR polymorphisms and osteoporosis, but evidence remains conflicting. MATERIALS AND METHODS We searched published studies from 1996 to September 2005 through PubMed and evaluated the genetic effect of the BsmI and TaqI polymorphism of VDR on fracture risk in a meta-analysis. Thirteen studies with a total of 20 eligible comparisons (1632 fracture cases and 5203 controls) were analyzed with fixed and random effects models. RESULT No evidence of relationship between the VDR BsmI or TaqI polymorphism and fracture risk was observed with any genetic model. The odds ratio (95% confidence interval) of b-allele versus B-allele was 0.98 (0.86-1.12) with random effects calculations. There was significant between-study heterogeneity. Small studies did not differ significantly from larger ones. CONCLUSION No relationship of the VDR BsmI or TaqI polymorphism and fracture risk was found in the meta-analysis of published data.
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Affiliation(s)
- Yue Fang
- Department of Internal Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
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13
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Abstract
Osteoporosis is a serious public health issue. The past 10 years have seen great advances in our understanding of its epidemiology, pathophysiology, and treatment, and further advances are rapidly being made. Clinical assessment will probably evolve from decisions mainly being made on the basis of bone densitometry, to use of algorithms of absolute fracture risk. Biochemical markers of bone turnover are also likely to become more widely used. Bisphosphonates will probably remain the mainstay of therapy, but improved understanding of the optimum amount of remodelling suppression and duration of therapy will be important. At the same time, other diagnostic and therapeutic approaches, including biological agents, are likely to become more widespread.
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Affiliation(s)
- Philip Sambrook
- Institute of Bone and Joint Research, University of Sydney, Sydney 2065, NSW, Australia.
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14
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Wengreen H, Cutler DR, Munger R, Willing M. Vitamin D receptor genotype and risk of osteoporotic hip fracture in elderly women of Utah: an effect modified by parity. Osteoporos Int 2006; 17:1146-53. [PMID: 16758135 DOI: 10.1007/s00198-006-0100-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 02/28/2006] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The associations between vitamin D receptor (VDR) Bsm I and Fok I genotypes, parity, and risk of osteoporotic hip fracture were evaluated in a statewide population-based case-control study in Utah. METHODS Women age 50-89 years with hip fracture (n=882) were ascertained via surveillance of 18 Utah hospitals from 1997 to 2001. Age-matched controls were randomly selected (n=897). Participants were interviewed in their homes, and blood samples were collected for genotyping. RESULTS In logistic regression analyses that controlled for multiple confounders, Bsm I VDR genotype but not Fok I genotype was associated with risk of osteoporotic hip fracture (OR bb vs. BB genotype: 0.68; 95% CI: 0.50, 0.95). In similar analyses, no overall association was observed between parity status and risk of osteoporotic hip fracture. However, the effect of VDR genotype was modified by parity status. Among nulliparous women (n=140), Bsm I genotype was not associated with risk of hip fracture (OR bb vs. BB: 0.82; 95% CI: 0.28, 2.4); among primiparous women (n=133), bb genotype was associated with increased risk of hip fracture (OR bb vs. BB: 3.30; 95% CI: 0.96, 11.29); among multiparous women (n=1,400), bb genotype was associated with decreased risk of hip fracture (OR bb vs. BB: 0.59; 95% CI: 0.42, 0.84). CONCLUSION VDR Bsm I genotype was associated with risk of hip fracture in Utah women, and this effect was modified by parity status. Hormonal or lifestyle factors related to parity may underlie this interaction.
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Affiliation(s)
- H Wengreen
- Department of Nutrition and Food Sciences, Utah State University, Logan, 84322, USA.
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15
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Hongsdusit N, von Mühlen D, Barrett-Connor E. A comparison between peripheral BMD and central BMD measurements in the prediction of spine fractures in men. Osteoporos Int 2006; 17:872-7. [PMID: 16525761 DOI: 10.1007/s00198-005-0061-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2005] [Accepted: 12/21/2005] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Most of the research on osteoporosis has been conducted on women. Few studies have compared central and peripheral densitometry and their association with vertebral fractures in men. The present study was designed to compare peripheral bone mineral density (BMD) measurements with central BMD measurements, and to examine their association with radiographic spine fracture in men. METHODS We studied 402 community-dwelling men aged 45-92 years (mean: 70 years) from the Rancho Bernardo Study cohort who attended a clinic visit between 1988 and 1992 when BMD measurements of the midshaft radius, ultradistal wrist, lumbar spine, and total hip were obtained, and who returned for lateral X-rays of the thoracic and lumbar spine an average of 4 years later. Logistic regression, T-scores, and quintiles were used to analyze BMD and its association with vertebral fractures. RESULTS The prevalence of osteoporosis defined by the National Osteoporosis Foundation criteria (for women) was 14.2% at the spine and 13% at the hip. Because there are no validated definitions of osteoporosis based on the ability to predict fracture risk for peripheral densitometry, the frequency of overlap by bone site was calculated among men in the lowest quintile of each site. Of the 402 men, 82 men (20.3%) had at least two sites with BMD measurements in the lowest quintile. After an average of 4 years, 33 (8.2%) men had at least one radiographic vertebral fracture, and ten (2.5%) men had at least two vertebral fractures. Low BMD at the spine (with and without covariate adjustment) was associated with having one or more vertebral fractures, whether using NOF T-score-defined osteoporosis [Odds ratio (OR): 3.81; confidence interval (CI): 1.52, 9.57] or the lowest quintile versus all others (OR: 2.53; CI: 1.03, 6.19). After age and/or other covariate adjustments, neither BMD at the total hip nor at the peripheral sites was associated with spine fractures using either NOF women-based criteria or male quintiles from this cohort. CONCLUSION Although different men had osteoporosis defined by quintiles at different sites, only low BMD at the spine was associated with vertebral fracture.
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Affiliation(s)
- N Hongsdusit
- School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA
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16
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Abstract
The prevalence of osteoporosis is raising worldwide as improving conditions of living and treatment of other common diseases continuously increases life expectancy. Thus, osteoporosis affects most women above 80 years of age and, at the age of 50, the lifetime risk of suffering an osteoporosis-related fracture approaches 50% in women and 20% in men. Numerous genetic, hormonal, nutritional and life-style factors contribute to the acquisition and maintenance of bone mass. Among them, genetic variations explain as much as 70% of the variance for bone mineral density (BMD) in the population. Dozens of quantitative trait loci (QTLs) for BMD have been identified by genome screening and linkage approaches in humans and mice, and more than 100 candidate gene polymorphisms tested for association with BMD and/or fracture. Sequence variants in the vitamin D receptor (VDR), collagen 1 alpha 1 chain (Col1A1), estrogen receptor alpha (ESR1), interleukin-6 (IL-6) and LDL receptor-related protein 5 (LRP5) genes were all found to be significantly associated with differences in BMD and/or fracture risk in multiple replication studies. Moreover, some genes, such as VDR and IL-6, were shown to interact with non-genetic factors, i.e. calcium intake and estrogens, to modulate BMD. Since these gene variants have also been associated with other complex disorders, including cancer and coronary heart disease, they may represent common genetic susceptibility factors exerting pleiotropic effects during the aging process.
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Affiliation(s)
- Serge L Ferrari
- Service of Bone Diseases, WHO Collaborating Center for Osteoporosis Prevention, Department of Rehabilitation and Geriatrics, Geneva University Hospital, Switzerland.
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17
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Nordström A, Gerdhem P, Brändström H, Stiger F, Lerner UH, Lorentzon M, Obrant K, Nordström P, Akesson K. Interleukin-6 promoter polymorphism is associated with bone quality assessed by calcaneus ultrasound and previous fractures in a cohort of 75-year-old women. Osteoporos Int 2004; 15:820-6. [PMID: 14997289 DOI: 10.1007/s00198-004-1610-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2003] [Accepted: 02/02/2004] [Indexed: 10/26/2022]
Abstract
Interleukin 6 (IL-6) is a multifunctional cytokine and a potent stimulator of bone resorption and has been implicated in the pathogenesis of osteoporosis in postmenopausal women. The aim of this study was to investigate if a functional IL-6 promoter polymorphism (-174) was related to bone mass and fractures in a cohort consisting of 964 postmenopausal Caucasian women aged 75 years. Bone mineral density (BMD; g/cm2) of the femoral neck, lumbar spine and total body was measured using dual energy X-ray absorptiometry (DXA). Quantitative ultrasound (QUS) was also measured in the calcaneus and quantified as speed of sound (SOS; m/s), broadband ultrasound attenuation (BUA; dB/MHz), and stiffness index (SI). IL-6 genotypes was determined by restriction fragment length polymorphism (RFLP) using the restriction enzyme NlaIII. The frequencies of the different IL-6 genotypes were 27.5% (GG), 47.9% (GC), 24.6% (CC). The IL-6 polymorphism (presence of G) was independently related to a lower stiffness (beta=-0.07; P=0.03) and BUA (beta=-0.08; P=0.02), but not to BMD at any site measured by DXA. In the cohort, 420 subjects (44%) reported at least one fracture during their lifetime, and 349 (36%) reported at least one fracture after the age of 50. Using binary logistic regression, the IL-6 polymorphism (presence of G) was significantly related to an increased risk of a previous fracture during life (odds ratio 1.46, 95% CI 1.08-1.97) and to an increased risk of a fracture occurring after 50 years of age (odds ratio 1.37, 95% CI 1.004-1.88). The risk was further increased for fractures grouped as osteoporotic fractures (odds ratio 1.67, 95% CI 1.14-2.45), including forearm fractures (odds ratio 1.59, 95% CI 1.05-2.40). In conclusion, presence of G allele in the IL-6 promoter polymorphism at position -174 is independently related to previous fractures in postmenopausal women. This association may be related primarily to an altered bone quality identified by QUS and not a lower bone mass. This is also the first demonstration of association of IL-6 gene polymorphism to calcaneal QUS.
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Affiliation(s)
- Anna Nordström
- Sports Medicine, Department of Surgical and Perioperative Sciences, Umeå University Hospital, 901 85, Umeå, Sweden.
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18
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Kulich M, Lin DY. Improving the Efficiency of Relative-Risk Estimation in Case-Cohort Studies. J Am Stat Assoc 2004. [DOI: 10.1198/016214504000000584] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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19
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Abstract
Osteoporosis has a strong genetic component, and clinical studies have shown that heritable factors play a key role in regulating bone mineral density, ultrasound properties of bone, skeletal geometry, and bone turnover and contribute to the pathogenesis of osteoporotic fracture. In most cases, osteoporosis is caused by the combined effects of several different genes and their interaction with environmental influences, but it can occasionally occur as the result of mutations in a single gene. Genes that have been implicated in the regulation of bone mass in humans include the genes encoding lipoprotein receptor-related protein 5, sclerostin, transforming growth factor beta-1, collagen Ialpha1, vitamin D receptor, tumor necrosis factor receptor 2, and the estrogen receptor alpha. From a clinical standpoint, advances in knowledge about the genetic basis of osteoporosis are important because they offer the prospect of developing genetic markers for the assessment of fracture risk and the opportunity to identify molecules that will be used as targets for the design of new drugs for the prevention and treatment of bone disease.
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Affiliation(s)
- Omar M E Albagha
- Department of Medicine and Therapeutics, University of Aberdeen Medical School, Aberdeen AB25 2ZD, UK.
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20
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Tabor HK, Risch NJ, Myers RM. Candidate-gene approaches for studying complex genetic traits: practical considerations. Nat Rev Genet 2002; 3:391-7. [PMID: 11988764 DOI: 10.1038/nrg796] [Citation(s) in RCA: 637] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Association studies with candidate genes have been widely used for the study of complex diseases. However, this approach has been criticized because of non-replication of results and limits on its ability to include all possible causative genes and polymorphisms. These challenges have led to pessimism about the candidate-gene approach and about the genetic analysis of complex diseases in general. We believe that these criticisms can be usefully countered with an appeal to the principles of epidemiological investigation.
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Affiliation(s)
- Holly K Tabor
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California 94305-5120, USA
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21
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Deng HW, Mahaney MC, Williams JT, Li J, Conway T, Davies KM, Li JL, Deng H, Recker RR. Relevance of the genes for bone mass variation to susceptibility to osteoporotic fractures and its implications to gene search for complex human diseases. Genet Epidemiol 2002; 22:12-25. [PMID: 11754470 DOI: 10.1002/gepi.1040] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We investigate the relevance of the genetic determination of bone mineral density (BMD) variation to that of differential risk to osteoporotic fractures (OF). The high heritability (h(2)) of BMD and the significant phenotypic correlations between high BMD and low risk to OF are well known. Little is reported on h(2) for OF. Extensive molecular genetic studies aimed at uncovering genes for differential risks to OF have focussed on BMD as a surrogate phenotype. However, the relevance of the genetic determination of BMD to that of OF is unknown. This relevance can be characterized by genetic correlation between BMD and OF. For 50 Caucasian pedigrees, we estimated that h(2) at the hip is 0.65 (P < 0.0001) for BMD and 0.53 (P < 0.05) for OF; however, the genetic correlation between BMD and OF is nonsignificant (P > 0.45) and less than 1% of additive genetic variance is shared between them. Hence, most genes found important for BMD may not be relevant to OF at the hip. The phenotypic correlation between high BMD and low risk to OF at the hip (approximately -0.30) is largely due to an environmental correlation (rho(E) = -0.73, P < 0.0001). The search for genes for OF should start with a significant h(2) for OF and should include risk factors (besides BMD) that are genetically correlated with OF. All genes found important for various risk factors must be tested for their relevance to OF. Ideally, employing OF per se as a direct phenotype for gene hunting and testing can ensure the importance and direct relevance of the genes found for the risk of OF. This study may have significant implications for the common practice of gene search for complex diseases through underlying risk factors (usually quantitative traits).
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Affiliation(s)
- Hong-Wen Deng
- Osteoporosis Research Center, Creighton University, 601 N. 30th St. Suite 6787, Omaha, NE 68131, USA.
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22
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Abstract
A genetic component clearly contributes to bone mass determination by influencing peak bone mass acquisition or, to a lesser degree, bone loss later in life. The analysis of genetic markers for osteoporosis is complex because multiple genes are involved and because osteoporosis is a multifactorial disease. The influence of a number of candidate gene alleles on bone mass has been studied in various populations. Results have been inconsistent and, at times, contradictory, as illustrated by studies on the vitamin D receptor gene. The most conclusive finding is the association linking the Sp1 polymorphism of type I collagen to bone mineral density and osteoporotic fractures. Polymorphisms of other genes either have very little influence or remain unexplored. In all likelihood, the best predictive value will be obtained by using a combination of several gene polymorphisms.
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Affiliation(s)
- S Roux
- Rheumatology Department, CHU de Bicêtre, Le Kremlin-Bicetre, France
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23
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Abstract
This article investigates: (1) the criteria used to select cohorts of patients for study when seeking genetic causes of "osteoporosis;" (2) the possibilities, genetic and otherwise, that might cause or help to cause this disorder; and (3) how one should define this disorder and bone health. Patients selected for such a study because current World Health Organization (WHO) absorptiometric criteria diagnosed them with "osteoporosis," or because they had extremity bone fractures, could possibly include people with biologically different disorders, in addition to those with healthy or diseased bones. Seeking a common genetic cause of "osteoporosis" in such inhomogeneous cohorts may be like seeking a common genetic cause of "anemia" in a cohort that contained iron deficiency and pernicious anemias, thalassemia, sickle-cell disease, anemias due to blood loss, malnutrition, malaria, metastatic disease, etc. The Utah paradigm's insights suggest how to select more homogeneous cohorts for such studies. This would require defining bone health in a way that acknowledges the main purpose of load-bearing bones, which the WHO criteria do not do. The present understanding of bone physiology indicates that many biologic mechanisms and features could cause or help to cause an osteopenia or osteoporosis. This study identifies 30 such mechanisms, some osseous and some extraosseous, and even this number seems conservative. Because each such mechanism could depend on any number of genes, when a strong genetic association with some kind of osteopenia or osteoporosis is found it could be difficult to determine which mechanism(s) it perturbed. This article summarizes the evidence and ideas on which these suggestions depend.
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Affiliation(s)
- H M Frost
- Department of Orthopedic Surgery, Southern Colorado Clinic, Pueblo, CO 81008-9000, USA
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24
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Abstract
Assume mythical physiologists were taught that renal physiology and its disorders depend on "kidney cells" and their regulation by nonmechanical factors, but were taught nothing about nephrons. For decades they "knew" that idea was correct, just as Ptolemy "knew" the universe centers on our planet. But then others began to describe nephrons, their roles in renal physiology and disorders, and problems they revealed in former views, so doubts and controversies began. Today real physiologists encounter a similar situation for bone health and its disorders. A 1960 paradigm attributed such things to bone's effector cells (osteoblasts and osteoclasts) and their regulation by nonmechanical factors, without "nephron-equivalent" or biomechanical input. But both mechanical and nonmechanical factors regulate bone's nephron equivalents. Adding features of those equivalents to the 1960 views led to the Utah paradigm, which suggests problems in former views and better explanations for "osteoporosis," whole-bone strength, and other bone disorders. Such things incited controversies among current skeletal physiologists. Cybernetics concerns the relationships, mechanisms, signals, and message traffic that help to control the behavior and other features of dynamic systems. A cybernetic analysis of the bone physiology in the Utah paradigm can add many features to the 1960 paradigm that help to understand osteoporoses, other bone disorders, and whole-bone strength (and bone mass). The added features also show new and pertinent targets for the related research.
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Affiliation(s)
- H M Frost
- Department of Orthopaedic Surgery, Southern Colorado Clinic, Pueblo 81008-9000, USA
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25
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Abstract
The present review addresses the relative contribution of diet and genotype to variability in human bone growth and mineralisation in the context of the aetiology of osteoporosis. Heritability studies indicate that 60-70 % of the variability in bone mineral mass or bone mineral density (BMD) can be accounted for by genetic variation. Cross-trait analyses suggest that a proportion of this variation reflects genetic influences on bone and body size, such as height and lean body mass. Candidate-gene studies have demonstrated associations between several genetic polymorphisms and bone mineral mass but, as yet, genotype determinations have proved unhelpful in identifying individuals at increased risk of osteoporosis. Variations in diet and other environmental factors contribute 30-40 % to total phenotypic variance in bone mineral mass or BMD. Correlations between intakes of individual nutrients and BMD have been reported, but these relationships are subject to confounding due to size. However, no specific dietary factor has been identified from prospective and twin studies as making a significant contribution to environmental variability in BMD or bone loss. This finding may reflect the difficulties in quantifying environmental exposures. both current and over a lifetime. In addition, the influence of diet on bone health may depend on the genotype of the individual. Optimisation of nutrition and lifestyle remains an attractive strategy for the reduction of fracture risk, but more research is required to fully define optimal dietary requirements.
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Affiliation(s)
- A Prentice
- MRC Human Nutrition Research, Cambridge, UK.
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26
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Abstract
As the population ages, preventive gerontology has been advocated to promote good personal health practices for a healthier longevity. While detection and management of high blood pressure, elevated serum glycemic and cholesterol levels, have been routine in the care of older persons, approaches to osteoporosis identification and management are more complex and less widely practiced. This article reviews aspects of osteoporosis detection and intervention in this patient population, with recommendations for meeting the needs of 'bone health' in an aging society.
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Affiliation(s)
- D Hamerman
- Department of Medicine and Resnick Gerontology Center, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, 10467, Bronx, NY, USA
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28
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Abstract
Osteoporosis is a major public health problem that affects the entire aging population. This report provides an update on the epidemiology of osteoporosis and its associated fractures. Published studies from 1997 to the present are highlighted. The current US prevalence estimates for osteoporosis, trends in fracture incidence rates, and latest reports on the morbidity, mortality, and costs attributable to osteoporotic fractures are discussed. Recent advances in our understanding of risk factors associated with osteoporosis and related fractures are reviewed. Special attention is paid to the rapid progress being made in the field of genetics, the growing importance of nutrition, and the new questions being raised as to the influence of hormonal factors on bone mineral density and fracture risk. New studies linking osteoporosis to several other important diseases in women including breast cancer, osteoarthritis, and stroke are also reviewed.
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Affiliation(s)
- R L Wolf
- University of Pittsburgh, Graduate School of Public Health, Department of Epidemiology, 130 DeSoto Street, Pittsburgh, PA 15261, USA. rlwst9+@pitt.edu
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29
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Affiliation(s)
- G S Cooper
- Epidemiology Branch, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
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