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Li L, Shen Y, Tan LH, Zhang H, Dai RC, Yuan LQ, Sheng ZF, Wu XY. Association of osteoporotic fractures of femoral neck and femoral neck geometric parameters in native Chinese women. BMC Musculoskelet Disord 2024; 25:349. [PMID: 38702706 PMCID: PMC11067106 DOI: 10.1186/s12891-024-07483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Although it is generally believed that the femoral neck fracture is related to the femoral neck geometric parameters (FNGPs), the association between the risk of osteoporotic fracture of the femoral neck and FNGPs in native Chinese women is still unclear. METHODS A total of 374 female patients (mean age 70.2 ± 9.32 years) with osteoporotic fracture of the femoral neck, and 374 non-fracture control groups were completely matched with the case group according to the age ratio of 1:1. Using DXA bone densitometer to measured eight FNGPs: the outer diameter (OD), cross-sectional area (CSA), cortical thickness (CT), endocortical diameter (ED), buckling ratio (BR), section modulus (SM), cross-sectional moment of inertia (CSMI), and compressive strength index (CSI) at the narrowest point of the femoral neck. RESULTS Compared with the control group, the average values of OD (2.9%), ED (4.5%), and BR (26.1%) in the patient group significantly increased (p = 0.015 to < 0.001), while CSA (‒15.3%), CT (‒18.2%), SM (‒10.3%), CSMI (‒6.4%), and CSI (‒10.8%) significantly decreased (all p < 0.001). The prevalence of osteoporosis in the lumbar spine, femoral neck, and total hip was, respectively, 82%, 81%, and 65% in fracture patients. Cox proportional hazard model analysis showed that in the age adjusted model, the fracture hazard ratio (HR) of CSA, CT, BR, SM, and CSI significantly increased (HRs = 1.60‒8.33; 95% CI = 1.08‒16.6; all p < 0.001). In the model adjusted for age and femoral neck BMD, HRs of CT (HRs = 3.90‒8.03; 95% CI = 2.45‒15.1; all p < 0.001) and BR (HRs = 1.62‒2.60; 95% CI = 1.20‒5.44; all p < 0.001) were still significantly increased. CONCLUSION These results suggest that the majority of osteoporotic fractures of the femoral neck of native Chinese women occur in patients with osteoporosis. CT thinning or BR increase of FNGPs may be independent predictors of fragility fracture of femoral neck in native Chinese women unrelated to BMD.
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Affiliation(s)
- Lin Li
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China
- Department of Endocrinology and Metabolism, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yi Shen
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Li-Hua Tan
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Hong Zhang
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China
| | - Ru-Chun Dai
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China
| | - Ling-Qing Yuan
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China
| | - Zhi-Feng Sheng
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China
| | - Xi-Yu Wu
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, Department of Metabolism and Endocrinology, The Second Xiangya, Hospital of Central South University, Changsha, 410011, China.
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Jepsen KJ, Bigelow EMR, Goulet RW, Nolan BT, Casden MA, Kennedy K, Hertz S, Kadur C, Clines GA, Leis AM, Karvonen-Gutierrez CA, Bredbenner TL. Structural differences contributing to sex-specific associations between FN BMD and whole-bone strength for adult White women and men. JBMR Plus 2024; 8:ziae013. [PMID: 38523663 PMCID: PMC10958990 DOI: 10.1093/jbmrpl/ziae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 03/26/2024] Open
Abstract
Hip areal BMD (aBMD) is widely used to identify individuals with increased fracture risk. Low aBMD indicates low strength, but this association differs by sex with men showing greater strength for a given aBMD than women. To better understand the structural basis giving rise to this sex-specific discrepancy, cadaveric proximal femurs from White female and male donors were imaged using nano-CT and loaded in a sideways fall configuration to assess strength. FN pseudoDXA images were generated to identify associations among structure, aBMD, and strength that differ by sex. Strength correlated significantly with pseudoDXA aBMD for females (R2 = 0.468, P < .001) and males (R2 = 0.393, P < .001), but the elevations (y-intercepts) of the linear regressions differed between sexes (P < .001). Male proximal femurs were 1045 N stronger than females for a given pseudoDXA aBMD. However, strength correlated with pseudoDXA BMC for females (R2 = 0.433, P < .001) and males (R2 = 0.443, P < .001) but without significant slope (P = .431) or elevation (P = .058) differences. Dividing pseudoDXA BMC by FN-width, total cross-sectional area, or FN-volume led to significantly different associations between strength and the size-adjusted BMC measures for women and men. Three structural differences were identified that differentially affected aBMD and strength for women and men: First, men had more bone mass per unit volume than women; second, different cross-sectional shapes resulted in larger proportions of bone mass orthogonal to the DXA image for men than women; and third, men and women had different proportions of cortical and trabecular bone relative to BMC. Thus, the proximal femurs of women were not smaller versions of men but were constructed in fundamentally different manners. Dividing BMC by a bone size measure was responsible for the sex-specific associations between hip aBMD and strength. Thus, a new approach for adjusting measures of bone mass for bone size and stature is warranted.
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Affiliation(s)
- Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Erin M R Bigelow
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Robert W Goulet
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Bonnie T Nolan
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Michael A Casden
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Kathryn Kennedy
- Biomedical Engineering, Marquette University, Milwaukee, WI 53201 United States
| | - Samantha Hertz
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Chandan Kadur
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
- Biomedical Laboratory R&D, VA Medical Center, Ann Arbor, MI 48105 United States
| | - Gregory A Clines
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | - Aleda M Leis
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI 48109 United States
| | | | - Todd L Bredbenner
- Department of Mechanical and Aerospace Engineering, University of Colorado Colorado Springs, Colorado Springs, CO 80918 United States
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Jepsen KJ, Bigelow EMR, Casden MA, Goulet RW, Kennedy K, Hertz S, Kadur C, Nolan BT, Richards‐McCullough K, Merillat S, Karvonen‐Gutierrez CA, Clines G, Bredbenner TL. Associations Among Hip Structure, Bone Mineral Density, and Strength Vary With External Bone Size in White Women. JBMR Plus 2023; 7:e10715. [PMID: 36936363 PMCID: PMC10020918 DOI: 10.1002/jbm4.10715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/01/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
Bone mineral density (BMD) is heavily relied upon to reflect structural changes affecting hip strength and fracture risk. Strong correlations between BMD and strength are needed to provide confidence that structural changes are reflected in BMD and, in turn, strength. This study investigated how variation in bone structure gives rise to variation in BMD and strength and tested whether these associations differ with external bone size. Cadaveric proximal femurs (n = 30, White women, 36-89+ years) were imaged using nanocomputed tomography (nano-CT) and loaded in a sideways fall configuration to assess bone strength and brittleness. Bone voxels within the nano-CT images were projected onto a plane to create pseudo dual-energy X-ray absorptiometry (pseudo-DXA) images consistent with a clinical DXA scan. A validation study using 19 samples confirmed pseudo-DXA measures correlated significantly with those measured from a commercially available DXA system, including bone mineral content (BMC) (R 2 = 0.95), area (R 2 = 0.58), and BMD (R 2 = 0.92). BMD-strength associations were conducted using multivariate linear regression analyses with the samples divided into narrow and wide groups by pseudo-DXA area. Nearly 80% of the variation in strength was explained by age, body weight, and pseudo-DXA BMD for the narrow subgroup. Including additional structural or density distribution information in regression models only modestly improved the correlations. In contrast, age, body weight, and pseudo-DXA BMD explained only half of the variation in strength for the wide subgroup. Including bone density distribution or structural details did not improve the correlations, but including post-yield deflection (PYD), a measure of bone material brittleness, did increase the coefficient of determination to more than 70% for the wide subgroup. This outcome suggested material level effects play an important role in the strength of wide femoral necks. Thus, the associations among structure, BMD, and strength differed with external bone size, providing evidence that structure-function relationships may be improved by judiciously sorting study cohorts into subgroups. © 2022 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)
- Karl J Jepsen
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Erin MR Bigelow
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Michael A Casden
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Robert W Goulet
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Kathryn Kennedy
- Department of Biomedical EngineeringMarquette UniversityMilwaukeeWIUSA
| | - Samantha Hertz
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Chandan Kadur
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Bonnie T Nolan
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Kerry Richards‐McCullough
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Steffenie Merillat
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Carrie A Karvonen‐Gutierrez
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
| | - Gregory Clines
- Department of Orthopaedic Surgery (Medical School) and Department of Epidemiology (Public Health)University of MichiganAnn ArborMIUSA
- EndocrinologyVA Medical CenterAnn ArborMIUSA
| | - Todd L Bredbenner
- Department of Mechanical and Aerospace EngineeringUniversity of Colorado Colorado SpringsColorado SpringsCOUSA
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Zhang M, Gong H, Zhang M. Prediction of femoral strength of elderly men based on quantitative computed tomography images using machine learning. J Orthop Res 2023; 41:170-182. [PMID: 35393726 DOI: 10.1002/jor.25334] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 03/07/2022] [Accepted: 03/22/2022] [Indexed: 02/04/2023]
Abstract
Hip fracture is the most common complication of osteoporosis, and its major contributor is compromised femoral strength. This study aimed to develop practical machine learning models based on clinical quantitative computed tomography (QCT) images for predicting proximal femoral strength. Eighty subjects with entire QCT data of the right hip region were randomly selected from the full MrOS cohorts, and their proximal femoral strengths were calculated by QCT-based finite element analysis (QCT/FEA). A total of 50 parameters of each femur were extracted from QCT images as the candidate predictors of femoral strength, including grayscale distribution, regional cortical bone mapping (CBM) measurements, and geometric parameters. These parameters were simplified by using feature selection and dimensionality reduction. Support vector regression (SVR) was used as the machine learning algorithm to develop the prediction models, and the performance of each SVR model was quantified by the mean squared error (MSE), the coefficient of determination (R2 ), the mean bias, and the SD of bias. For feature selection, the best prediction performance of SVR models was achieved by integrating the grayscale value of 30% percentile and specific regional CBM measurements (MSE ≤ 0.016, R2 ≥ 0.93); and for dimensionality reduction, the best prediction performance of SVR models was achieved by extracting principal components with eigenvalues greater than 1.0 (MSE ≤ 0.014, R2 ≥ 0.93). The femoral strengths predicted from the well-trained SVR models were in good agreement with those derived from QCT/FEA. This study provided effective machine learning models for femoral strength prediction, and they may have great potential in clinical bone health assessments.
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Affiliation(s)
- Meng Zhang
- Department of Engineering Mechanics, Nanling Campus, Jilin University, Changchun, China
| | - He Gong
- Department of Engineering Mechanics, Nanling Campus, Jilin University, Changchun, China
| | - Ming Zhang
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Jadzic J, Zagorac S, Djuric M, Djonic D. Hip structure analysis and femoral osteodensitometry in aged postmenopausal women with hip osteoarthritis and femoral neck fracture. INTERNATIONAL ORTHOPAEDICS 2022; 46:2747-2755. [PMID: 36222881 DOI: 10.1007/s00264-022-05602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Osteoarthritis (OA), osteoporosis, and bone fractures are frequent aging-related conditions. Regardless of the growing research interest in the effects of hip OA on femoral fracture risk, data about the region specificity of osteodensitometric and hip structure analysis (HSA) parameters of the proximal femora are lacking in aged postmenopausal women with hip OA compared to individuals with femoral neck fragility fracture. METHODS This study included 76 postmenopausal women admitted for total hip arthroplasty due to non-traumatic femoral neck fracture (FN_Fx group, n = 39) and hip osteoarthritis (OA group, n = 37). RESULTS Osteodensitometric parameters differed significantly between the OA and FN_Fx groups, depicting lower bone mineral density in the FN_Fx group (p < 0.05). The most significant increase in these parameters was registered in the intertrochanteric region of the OA group. Moreover, the OA-induced changes in HSA-derived parameters displayed significant regional heterogeneity, with the intertrochanteric region showing the most notable difference between OA and FN_Fx group. CONCLUSION Our data may indicate that OA displayed the most prominent positive effect on the intertrochanteric femoral region, revealing the regional heterogeneity in structural geometry and biomechanical indices of proximal femora in OA individuals. Since we did not observe significant differences in the femoral neck region, we may speculate that OA does not have a substantial protective effect on the femoral neck fracture risk in aged postmenopausal women.
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Affiliation(s)
- Jelena Jadzic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Dr Subotica no. 4/II, 11000, Belgrade, Serbia
| | - Slavisa Zagorac
- University Clinic for Orthopedic Surgery and Traumatology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Marija Djuric
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Dr Subotica no. 4/II, 11000, Belgrade, Serbia
| | - Danijela Djonic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Dr Subotica no. 4/II, 11000, Belgrade, Serbia.
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Andrew TW, Koepke LS, Wang Y, Lopez M, Steininger H, Struck D, Boyko T, Ambrosi TH, Tong X, Sun Y, Gulati GS, Murphy MP, Marecic O, Telvin R, Schallmoser K, Strunk D, Seita J, Goodman SB, Yang F, Longaker MT, Yang GP, Chan CKF. Sexually dimorphic estrogen sensing in skeletal stem cells controls skeletal regeneration. Nat Commun 2022; 13:6491. [PMID: 36310174 PMCID: PMC9618571 DOI: 10.1038/s41467-022-34063-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 10/05/2022] [Indexed: 12/25/2022] Open
Abstract
Sexually dimorphic tissues are formed by cells that are regulated by sex hormones. While a number of systemic hormones and transcription factors are known to regulate proliferation and differentiation of osteoblasts and osteoclasts, the mechanisms that determine sexually dimorphic differences in bone regeneration are unclear. To explore how sex hormones regulate bone regeneration, we compared bone fracture repair between adult male and female mice. We found that skeletal stem cell (SSC) mediated regeneration in female mice is dependent on estrogen signaling but SSCs from male mice do not exhibit similar estrogen responsiveness. Mechanistically, we found that estrogen acts directly on the SSC lineage in mice and humans by up-regulating multiple skeletogenic pathways and is necessary for the stem cell's ability to self- renew and differentiate. Our results also suggest a clinically applicable strategy to accelerate bone healing using localized estrogen hormone therapy.
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Affiliation(s)
- Tom W. Andrew
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Lauren S. Koepke
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Yuting Wang
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA ,grid.412793.a0000 0004 1799 5032Department of Orthopaedic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Michael Lopez
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Holly Steininger
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Danielle Struck
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Tatiana Boyko
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Thomas H. Ambrosi
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Xinming Tong
- grid.168010.e0000000419368956Department of Bioengineering, Stanford University, Palo Alto, CA 94305 USA
| | - Yuxi Sun
- grid.265892.20000000106344187Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233 USA ,grid.280808.a0000 0004 0419 1326Birmingham VA Medical Center, Birmingham, AL 35233 USA
| | - Gunsagar S. Gulati
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Matthew P. Murphy
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Owen Marecic
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Ruth Telvin
- grid.490568.60000 0004 5997 482XDivision of Plastic and Reconstructive Surgery, Stanford Hospital and Clinics, Palo Alto, CA USA
| | - Katharina Schallmoser
- grid.21604.310000 0004 0523 5263Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Department for Transfusion Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Dirk Strunk
- grid.21604.310000 0004 0523 5263Spinal Cord Injury and Tissue Regeneration Center Salzburg (SCI-TReCS), Department for Transfusion Medicine, Paracelsus Medical University of Salzburg, Salzburg, Austria ,grid.21604.310000 0004 0523 5263Cell Therapy Institute, Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Jun Seita
- grid.7597.c0000000094465255Center for Integrative Medical Sciences and Advanced Data Science Project, RIKEN, Tokyo, Japan
| | - Stuart B. Goodman
- grid.168010.e0000000419368956Department of Orthopedic Surgery, Stanford University, Palo Alto, CA 94305 USA
| | - Fan Yang
- grid.168010.e0000000419368956Department of Bioengineering, Stanford University, Palo Alto, CA 94305 USA ,grid.168010.e0000000419368956Department of Orthopedic Surgery, Stanford University, Palo Alto, CA 94305 USA
| | - Michael T. Longaker
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - George P. Yang
- grid.265892.20000000106344187Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233 USA ,grid.280808.a0000 0004 0419 1326Birmingham VA Medical Center, Birmingham, AL 35233 USA
| | - Charles K. F. Chan
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA 94305 USA
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Triglyceride Glucose-Body Mass Index Is a Reliable Indicator of Bone Mineral Density and Risk of Osteoporotic Fracture in Middle-Aged and Elderly Nondiabetic Chinese Individuals. J Clin Med 2022; 11:jcm11195694. [PMID: 36233562 PMCID: PMC9572437 DOI: 10.3390/jcm11195694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: This study aimed to investigate the relationship of triglyceride glucose−body mass index (TyG-BMI) with bone mineral density (BMD), femoral neck geometry, and risk of fracture in middle-aged and elderly Chinese individuals. (2) Methods: A total of 832 nondiabetic individuals were selected from the prospective population-based HOPE cohort. All individuals underwent DXA for assessment of BMD at the lumbar spine, femoral neck, and total hip, as well as femoral neck geometry. The 10-year probabilities of both major osteoporotic (MOFs) and hip fractures (HFs) were calculated. (3) Results: Cortical thickness, compression strength index, cross-sectional moment of inertia, cross-sectional area, section modulus, and 25(OH)D levels were significantly lower in women (all p < 0.001). The presence of osteoporosis was related to age, BMI, BMD and femoral neck geometry, TyG-BMI, MOF, and HF. TyG-BMI was positively correlated with BMD. In men, TyG-BMI showed significant negative correlation with HF but not with MOF, the correlation exists only after adjusting for other variables in women. Femoral neck geometries were significantly impaired in individuals with low TyG-BMI. (4) Conclusion: TyG-BMI is positively associated with BMD and geometry, and negatively associated with risk of fracture in nondiabetic middle-aged and elderly Chinese men and women.
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Staphylococcus aureus and Acinetobacter sp. inhibit osseointegration of orthopaedic implants. Infect Immun 2022; 90:e0066921. [PMID: 35099267 DOI: 10.1128/iai.00669-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bacterial infections routinely cause inflammation and thereby impair osseointegration of orthopaedic implants. Acinetobacter spp., which causes osteomyelitis following trauma, on or off the battlefield, was however reported to cause neither osteomyelitis nor osteolysis in rodents. We therefore compared the effects of Acinetobacter strain M2 to those of Staphylococcus aureus in a murine implant infection model. Sterile implants and implants with adherent bacteria were inserted in the femur of mice. Bacterial burden, levels of pro-inflammatory cytokines, and osseointegration were measured. All infections were localized to the implant site. Infection with either S. aureus or Acinetobacter strain M2 increased the levels of pro-inflammatory cytokines and the chemokine CCL2 in the surrounding femurs, inhibited bone formation around the implant, and caused loss of the surrounding cortical bone leading to decreases in both histomorphometric and biomechanical measures of osseointegration. Genetic deletion of TLR2 and TLR4 from the mice partially reduced the effects of Acinetobacter strain M2 on osseointegration but did not alter the effects of S. aureus. This is the first report that Acinetobacter spp. impair osseointegration of orthopaedic implants in mice and the murine model developed for this study will be useful for future efforts to clarify the mechanism of implant failure due to Acinetobacter spp. and to assess novel diagnostic tools or therapeutic agents.
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Loundagin LL, Bredbenner TL, Jepsen KJ, Edwards WB. Bringing Mechanical Context to Image-Based Measurements of Bone Integrity. Curr Osteoporos Rep 2021; 19:542-552. [PMID: 34269975 DOI: 10.1007/s11914-021-00700-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW Image-based measurements of bone integrity are used to estimate failure properties and clinical fracture risk. This paper (1) reviews recent imaging studies that have enhanced our understanding of the mechanical pathways to bone fracture and (2) discusses the influence that inter-individual differences in image-based measurements may have on the clinical assessment of fracture risk RECENT FINDINGS: Increased tissue mineralization is associated with improved bone strength but reduced fracture toughness. Trabecular architecture that is important for fatigue resistance is less important for bone strength. The influence of porosity on bone failure properties is heavily dependent on pore location and size. The interaction of various characteristics, such as bone area and mineral content, can further complicate their influence on bone failure properties. What is beneficial for bone strength is not always beneficial for bone toughness or fatigue resistance. Additionally, given the large amount of imaging data that is clinically available, there is a need to develop effective translational strategies to better interpret non-invasive measurements of bone integrity.
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Affiliation(s)
- Lindsay L Loundagin
- Department of Anatomy, Physiology and Pharmacology, University of Saskatchewan, 105 Administration Place, Saskatoon, SK, S7N 5A2, Canada
| | - Todd L Bredbenner
- Department of Mechanical and Aerospace Engineering, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, T2N 1N4, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, HRIC 3A08, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada.
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10
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Li M, Cheng D, Li H, Yao W, Guo D, Wang S, Si J. Tributyltin perturbs femoral cortical architecture and polar moment of inertia in rat. BMC Musculoskelet Disord 2021; 22:427. [PMID: 33962613 PMCID: PMC8106170 DOI: 10.1186/s12891-021-04298-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 04/20/2021] [Indexed: 01/22/2023] Open
Abstract
Background Tributyltin, a well-known endocrine disruptor, is widely used in agriculture and industry. Previous studies have shown that tributyltin could cause deleterious effects on bone health by impairing the adipo-osteogenic balance in bone marrow. Methods To investigate further the effects of tributyltin on bone, weaned male SD rats were treated with tributyltin (0.5, 5 or 50 μg·kg− 1) or corn oil by gavage once every 3 days for 60 days in this study. Then, we analyzed the effects of tributyltin on geometry, the polar moment of inertia, mineral content, relative abundances of mRNA from representative genes related to adipogenesis and osteogenesis, serum calcium ion and inorganic phosphate levels. Results Micro-computed tomography analysis revealed that treatment with 50 μg·kg− 1 tributyltin caused an obvious decrease in femoral cortical cross sectional area, marrow area, periosteal circumference and derived polar moment of inertia in rats. However, other test results showed that exposure to tributyltin resulted in no significant changes in the expression of genes detected, femoral cancellous architecture, ash content, as well as serum calcium ion and inorganic phosphate levels. Conclusions Exposure to a low dose of tributyltin from the prepubertal to adult stage produced adverse effects on skeletal architecture and strength. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04298-2.
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Affiliation(s)
- Mingjun Li
- Department of Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua Xi Lu, Jinan, 250012, Shandong, China
| | - Dong Cheng
- Department of Toxicology, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Hui Li
- Department of Toxicology, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Wenhuan Yao
- Department of Toxicology, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Dongmei Guo
- Department of Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua Xi Lu, Jinan, 250012, Shandong, China
| | - Shu'e Wang
- Department of Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua Xi Lu, Jinan, 250012, Shandong, China
| | - Jiliang Si
- Department of Environmental Health, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhua Xi Lu, Jinan, 250012, Shandong, China.
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11
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van der Loos MA, Hellinga I, Vlot MC, Klink DT, den Heijer M, Wiepjes CM. Development of Hip Bone Geometry During Gender-Affirming Hormone Therapy in Transgender Adolescents Resembles That of the Experienced Gender When Pubertal Suspension Is Started in Early Puberty. J Bone Miner Res 2021; 36:931-941. [PMID: 33507568 PMCID: PMC8247856 DOI: 10.1002/jbmr.4262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 01/02/2023]
Abstract
Bone geometry can be described in terms of periosteal and endocortical growth and is partly determined by sex steroids. Periosteal and endocortical apposition are thought to be regulated by testosterone and estrogen, respectively. Gender-affirming hormone (GAH) treatment with sex steroids in transgender people might affect bone geometry. However, in adult transgender people, no change in bone geometry during GAH was observed. In this study, we investigated changes in bone geometry among transgender adolescents using a gonadotropin-releasing hormone agonist (GnRHa) and GAH before achieving peak bone mass. Transgender adolescents treated with GnRHa and subsequent GAH before the age of 18 years were eligible for inclusion. Participants were grouped based on their Tanner stage at the start of GnRHa treatment and divided into early, mid, and late puberty groups. Hip structure analysis software calculating subperiosteal width (SPW) and endocortical diameter (ED) was applied to dual-energy X-ray absorptiometry scans performed at the start of GnRHa and GAH treatments, and after ≥2 years of GAH treatment. Mixed-model analyses were performed to study differences over time. Data were visually compared with reference values of the general population. A total of 322 participants were included, of whom 106 were trans women and 216 trans men. In both trans women and trans men, participants resembled the reference curve for SPW and ED of the experienced gender but only when GnRHa was started during early puberty. Those who started during mid and late puberty remained within the reference curve of the gender assigned at birth. A possible explanation might be sought in the phenomenon of programming, which conceptualizes that stimuli during critical windows of development can have major consequences throughout one's life span. Therefore, this study adds insights into sex-specific bone geometry development during puberty of transgender adolescents treated with GnRHa, as well as the general population. © 2021 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
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Affiliation(s)
- Maria Atc van der Loos
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ilse Hellinga
- Department of Pediatrics, Zaans Medical Center, Zaandam, the Netherlands
| | - Mariska C Vlot
- Department of Endocrinology, Amsterdam University Medical Center, Amsterdam, the Netherlands.,Department of Internal Medicine, Hospital St Jansdal, Harderwijk/Lelystad, the Netherlands
| | - Daniel T Klink
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium
| | - Martin den Heijer
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Chantal M Wiepjes
- Department of Endocrinology and Center of Expertise on Gender Dysphoria, Amsterdam University Medical Center, Amsterdam, the Netherlands
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12
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Rokidi S, Andrade VFC, Borba V, Shane E, Cohen A, Zwerina J, Paschalis EP, Moreira CA. Bone tissue material composition is compromised in premenopausal women with Type 2 diabetes. Bone 2020; 141:115634. [PMID: 32927103 DOI: 10.1016/j.bone.2020.115634] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Abstract
Type 2 diabetes mellitus (T2DM) patients are at an increased risk of fracture despite normal to high bone mineral density (BMD) values. In this cross-sectional study we establish bone compositional properties in tetracycline labeled iliac crest biopsies from premenopausal women diagnosed with T2DM (N = 26). Within group comparisons were made as a function of tissue age (TA), presence of chronic complications (CC), glycosylated haemoglobin (HbA1c) levels, and morphometric fracture (MFx). We also compared these data at actively trabecular bone forming surfaces against sex- and age-matched healthy controls (N = 32). The bone quality indices determined by Raman microspectroscopic analysis were: mineral/matrix (MM), tissue water content (nanoporosity; NanoP), mineral maturity/crystallinity (MMC), and glycosaminoglycan (GAG), pyridinoline (Pyd), N-(carboxymethyl)lysine (CML), and pentosidine (PEN) content. Within the T2DM group, at the oldest tissue, CML and PEN contents were significantly elevated in the cancellous compared to cortical compartment. The outcomes were not dependent on MFx. On the other hand, both were significantly elevated in patients with CC, as well as those with HbA1c levels > 7%. At actively forming surfaces, the cortical compartment had higher NanoP compared to cancellous. Still within the T2DM group, patients with MFx had significantly elevated MM and GAGs compared to the ones that did not. At actively forming trabecular surfaces, compared to healthy women, T2DM patients had elevated GAGs content and MMC. The results of this study indicate increased AGEs in those with poor glycation control and chronic complications. Additionally, T2DM patients had elevated MMC and decreased GAGs content compared to healthy controls. These alterations may be contributing to the T2DM inherent elevated fracture risk and suggest a role for hyperglycemia on bone quality.
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Affiliation(s)
- Stamatia Rokidi
- Ludwig Boltzmann Institute for Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Vicente F C Andrade
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil
| | - Victoria Borba
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil
| | - Elizabeth Shane
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Adi Cohen
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jochen Zwerina
- Ludwig Boltzmann Institute for Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Eleftherios P Paschalis
- Ludwig Boltzmann Institute for Osteology at the Hanusch Hospital of OEGK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
| | - Carolina A Moreira
- Endocrine Division (SEMPR), Hospital de Clinicas, Federal University of Paraná, Curitiba, Brazil; Lab PRO, Bone Histomorphometry, Pro Renal Foundation, Curitiba, Brazil
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13
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Su Y, Wang L, Liu X, Yang M, Yi C, Liu Y, Huang P, Guo Z, Yu A, Cheng X, Wu X, Blake GM, Engelke K. Lack of periosteal apposition in the head and neck of femur after menopause in Chinese women with high risk for hip fractures - A cross-sectional study with QCT. Bone 2020; 139:115545. [PMID: 32730940 DOI: 10.1016/j.bone.2020.115545] [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: 05/09/2020] [Revised: 07/14/2020] [Accepted: 07/17/2020] [Indexed: 11/24/2022]
Abstract
In elderly subjects and in particular in those with osteoporosis the evidence on age related volume changes of the hip is still very limited. Even less is known about bone changes of the femoral head. The aim of this study is to explore associations of bone size of the femoral head and neck with age in postmenopausal women with very high risk of hip fracture and to investigate associations of femoral head and neck bone mineral density. MIAF (medical image analysis framework)-Femur was used for the analysis of CT datasets from 319 females with acute hip fractures age 50 to 98. Integral BMD and volume of the head and neck were assessed. The femoral head was divided into four quadrants to address differential vBMD and volume responses of its superior, inferior, posterior and anterior parts. Areal BMD (aBMD) of femoral neck was also obtained. In this population of postmenopausal women we did not observe age-related changes in bone volume of the femoral head or neck between ages 50 and 98 years. Integral vBMD in the head in the 90-98 year group was 48.0 mg/cm3 lower than that in 50-59 year group, which accounts for nearly 30% decrease in vBMD with 40 years increase. Age-related vBMD changes in the head quadrants were similar to that in total. With age, the trend line correlation coefficients for vBMD in quadrants were relatively small, but significant (p < 0.001) for all. The femoral head integral vBMD correlates well with neck vBMD and FN aBMD. FN aBMD explained 45% of head integral vBMD variance (p < 0.0001). Elderly women had relative preservation of femoral head and neck bone volume from 50 yrs. over four decades but markedly lower integral vBMD of proximal femur. The findings of our study call in question about the concept of bone expansion with aging even in elderly age.
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Affiliation(s)
- Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
| | - Xiaoyan Liu
- Department of Internal Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Minghui Yang
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Chen Yi
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Yandong Liu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Pengju Huang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Aihong Yu
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xinbao Wu
- Department of Traumatic Orthopedics, Beijing Jishuitan Hospital, Beijing, China
| | - Glen M Blake
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, United Kingdom
| | - Klaus Engelke
- Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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14
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Jackson K, Moseley KF. Diabetes and Bone Fragility: SGLT2 Inhibitor Use in the Context of Renal and Cardiovascular Benefits. Curr Osteoporos Rep 2020; 18:439-448. [PMID: 32710428 DOI: 10.1007/s11914-020-00609-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Type 2 diabetes mellitus (T2DM) has been shown to negatively impact bone quality and increase fracture risk. While the pathophysiology of bone fragility in T2DM is not clear and likely multifactorial, medications used to treat T2DM are increasingly scrutinized for their potential role in aberrant bone metabolism. Sodium-glucose co-transporter 2 (SGLT2) inhibitors are gaining popularity in patients with T2DM. In addition to lowering blood glucose, there is evidence that these drugs offer cardiac and renal benefit to individuals with T2DM, leading to FDA-approved indications for use in at-risk individuals. At the same time, there remain concerns that SGLT2 inhibitors, specifically canagliflozin, have adverse effects on bone metabolism and increase fracture risk in T2DM. This review seeks to further clarify the impact of these agents on the skeleton. RECENT FINDINGS SGLT2 inhibitors may indirectly disrupt calcium and phosphate homeostasis, contribute to weight loss, and cause hypotension, resulting in bone mineral density (BMD) losses and increased falls. The true long-term impact of SGLT2 inhibitors on the diabetic skeleton is still unclear; this review summarizes the results in studies investigating the impact of SGLT2 inhibitors on fracture risk in T2DM. Whereas studies performed with dapagliflozin and empagliflozin have not shown an increased risk of bone fractures compared with placebo, some studies have shown increased markers of bone turnover and reduced bone mineral density with canagliflozin treatment. While an increased fracture risk was observed with canagliflozin in the CANVAS trial (HR 1.26; 95% CI 1.04, 1.52), an increased risk was not seen in the CANVAS-R (HR 0.86) or CREDENCE (HR 0.98) trials. There is substantial evidence of the cardiac and renal protective benefits of SGLT2 inhibitors. There does not appear to be an increased fracture risk with the use of dapagliflozin or empagliflozin. Given the possible association between canagliflozin and adverse bone outcomes described in CANVAS, canagliflozin use should be pursued in individuals with T2DM only after careful consideration of the individual's skeletal risk.
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Affiliation(s)
- Kristen Jackson
- School of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, 5501 Hopkins Bayview Circle, 2A62, Baltimore, MD, 21224, USA
| | - Kendall F Moseley
- School of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, 5501 Hopkins Bayview Circle, 2A62, Baltimore, MD, 21224, USA.
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15
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Sarcopenia negatively affects hip structure analysis variables in a group of Lebanese postmenopausal women. BMC Bioinformatics 2020; 21:86. [PMID: 32164524 PMCID: PMC7068911 DOI: 10.1186/s12859-020-3353-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The current study's purpose is to compare hip structural analysis variables in a group of postmenopausal women with sarcopenia and another group of postmenopausal women with normal skeletal muscle mass index. To do so, the current study included 8 postmenopausal women (whose ages ranged between 65 and 84 years) with sarcopenia and 60 age-matched controls (with normal skeletal muscle mass index (SMI)). Body composition and bone parameters were evaluated by dual-energy X-ray absorptiometry (DXA). RESULTS Weight, lean mass, body mass index, femoral neck cross-sectional area (FN CSA), FN section modulus (Z), FN cross sectional moment of inertia (CSMI), intertrochanteric (IT) CSA, IT Z, IT CSMI, IT cortical thickness (CT), femoral shaft (FS) CSA, FS Z and FS CSMI were significantly greater (p < 0.05) in women with normal SMI compared to women with sarcopenia. In the whole population, SMI was positively associated with IT CSA, IT Z, IT CSMI, IT CT, FS CSA, FS Z, FS CSMI, FS CT but negatively correlated to IT buckling ratio (BR) and FS BR. CONCLUSION The current study suggests that sarcopenia has a negative effect on hip bone strength indices in postmenopausal women.
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16
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Lu Y, Uppal HS. Hip Fractures: Relevant Anatomy, Classification, and Biomechanics of Fracture and Fixation. Geriatr Orthop Surg Rehabil 2019; 10:2151459319859139. [PMID: 31321116 PMCID: PMC6610445 DOI: 10.1177/2151459319859139] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction Hip fractures represent an important health-care dilemma, costing the US$ billions annually. Hip fractures can diminish quality of life and significantly increase morbidity and mortality if not properly treated. Recent research has brought forth new information regarding treatment as well as information on emerging complications seen within the fixation constructs themselves. Significance Understanding the pathoanatomy of hip fractures and the biomechanics of surgical fixation constructs is critical for successful treatment. In this article, we review the relevant anatomy and classification of femoral neck and intertrochanteric fractures. Furthermore, the biomechanics of hip fracture fixation strategies as well as implant-related complications are addressed. Results Even though laboratory testing demonstrated that intramedullary nails have greater biomechanical stability, the clinical results between fixation constructs have been similar when the chosen implant (ie, sliding hip screw vs cephalomedullary nail) has been correctly applied to the specific fracture pattern. Recently, data have shown that when using cephalomedullary nails, there is potential for increased failure with cutout when using the helical blade versus the lag screw, with majority being the atypical "medial cutout." Conclusion The goal of surgical treatment of hip fractures is surgical treatment that allows for early mobilization and weight bearing. A full understanding of the anatomy and fracture characteristics will allow the surgeon to correctly apply the right implant to allow for uneventful healing. Surgeons need to be aware, however, of complications that can arise when using specific implants. Further research is ongoing to further determine the treatments that will allow optimal cost-effective care for the geriatric patient with hip fracture.
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Affiliation(s)
- Young Lu
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, CA, USA
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17
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Abstract
It is well known that sex steroids, particularly estrogen, play a crucial role in the attainment and maintenance of peak bone density in all people. Transgender (trans) women have been frequently observed to have low bone density prior to initiation of gender-affirming hormone therapy, while trans men generally do not. With pharmacologic estrogen, many studies show improving bone density in trans women. With pharmacologic testosterone, bone density in trans men remains largely unchanged although androgens have indirect effects on bone health via changes in fat and lean mass. Much remains unknown about best practices to optimize bone health, interpret DXA scans and assess fracture risk in trans adults.
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Affiliation(s)
- Micol S Rothman
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, 12801 East 17th Avenue, Mail Stop: 8106, Aurora, CO 80045, USA
| | - Sean J Iwamoto
- Division of Endocrinology, Metabolism & Diabetes, University of Colorado School of Medicine, Anschutz Medical Campus, 12801 East 17th Avenue, Mail Stop: 8106, Aurora, CO 80045, USA
- Division of Endocrinology, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
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18
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Bigelow EM, Patton DM, Ward FS, Ciarelli A, Casden M, Clark A, Goulet RW, Morris MD, Schlecht SH, Mandair GS, Bredbenner TL, Kohn DH, Jepsen KJ. External Bone Size Is a Key Determinant of Strength-Decline Trajectories of Aging Male Radii. J Bone Miner Res 2019; 34:825-837. [PMID: 30715752 PMCID: PMC6536328 DOI: 10.1002/jbmr.3661] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/06/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Given prior work showing associations between remodeling and external bone size, we tested the hypothesis that wide bones would show a greater negative correlation between whole-bone strength and age compared with narrow bones. Cadaveric male radii (n = 37 pairs, 18 to 89 years old) were evaluated biomechanically, and samples were sorted into narrow and wide subgroups using height-adjusted robustness (total area/bone length). Strength was 54% greater (p < 0.0001) in wide compared with narrow radii for young adults (<40 years old). However, the greater strength of young-adult wide radii was not observed for older wide radii, as the wide (R2 = 0.565, p = 0.001), but not narrow (R2 = 0.0004, p = 0.944) subgroup showed a significant negative correlation between strength and age. Significant positive correlations between age and robustness (R2 = 0.269, p = 0.048), cortical area (Ct.Ar; R2 = 0.356, p = 0.019), and the mineral/matrix ratio (MMR; R2 = 0.293, p = 0.037) were observed for narrow, but not wide radii (robustness: R2 = 0.015, p = 0.217; Ct.Ar: R2 = 0.095, p = 0.245; MMR: R2 = 0.086, p = 0.271). Porosity increased with age for the narrow (R2 = 0.556, p = 0.001) and wide (R2 = 0.321, p = 0.022) subgroups. The wide subgroup (p < 0.0001) showed a significantly greater elevation of a new measure called the Cortical Pore Score, which quantifies the cumulative effect of pore size and location, indicating that porosity had a more deleterious effect on strength for wide compared with narrow radii. Thus, the divergent strength-age regressions implied that narrow radii maintained a low strength with aging by increasing external size and mineral content to mechanically offset increases in porosity. In contrast, the significant negative strength-age correlation for wide radii implied that the deleterious effect of greater porosity further from the centroid was not offset by changes in outer bone size or mineral content. Thus, the low strength of elderly male radii arose through different biomechanical mechanisms. Consideration of different strength-age regressions (trajectories) may inform clinical decisions on how best to treat individuals to reduce fracture risk. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Erin Mr Bigelow
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Daniella M Patton
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Ferrous S Ward
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Antonio Ciarelli
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Michael Casden
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Clark
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Robert W Goulet
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michael D Morris
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | | | - Gurjit S Mandair
- Biological and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Todd L Bredbenner
- Department of Mechanical and Aerospace Engineering, University of Colorado-Colorado Springs, Colorado Springs, CO, USA
| | - David H Kohn
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biological and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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19
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Cronholm F, Rosengren BE, Nilsson JÅ, Ohlsson C, Mellström D, Ribom E, Karlsson MK. The fracture predictive ability of a musculoskeletal composite score in old men - data from the MrOs Sweden study. BMC Geriatr 2019; 19:90. [PMID: 30902044 PMCID: PMC6431016 DOI: 10.1186/s12877-019-1106-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/18/2019] [Indexed: 01/07/2023] Open
Abstract
Background Detection of high-risk individuals for fractures are needed. This study assessed whether level of physical activity (PA) and a musculoskeletal composite score could be used as fracture predictive tools, and if the score could predict fractures better than areal bone mineral density (aBMD). Methods MrOs Sweden is a prospective population-based observational study that at baseline included 3014 men aged 69–81 years. We assessed femoral neck bone mineral content (BMC), bone area, aBMD and total body lean mass by dual energy X-ray absorptiometry, calcaneal speed of sound by quantitative ultrasound and hand grip strength by a handheld dynamometer. PA was assessed by the Physical Activity Scale for the Elderly (PASE) questionnaire. We followed the participants until the date of first fracture, death or relocation (median 9.6 years). A musculoskeletal composite score was calculated as mean Z-score of the five measured traits. A Cox proportional hazards model was used to analyze the association between the musculoskeletal traits, the composite score and incident fractures (yes/no) during the follow-up period. Data are presented as hazard ratios (HR) with 95% confidence intervals (95% CI) for fracture for a + 1 standard deviation (SD) change (+ 1 Z-score) in the various musculoskeletal traits as well as the composite score. We used a linear regression model to estimate the association between level of PA, measured as PASE-score and the different musculoskeletal traits as well as the composite score. Results A + 1 SD higher composite score was associated with an incident fracture HR of 0.61 (0.54, 0.69), however not being superior to aBMD in fracture prediction. A + 1 SD higher PASE-score was associated with both a higher composite score and lower fracture incidence (HR 0.83 (0.76, 0.90)). Conclusions The composite score was similar to femoral neck aBMD in predicting fractures, and also low PA predicted fractures. This highlights the need of randomized controlled trials to evaluate if PA could be used as a fracture preventive strategy.
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Affiliation(s)
- Felix Cronholm
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jan-Åke Nilsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Claes Ohlsson
- Centre for Bone and Arthritis Research, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dan Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva Ribom
- Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences and Orthopedics, Lund University, Skåne University Hospital, Malmö, Sweden
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Ireland A, Saunders FR, Muthuri SG, Pavlova AV, Hardy RJ, Martin KR, Barr RJ, Adams JE, Kuh D, Aspden RM, Gregory JS, Cooper R. Age at Onset of Walking in Infancy Is Associated With Hip Shape in Early Old Age. J Bone Miner Res 2019; 34:455-463. [PMID: 30496618 PMCID: PMC6446733 DOI: 10.1002/jbmr.3627] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/21/2018] [Accepted: 10/06/2018] [Indexed: 12/12/2022]
Abstract
Bones' shapes and structures adapt to the muscle and reaction forces they experience during everyday movements. Onset of independent walking, at approximately 12 months, represents the first postnatal exposure of the lower limbs to the large forces associated with bipedal movements; accordingly, earlier walking is associated with greater bone strength. However, associations between early life loading and joint shape have not been explored. We therefore examined associations between walking age and hip shape at age 60 to 64 years in 1423 individuals (740 women) from the MRC National Survey of Health and Development, a nationally representative British birth cohort. Walking age in months was obtained from maternal interview at age 2 years. Ten modes of variation in hip shape (HM1 to HM10), described by statistical shape models, were ascertained from DXA images. In sex-adjusted analyses, earlier walking age was associated with higher HM1 and HM7 scores; these associations were maintained after further adjustment for height, body composition, and socioeconomic position. Earlier walking was also associated with lower HM2 scores in women only, and lower HM4 scores in men only. Taken together, this suggests that earlier walkers have proportionately larger (HM4) and flatter (HM1, HM4) femoral heads, wider (HM1, HM4, HM7) and flatter (HM1, HM7) femoral necks, a smaller neck-shaft angle (HM1, HM4), anteversion (HM2, HM7), and early development of osteophytes (HM1). These results suggest that age at onset of walking in infancy is associated with variations in hip shape in older age. Early walkers have a larger femoral head and neck and smaller neck-shaft angle; these features are associated with reduced hip fracture risk, but also represent an osteoarthritic-like phenotype. Unlike results of previous studies of walking age and bone mass, associations in this study were not affected by adjustment for lean mass, suggesting that associations may relate directly to skeletal loading in early life when joint shape changes rapidly. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Alex Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | - Fiona R Saunders
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Anastasia V Pavlova
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | | | - Kathryn R Martin
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rebecca J Barr
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Medicines Monitoring Unit (MEMO), Division of Molecular & Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital & Medical School, Dundee, Scotland
| | - Judith E Adams
- Manchester Academic Health Science Centre and Radiology, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester, Manchester Royal Infirmary, Manchester, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Richard M Aspden
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Jennifer S Gregory
- Aberdeen Centre for Arthritis and Musculoskeletal Health, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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21
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Management of Male Osteoporosis: an Update. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2018. [DOI: 10.1007/s40674-018-0107-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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22
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Sex-difference in bone architecture and bone fragility in Vietnamese. Sci Rep 2018; 8:7707. [PMID: 29769605 PMCID: PMC5955960 DOI: 10.1038/s41598-018-26053-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/16/2018] [Indexed: 12/14/2022] Open
Abstract
This study sought to define the sex-difference in trabecular and cortical bone parameters in Vietnamese individuals. The study involved 1404 women and 864 men aged between 20 and 86 years who were recruited from Ho Chi Minh City, Vietnam. Trabecular and cortical volumetric BMD were measured at the proximal tibia and proximal radius at 4%, 38%, and 66% points, using a peripheral quantitative computed tomography XCT2000 (Stratec, Germany). Polar strength strain index was estimated from cortical bone parameters. Changes in bone parameters were assessed by the multiple linear regression model. Among individuals aged 20–39 years, women had significantly lower peak trabecular BMD at both the radius (40%) and tibia (16%) than men, but the age-related reduction in trabecular BMD were similar between two sexes. For cortical BMD, peak values in women and men were comparable, but the age-related diminution was greater in women than men. At any age, polar strength strain index in women was lower than men, and the difference was mainly attributable to cortical bone area and total bone mass. We conclude that in the elderly, sex-related difference in trabecular BMD is originated during growth, but sex-related difference in cortical BMD is determined by differential age-related bone loss.
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Ben Kahla R, Barkaoui A, Merzouki T. Age-related mechanical strength evolution of trabecular bone under fatigue damage for both genders: Fracture risk evaluation. J Mech Behav Biomed Mater 2018; 84:64-73. [PMID: 29751273 DOI: 10.1016/j.jmbbm.2018.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 07/23/2017] [Accepted: 05/03/2018] [Indexed: 12/11/2022]
Abstract
Bone tissue is a living composite material, providing mechanical and homeostatic functions, and able to constantly adapt its microstructure to changes in long term loading. This adaptation is conducted by a physiological process, known as "bone remodeling". This latter is manifested by interactions between osteoclasts and osteoblasts, and can be influenced by many local factors, via effects on bone cell differentiation and proliferation. In the current work, age and gender effects on damage rate evolution, throughout life, have been investigated using a mechanobiological finite element modeling. To achieve the aim, a mathematical model has been developed, coupling both cell activities and mechanical behavior of trabecular bone, under cyclic loadings. A series of computational simulations (ABAQUS/UMAT) has been performed on a 3D human proximal femur, allowing to investigate the effects of mechanical and biological parameters on mechanical strength of trabecular bone, in order to evaluate the fracture risk resulting from fatigue damage. The obtained results revealed that mechanical stimulus amplitude affects bone resorption and formation rates, and indicated that age and gender are major factors in bone response to the applied loadings.
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Affiliation(s)
- Rabeb Ben Kahla
- Laboratoire de Systèmes et de Mécanique Appliquée (Lasmap-EPT), Ecole Polytechnique de Tunis, Université de Carthage, 2078 La Marsa, Tunisia
| | - Abdelwahed Barkaoui
- Laboratoire de Mécanique Appliquée et Ingénierie (LR-MAI), LR-ES19, Ecole Nationale d'Ingénieurs de Tunis, Université de Tunis El Manar, 1002 Tunis, Tunisa; Laboratoire des Energies Renouvelables et Matériaux Avancés (LERMA), Ecole Supérieure de l'Ingénierie de l'Energie,Université Internationale de Rabat, Rocade Rabat-Salé, 11100, Rabat-Sala El Jadida, Morocco.
| | - Tarek Merzouki
- Laboratoire Ingénierie des Systèmes de Versailles, Université de Versailles St Quentin en Yvelines, 10 avenue de l'Europe, 78140 Velizy, France
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24
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Gennari L, Bilezikian JP. New and developing pharmacotherapy for osteoporosis in men. Expert Opin Pharmacother 2018; 19:253-264. [DOI: 10.1080/14656566.2018.1428559] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Luigi Gennari
- Department Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - John P. Bilezikian
- Medicine and Pharmacology, International Education and Research, Division of Endocrinology, Emeritus, Metabolic Bone Diseases Unit, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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25
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Leslie WD, Lix LM, Majumdar SR, Morin SN, Johansson H, Odén A, McCloskey EV, Kanis JA. Total Hip Bone Area Affects Fracture Prediction With FRAX® in Canadian White Women. J Clin Endocrinol Metab 2017; 102:4242-4249. [PMID: 29092086 DOI: 10.1210/jc.2017-01327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/11/2017] [Indexed: 01/17/2023]
Abstract
CONTEXT Areal bone mineral density (BMD) measurements are confounded by skeletal size. Hip BMD is an input to the FRAX® tool (Centre for Metabolic Bone Diseases, University of Sheffield, United Kingdom), but it is unknown whether performance is affected by hip area. OBJECTIVE To examine whether fracture prediction by FRAX® is affected by hip area. DESIGN AND SETTING Cohort study using a population-based BMD registry. PATIENTS A total of 58,108 white women aged ≥40 years. MAIN OUTCOME MEASURES Incident major osteoporotic fracture (MOF; n = 4913) and hip fracture (n = 1369), stratified by total hip area quintile, before and after adjustment for hip axis length (HAL). RESULTS Smaller hip area was associated with younger age and lower FRAX® scores, whereas incident fractures were greater in those with larger hip area (P for trend < 0.001). Larger hip area quintile increased risk for MOF and hip fracture when adjusted for FRAX® score with BMD (P for trend < 0.001). Each standard deviation increase in hip area was associated with greater risk for incident MOF [adjusted hazard ratio (HR), 1.08; 95% confidence interval (CI), 1.05 to 1.11] and hip fracture (HR, 1.16; 95% CI, 1.11 to 1.21), but not after adjustment for HAL. FRAX® with BMD underestimated MOF risk in the largest hip area quintile and underestimated hip fracture risk in the three largest hip area quintiles. CONCLUSIONS In Canadian white women, skeletal size based on hip area affects fracture risk assessment based on FRAX® score with BMD, with risk underestimated in those with larger hip areas. Including HAL in the risk assessment compensates for this confounding by skeletal size and provides for more accurate assessment of fracture risk.
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Affiliation(s)
- William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Lisa M Lix
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Sumit R Majumdar
- Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2G3, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Helena Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Victoria 3000, Australia
| | - Anders Odén
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Victoria 3000, Australia
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26
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Fang A, Li K, Li H, Guo M, He J, Shen X, Song J. Low Habitual Dietary Calcium and Linear Growth from Adolescence to Young Adulthood: results from the China Health and Nutrition Survey. Sci Rep 2017; 7:9111. [PMID: 28831091 PMCID: PMC5567300 DOI: 10.1038/s41598-017-08943-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/21/2017] [Indexed: 11/13/2022] Open
Abstract
Evidences from clinical trials and meta-analyses of calcium supplementation in linear growth have given conflicting results, and few longitudinal studies have investigated the long-term associations between dietary calcium and linear growth, especially in the population with low-calcium plant-based diets. We investigated the prospective associations of low habitual dietary calcium with adult height and height-for-age z-score (HAZ) from adolescence to adulthood among 2019 adolescents from the China Health and Nutrition Survey (CHNS). The average dietary calcium intakes were 426(standard deviation: 158) mg/d in boys and 355(134) mg/d in girls during adolescence. During a median follow-up of 7.0 (interquartile range: 5.9–9.0) years, boys reached an average of 169.0(6.7) cm and girls reached 158.4(5.8) cm in adulthood. After adjusting for other potential confounders, non-linear regression found that boys with dietary calcium intakes below 327 mg/d had shorter adult stature, and those taking over 566 mg/d had faster height growth whether adjusting for physical exercises level or not. No significant associations were found in girls. Our study suggests that in boys with plant-based diets, higher dietary calcium intake during adolescence is associated with faster height growth, but not with adult height; calcium intake below 300 mg/d may result in shorter adult stature.
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Affiliation(s)
- Aiping Fang
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.,Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, 100191, China
| | - Keji Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, 100191, China.
| | - He Li
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, 100191, China
| | - Meihan Guo
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, 100191, China
| | - Jingjing He
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, 100191, China
| | - Xin Shen
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, 100191, China
| | - Jie Song
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, 100191, China
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27
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Jepsen KJ, Kozminski A, Bigelow EM, Schlecht SH, Goulet RW, Harlow SD, Cauley JA, Karvonen-Gutierrez C. Femoral Neck External Size but not aBMD Predicts Structural and Mass Changes for Women Transitioning Through Menopause. J Bone Miner Res 2017; 32:1218-1228. [PMID: 28084657 PMCID: PMC5466474 DOI: 10.1002/jbmr.3082] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 01/03/2017] [Accepted: 01/11/2017] [Indexed: 01/23/2023]
Abstract
The impact of adult bone traits on changes in bone structure and mass during aging is not well understood. Having shown that intracortical remodeling correlates with external size of adult long bones led us to hypothesize that age-related changes in bone traits also depend on external bone size. We analyzed hip dual-energy X-ray absorptiometry images acquired longitudinally over 14 years for 198 midlife women transitioning through menopause. The 14-year change in bone mineral content (BMC, R2 = 0.03, p = 0.015) and bone area (R2 = 0.13, p = 0.001), but not areal bone mineral density (aBMD, R2 = 0.00, p = 0.931) correlated negatively with baseline femoral neck external size, adjusted for body size using the residuals from a linear regression between baseline bone area and height. The dependence of the 14-year changes in BMC and bone area on baseline bone area remained significant after adjusting for race/ethnicity, postmenopausal hormone use, the 14-year change in weight, and baseline aBMD, weight, height, and age. Women were sorted into tertiles using the baseline bone area-height residuals. The 14-year change in BMC (p = 0.009) and bone area (p = 0.001) but not aBMD (p = 0.788) differed across the tertiles. This suggested that women showed similar changes in aBMD for different structural and biological reasons: women with narrow femoral necks showed smaller changes in BMC but greater increases in bone area compared to women with wide femoral necks who showed greater losses in BMC but without large compensatory increases in bone area. This finding is opposite to expectations that periosteal expansion acts to mechanically offset bone loss. Thus, changes in femoral neck structure and mass during menopause vary widely among women and are predicted by baseline external bone size but not aBMD. How these different structural and mass changes affect individual strength-decline trajectories remains to be determined. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrew Kozminski
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Erin Mr Bigelow
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Stephen H Schlecht
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Robert W Goulet
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Sioban D Harlow
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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28
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Golds G, Houdek D, Arnason T. Male Hypogonadism and Osteoporosis: The Effects, Clinical Consequences, and Treatment of Testosterone Deficiency in Bone Health. Int J Endocrinol 2017; 2017:4602129. [PMID: 28408926 PMCID: PMC5376477 DOI: 10.1155/2017/4602129] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 02/07/2017] [Indexed: 01/22/2023] Open
Abstract
It is well recognized that bone loss accelerates in hypogonadal states, with female menopause being the classic example of sex hormones affecting the regulation of bone metabolism. Underrepresented is our knowledge of the clinical and metabolic consequences of overt male hypogonadism, as well as the more subtle age-related decline in testosterone on bone quality. While menopause and estrogen deficiency are well-known risk factors for osteoporosis in women, the effects of age-related testosterone decline in men on bone health are less well known. Much of our knowledge comes from observational studies and retrospective analysis on small groups of men with variable causes of primary or secondary hypogonadism and mild to overt testosterone deficiencies. This review aims to present the current knowledge of the consequences of adult male hypogonadism on bone metabolism. The direct and indirect effects of testosterone on bone cells will be explored as well as the important differences in male osteoporosis and assessment as compared to that in females. The clinical consequence of both primary and secondary hypogonadism, as well as testosterone decline in older males, on bone density and fracture risk in men will be summarized. Finally, the therapeutic options and their efficacy in male osteoporosis and hypogonadism will be discussed.
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Affiliation(s)
- Gary Golds
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8
| | - Devon Houdek
- Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8
| | - Terra Arnason
- Division of Endocrinology and Metabolism, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada S7N 0W8
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29
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Shen Y, Tang ML, Wu XP, Yuan LQ, Dai RC, Zhang H, Sheng ZF, Peng YQ, Luo XH, Wu XY, Liao EY. Gender differences in a reference database of age-related femoral neck geometric parameters for Chinese population and their association with femoral neck fractures. Bone 2016; 93:64-70. [PMID: 27641474 DOI: 10.1016/j.bone.2016.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 08/15/2016] [Accepted: 09/15/2016] [Indexed: 10/21/2022]
Abstract
Femoral neck geometric parameters (FNGPs) are closely related to the strength of the femoral neck and the risk of fragility fractures. No reference database is available for FNGPs for Chinese population, and gender-related differences in FNGPs as well as their association with the risk of femoral neck fractures are unknown. This investigation aimed to set up reference databases for FNGPs, understand gender-related differences in FNGPs, and examine the association between FNGPs and the risk of osteoporotic fractures of the femoral neck. This study included 5268 females and 2156 males (aged 15-91years) from Chinese population. A total of 384 patients (282 females and 102 males) had sustained femoral neck fractures; 384 age- and sex-matched individuals without any fractures served as controls. Femoral neck DXA images were used to measure bone mineral density (BMD) and eight FNGPs. Our results showed that the age-related trends of FNGPs were fitted with the best goodness-of-fit by applying the cubic regression model. The trends shown by FNGPs were significantly different between male and female subjects, and the fitting curves were significantly higher in male subjects. After adjustments were made for age, height, weight, and body mass index, Cox regression analysis showed that changes in all FNGPs were related to increased hazard ratios (HRs) of femoral neck fractures. After further adjustment was made for BMD of the femoral neck, the HRs related to a cortical thickness (CT) decrease and buckling ratio (BR) increase in females went up by 3.35-folds (95% CI: 2.75-4.07) and 1.86-folds (95% CI: 1.33-2.60), respectively. In males, the HRs related to the decrease in CT and cross-sectional area (CSA) increased by 3.21-folds (95% CI: 2.32-4.45) and 1.88-folds (95% CI: 1.03-3.44), respectively. In conclusions, the reference databases of FNGPs established in this study will assist in the evaluation and prediction of femoral neck fracture risk in the clinic. The decrease in CT and increase in BR of the femoral neck were independent risk factors for osteoporotic fractures of the femoral neck in females from mainland China, while a decrease in CT and CSA were risk factors in male.
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Affiliation(s)
- Yi Shen
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Orthopedics, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Meng-Lu Tang
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Heze Hospital of Traditional Chinese Medicine, Shandong Province, No.1036 Danyang Road, Heze, Shandong 274000, PR China
| | - Xian-Ping Wu
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Ling-Qing Yuan
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Ru-Chun Dai
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Hong Zhang
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Zhi-Feng Sheng
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Yi-Qun Peng
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Xiang-Hang Luo
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
| | - Xi-Yu Wu
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China.
| | - Er-Yuan Liao
- National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Institute of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China; Department of Endocrinology and Metabolism, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan 410011, PR China
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Zhou H, Mori S, Ishizaki T, Tanaka M, Tanisawa K, Mieno MN, Sawabe M, Arai T, Muramatsu M, Yamada Y, Ito H. Genetic risk score based on the lifetime prevalence of femoral fracture in 924 consecutive autopsies of Japanese males. J Bone Miner Metab 2016; 34:685-691. [PMID: 26462479 DOI: 10.1007/s00774-015-0718-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 09/04/2015] [Indexed: 12/27/2022]
Abstract
A genetic risk score (GRS) was developed for predicting fracture risk based on lifetime prevalence of femoral fractures in 924 consecutive autopsies of Japanese males. A total of 922 non-synonymous single nucleotide polymorphisms (SNPs) located in 62 osteoporosis susceptibility genes were genotyped and evaluated for their association with the prevalence of femoral fracture in autopsy cases. GRS values were calculated as the sum of risk allele counts (unweighted GRS) or the sum of weighted scores estimated from logistic regression coefficients (weighted GRS). Five SNPs (α-ʟ-iduronidase rs3755955, C7orf58 rs190543052, homeobox C4 rs75256744, G patch domain-containing gene 1 rs2287679, and Werner syndrome rs2230009) showed a significant association (P < 0.05) with the prevalence of femoral fracture in 924 male subjects. Both the unweighted and weighted GRS adequately predicted fracture prevalence; areas under receiver-operating characteristic curves were 0.750 [95 % confidence interval (CI) 0.660-0.840] and 0.770 (95 % CI 0.681-0.859), respectively. Multiple logistic regression analysis revealed that the odds ratio (OR) for the association between fracture prevalence and unweighted GRS ≥3 (n = 124) was 8.39 (95 % CI 4.22-16.69, P < 0.001) relative to a score <3 (n = 797). Likewise, the OR for a weighted GRS of 6-15 (n = 135) was 7.73 (95 % CI 3.89-15.36, P < 0.001) relative to scores of 0-5 (n = 786). The GRS based on risk allele profiles of the five SNPs could help identify at-risk individuals and enable implementation of preventive measures for femoral fracture.
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Affiliation(s)
- Heying Zhou
- Center for Promotion of Clinical Investigation, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae, Itabashi, Tokyo, 173-0015, Japan
| | - Seijiro Mori
- Center for Promotion of Clinical Investigation, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakae, Itabashi, Tokyo, 173-0015, Japan.
| | - Tatsuro Ishizaki
- Research Team for Human Care, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Masashi Tanaka
- Department of Genomics for Longevity and Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Kumpei Tanisawa
- Department of Genomics for Longevity and Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
- Graduate School of Sport Sciences, Waseda University, Saitama, Japan
| | - Makiko Naka Mieno
- Department of Medical Informatics, Center for Information, Jichi Medical University, Tochigi, Japan
| | - Motoji Sawabe
- Section of Molecular Pathology, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Masaaki Muramatsu
- Department of Molecular Epidemiology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiji Yamada
- Department of Human Functional Genomics, Life Science Research Center, Mie University, Mie, Japan
| | - Hideki Ito
- Local Independent Administrative Agency, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
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Hernandez-de Sosa N, Athanasiadis G, Malouf J, Laiz A, Marin A, Herrera S, Farrerons J, Soria JM, Casademont J. Genetic Contribution of Femoral Neck Bone Geometry to the Risk of Developing Osteoporosis: A Family-Based Study. PLoS One 2016; 11:e0154833. [PMID: 27163365 PMCID: PMC4862643 DOI: 10.1371/journal.pone.0154833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/20/2016] [Indexed: 11/19/2022] Open
Abstract
Femoral neck geometry parameters are believed to be as good as bone mineral density as independent factors in predicting hip fracture risk. This study was conducted to analyze the roles of genetic and environmental factors in femoral properties measured in a sample of Spanish families with osteoporotic fractures and extended genealogy. The "Genetic Analysis of Osteoporosis (GAO) Project" involved 11 extended families with a total number of 376 individuals. We studied three categorical phenotypes of particular clinical interest and we used a Hip structural analysis based on DXA to analyze 17 strength and geometrical phenotypes of the hip. All the femoral properties had highly significant heritability, ranging from 0.252 to 0.586. The most significant correlations were observed at the genetic level (ρG). Osteoporotic fracture status (Affected 2) and, particularly, low bone mass and osteoporotic condition (Affected 3) had the highest number of significant genetic correlations with diverse femoral properties. In conclusion, our findings suggest that a relatively simple and easy to use method based on DXA studies can provide useful data on properties of the Hip in clinical practice. Furthermore, our results provide a strong motivation for further studies in order to improve the understanding of the pathophysiological mechanism underlying bone architecture and the genetics of osteoporosis.
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Affiliation(s)
- Nerea Hernandez-de Sosa
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- * E-mail:
| | - Georgios Athanasiadis
- Department of Genomics of Complex Diseases, Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Jorge Malouf
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Laiz
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Marin
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Herrera
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Farrerons
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose Manuel Soria
- Department of Genomics of Complex Diseases, Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Casademont
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Jepsen KJ, Bigelow EMR, Ramcharan M, Schlecht SH, Karvonen-Gutierrez CA. Moving toward a prevention strategy for osteoporosis by giving a voice to a silent disease. Womens Midlife Health 2016; 2. [PMID: 27672442 PMCID: PMC5035036 DOI: 10.1186/s40695-016-0016-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
A major unmet challenge in developing preventative treatment programs for osteoporosis is that the optimal timing of treatment remains unknown. In this commentary we make the argument that the menopausal transition (MT) is a critical period in a woman's life for bone health, and that efforts aimed at reducing fracture risk later in life may benefit greatly from strategies that treat women earlier with the intent of keeping bones strong as long as possible. Bone strength is an important parameter to monitor during the MT because engineering principles can be applied to differentiate those women that maintain bone strength from those women that lose bone strength and are in need of early treatment. It is critical to understand the underlying mechanistic causes for reduced strength to inform treatment strategies. Combining measures of strength with data on how bone structure changes during the MT may help differentiate whether a woman is losing strength because of excessive bone resorption, insufficient compensatory bone formation, trabeculae loss, or some combination of these factors. Each of these biomechanical mechanisms may require a different treatment strategy to keep bones strong. The technologies that enable physicians to differentially diagnose and treat women in a preventive manner, however, have lagged behind the development of prophylactic treatments for osteoporosis. To take advantage of these treatment options, advances in preventive treatment strategies for osteoporosis may require developing new technologies with imaging resolutions that match the pace by which bone changes during the MT and supplementing a woman's bone mineral density (BMD)-status with information from engineering-based analyses that reveal the structural and material changes responsible for the decline in bone strength during the menopausal transition.
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Affiliation(s)
- Karl J Jepsen
- Department of Orthopaedic Surgery, Biomedical Sciences Research Building, 109 Zina Pitcher Place, University of Michigan, Ann Arbor, MI 48109-2200, USA
| | - Erin M R Bigelow
- Department of Orthopaedic Surgery, Biomedical Sciences Research Building, 109 Zina Pitcher Place, University of Michigan, Ann Arbor, MI 48109-2200, USA
| | - Melissa Ramcharan
- Department of Orthopaedic Surgery, Biomedical Sciences Research Building, 109 Zina Pitcher Place, University of Michigan, Ann Arbor, MI 48109-2200, USA
| | - Stephen H Schlecht
- Department of Orthopaedic Surgery, Biomedical Sciences Research Building, 109 Zina Pitcher Place, University of Michigan, Ann Arbor, MI 48109-2200, USA
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Gong J, Tang M, Guo B, Shang J, Tang Y, Xu H. Sex- and age-related differences in femoral neck cross-sectional structural changes in mainland Chinese men and women measured using dual-energy X-ray absorptiometry. Bone 2016; 83:58-64. [PMID: 26475501 DOI: 10.1016/j.bone.2015.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 07/05/2015] [Accepted: 09/29/2015] [Indexed: 11/23/2022]
Abstract
We investigated age-related changes in estimated bone strength and cross-sectional structure of the femoral neck (FN) in mainland Chinese men and women (according to age and sex) using dual-energy X-ray absorptiometry (DXA). A total of 3855 healthy adults (2713 women, 1142 men; ages 25-91years) were analyzed by FN bone mineral density (BMD) assessment and hip structural/strength analysis (HSA), including cross-sectional moment of inertia (CSMI), cross-sectional area (CSA), section modulus (Z), periosteal diameter (PD), endocortical diameter (ED), and cortical thickness (CT) using DXA. HSA differences between age and sex groups were adjusted for body weight, height and FN BMD. Trends according to age were estimated by linear regression analysis. There was no inverse correlation between HSA parameters and age in young adults. Some HSA parameters (CSMI, CSA, Z, CT) decreased significantly with age, whereas PD and ED increased significantly. Older adults had less estimated bone strength and CT and higher PD and ED (p<0.05) than young adults. Men had greater increases in PD and ED than women across all ages. FN strength decreases with age in both sexes, caused by FN cross-sectional structural deterioration. Indirect comparison of our data with those from other populations showed less age-related FN periosteal apposition in Chinese than Caucasian men, but similar amounts in women. This may partly explain different male/female hip fracture rates among ethnic groups. Chinese men have more structural disadvantages regarding FN geometry during aging than Caucasian men, possibly conferring added susceptibility to hip fracture.
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Affiliation(s)
- Jian Gong
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Min Tang
- Department of Ophthalmology, Guangdong Second Traditional Chinese Medicine Hospital, Guangzhou, China
| | - Bin Guo
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - JingJie Shang
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Yongjin Tang
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Hao Xu
- Department of Nuclear Medicine, The First Affiliated Hospital, Jinan University, Guangzhou, China.
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Abstract
Conventional dual-energy X-ray absorptiometry images display a digital projection of the inorganic mineral mass in a scanned region. Bone mineral density software generates an average of the pixels within one or more regions. Although not used in the conventional analysis, the images also contain dimensional information limited to the plane of the image. The hip structure analysis method and that of the similar GE, Madison, WI, algorithm Advanced Hip Analysis use both the dimensional information and the mineral mass data to compute the types of dimensional properties (i.e., geometry) that are used to evaluate mechanical strength in engineering analyses. This article describes the hip structure analysis method and a somewhat cruder geometry approximation that does not require a reanalysis of the image. Limitations of the methods are discussed.
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Affiliation(s)
- Thomas J Beck
- Beck Radiological Innovations, Cantonsville, MD, USA.
| | - Susan B Broy
- Department of Medicine, Rosalind Franklin School of Medicine, Chicago Medical School, North Chicago, IL, USA
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Leonard MB, Zemel BS, Wrotniak BH, Klieger SB, Shults J, Stallings VA, Stettler N. Tibia and radius bone geometry and volumetric density in obese compared to non-obese adolescents. Bone 2015; 73:69-76. [PMID: 25497572 PMCID: PMC4540475 DOI: 10.1016/j.bone.2014.12.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/27/2014] [Accepted: 12/03/2014] [Indexed: 11/23/2022]
Abstract
Childhood obesity is associated with biologic and behavioral characteristics that may impact bone mineral density (BMD) and structure. The objective was to determine the association between obesity and bone outcomes, independent of sexual and skeletal maturity, muscle area and strength, physical activity, calcium intake, biomarkers of inflammation, and vitamin D status. Tibia and radius peripheral quantitative CT scans were obtained in 91 obese (BMI>97th percentile) and 51 non-obese adolescents (BMI>5th and <85th percentiles). Results were converted to sex- and race-specific Z-scores relative to age. Cortical structure, muscle area and muscle strength (by dynamometry) Z-scores were further adjusted for bone length. Obese participants had greater height Z-scores (p<0.001), and advanced skeletal maturity (p<0.0001), compared with non-obese participants. Tibia cortical section modulus and calf muscle area Z-scores were greater in obese participants (1.07 and 1.63, respectively, both p<0.0001). Tibia and radius trabecular and cortical volumetric BMD did not differ significantly between groups. Calf muscle area and strength Z-scores, advanced skeletal maturity, and physical activity (by accelerometry) were positively associated with tibia cortical section modulus Z-scores (all p<0.01). Adjustment for muscle area Z-score attenuated differences in tibia section modulus Z-scores between obese and non-obese participants from 1.07 to 0.28. After multivariate adjustment for greater calf muscle area and strength Z-scores, advanced maturity, and less moderate to vigorous physical activity, tibia section modulus Z-scores were 0.32 (95% CI -0.18, 0.43, p=0.06) greater in obese, vs. non-obese participants. Radius cortical section modulus Z-scores were 0.45 greater (p=0.08) in obese vs. non-obese participants; this difference was attenuated to 0.14 with adjustment for advanced maturity. These findings suggest that greater tibia cortical section modulus in obese adolescents is attributable to advanced skeletal maturation and greater muscle area and strength, while less moderate to vigorous physical activities offset the positive effects of these covariates. The impact of obesity on cortical structure was greater at weight bearing sites.
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Affiliation(s)
- Mary B Leonard
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, USA.
| | - Babette S Zemel
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Brian H Wrotniak
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Physical Therapy, D'Youville College, Buffalo, NY, USA
| | - Sarah B Klieger
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Justine Shults
- Department of Physical Therapy, D'Youville College, Buffalo, NY, USA
| | - Virginia A Stallings
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Wang Q, Chen D, Cheng SM, Nicholson P, Alen M, Cheng S. Growth and aging of proximal femoral bone: a study with women spanning three generations. J Bone Miner Res 2015; 30:528-34. [PMID: 25195663 DOI: 10.1002/jbmr.2353] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/30/2014] [Accepted: 09/03/2014] [Indexed: 02/05/2023]
Abstract
Osteoporotic hip fracture is a serious clinical event associated with high morbidity and mortality. Understanding femoral growth patterns is important for promoting bone health in the young and preventing fractures in later life. In this study, growth patterns of areal bone mineral density (aBMD) and geometric properties of the proximal femur were measured by dual-energy X-ray absorptiometry. They were studied in 251 girls from premenarche (11.2 ± 0.7 years) to late adolescence (18.3 ± 1.1 years) and compared with their premenopausal mothers (n = 128, aged 44.9 ± 4.1 years) and postmenopausal grandmothers (n = 128, aged 70.0 ± 6.3 years). Hip axis length (HAL) was the first to reach peak growth velocity (-10.5 months before menarche), followed by neck diameter (ND) and neck cross-sectional area (CSA), (-7.1 and -4.1 months before menarche, respectively). Both neck-shaft angle (NSA) and aBMD of neck and total hip peaked at menarche. At 18 years (7-year follow-up), girls already had higher femoral neck aBMD but similar HAL and NSA compared with their mothers. Grandmothers had the longest HAL, narrowest NSA, widest ND but lowest aBMD and CSA. Hip strength index (HSI), an index of femoral neck strength during a fall, dropped rapidly after menarche in girls but thereafter remained relatively constant. Grandmothers had lower HSI than either mothers or girls. In conclusion, differences in proximal femoral bone mass and structure in adulthood are largely established before menarche, indicating that heritable factors are responsible for most of the individual variance. The development of geometric properties precedes aBMD in puberty, resulting in relatively constant hip strength after menarche. This asynchronous growth leads to adaptation of bone strength to the imposed loads, avoiding fractures in a biologically efficient manner. Both deterioration of aBMD and inadequate compensatory change in bone geometry after menopause contribute to the increased fracture risk later in life.
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Affiliation(s)
- Qin Wang
- Department of Endocrinology, West China Hospital of Sichuan University, Sichuan, China; Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Esenyel M, Ozen A, Esenyel CZ, Rezvani A, Sariyildiz MA, Ergin O. Hip structural changes and fracture risk in osteopenia and osteoporosis. Eurasian J Med 2015; 43:73-8. [PMID: 25610167 DOI: 10.5152/eajm.2011.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 07/08/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Although bone mineral density (BMD) is an important predictor of hip fracture, there is a large overlap of BMD values between those who fracture their hips and those who do not. The aim of this study was to evaluate differences in the structural parameters of the hip in patients with osteopenia and osteoporosis in the hip region and to assess their relationship with osteoporotic fracture risk, age and gender. MATERIALS AND METHODS In this observational retrospective study, 150 patients with osteopenia (100 postmenopausal women and 50 men ≥50 years of age) and 125 patients with osteoporosis in the hip (100 postmenopaussal women and 25 men ≥50 years of age) were included. In addition to densitometry measurements by DEXA (Dual Energy X-ray Absorbimetry), structural variables were determined using the Hip Strength Analysis program (HSA). RESULTS In logistic regression analyses, the femoral neck BMD (odds ratio (OR), 2.6; 95% Confidence Interval (CI) 1.8-3.8), age (OR per 10 years 1.4; 95% CI, 1.1-1.9), femoral neck shaft angle (NSA) (OR 1.5; 95% CI, 1.2-2.1), Femur Strength Index (FSI) (OR 1.6; 95% CI 1.3-2.2), and Cross sectional area (CSA) (OR 1.6; 95% CI 1.2-2.1) were all associated with osteoporotic fractures in women and men. Osteopenic patients had smaller femoral neck-shaft angles (NSA) compared to osteoporotic patients (p<0.05). This angle was larger in women (p<0.05); and women had decreased (FSI) (p<0.001) and CSA (p<0.05), which cause increased fracture risk. CONCLUSION Spatial distribution of bone tissue is a useful determinant of fracture risk.
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Affiliation(s)
- Meltem Esenyel
- Department of Physical Medicine and Rehabilitation, Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Aynur Ozen
- Department of Nuclear Medicine, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Cem Zeki Esenyel
- Department of Orthopedy and Tarumatology, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| | - Aylin Rezvani
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Mustafa Akif Sariyildiz
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Onder Ergin
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
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Willson T, Nelson SD, Newbold J, Nelson RE, LaFleur J. The clinical epidemiology of male osteoporosis: a review of the recent literature. Clin Epidemiol 2015; 7:65-76. [PMID: 25657593 PMCID: PMC4295898 DOI: 10.2147/clep.s40966] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Osteoporosis, a musculoskeletal disease characterized by decreased bone mineral density (BMD) and an increased risk of fragility fractures, is now recognized as an important public health problem in men. Osteoporotic fractures, particularly of the hip, result in significant morbidity and mortality in men and lead to considerable societal costs. Many national and international organizations now address screening and treatment for men in their osteoporosis clinical guidelines. However, male osteoporosis remains largely underdiagnosed and undertreated. The objective of this paper is to provide an overview of recent findings in male osteoporosis, including pathophysiology, epidemiology, and incidence and burden of fracture, and discuss current knowledge about the evaluation and treatment of osteoporosis in males. In particular, clinical practice guidelines, fracture risk assessment, and evidence of treatment effectiveness in men are addressed.
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Affiliation(s)
- Tina Willson
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | - Scott D Nelson
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
| | | | - Richard E Nelson
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joanne LaFleur
- University of Utah College of Pharmacy, Salt Lake City, UT, USA
- Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
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40
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Galea GL, Hannuna S, Meakin LB, Delisser PJ, Lanyon LE, Price JS. Quantification of Alterations in Cortical Bone Geometry Using Site Specificity Software in Mouse models of Aging and the Responses to Ovariectomy and Altered Loading. Front Endocrinol (Lausanne) 2015; 6:52. [PMID: 25954246 PMCID: PMC4407614 DOI: 10.3389/fendo.2015.00052] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/03/2015] [Indexed: 11/13/2022] Open
Abstract
Investigations into the effect of (re)modeling stimuli on cortical bone in rodents normally rely on analysis of changes in bone mass and architecture at a narrow cross-sectional site. However, it is well established that the effects of axial loading produce site-specific changes throughout bones' structure. Non-mechanical influences (e.g., hormones) can be additional to or oppose locally controlled adaptive responses and may have more generalized effects. Tools currently available to study site-specific cortical bone adaptation are limited. Here, we applied novel site specificity software to measure bone mass and architecture at each 1% site along the length of the mouse tibia from standard micro-computed tomography (μCT) images. Resulting measures are directly comparable to those obtained through μCT analysis (R (2) > 0.96). Site Specificity analysis was used to compare a number of parameters in tibiae from young adult (19-week-old) versus aged (19-month-old) mice; ovariectomized and entire mice; limbs subjected to short periods of axial loading or disuse induced by sciatic neurectomy. Age was associated with uniformly reduced cortical thickness and site-specific decreases in cortical area most apparent in the proximal tibia. Mechanical loading site-specifically increased cortical area and thickness in the proximal tibia. Disuse uniformly decreased cortical thickness and decreased cortical area in the proximal tibia. Ovariectomy uniformly reduced cortical area without altering cortical thickness. Differences in polar moment of inertia between experimental groups were only observed in the proximal tibia. Aging and ovariectomy also altered eccentricity in the distal tibia. In summary, site specificity analysis provides a valuable tool for measuring changes in cortical bone mass and architecture along the entire length of a bone. Changes in the (re)modeling response determined at a single site may not reflect the response at different locations within the same bone.
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Affiliation(s)
- Gabriel L. Galea
- School of Veterinary Sciences, University of Bristol, Bristol, UK
- *Correspondence: Gabriel L. Galea, School of Veterinary Sciences, University of Bristol, Southwell Street, Bristol BS2 8EJ, UK
| | - Sion Hannuna
- Faculty of Engineering, University of Bristol, Bristol, UK
| | - Lee B. Meakin
- School of Veterinary Sciences, University of Bristol, Bristol, UK
| | | | - Lance E. Lanyon
- School of Veterinary Sciences, University of Bristol, Bristol, UK
| | - Joanna S. Price
- School of Veterinary Sciences, University of Bristol, Bristol, UK
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Abstract
One in three osteoporotic fractures occur in men and the consequences of a fracture in men tend to be more severe than in women. Still, only a small minority of men with high risk of fracture are detected and treated. Although there are gender differences in the pathophysiology of osteoporosis, such as in the pattern of bone loss, similarities predominate, which is also the case for clinical risk factors. It seems appropriate to consider treatment for men and women with a similar 10 year fracture risk. Drugs now approved for treatment of osteoporosis in men include the anti-resorptive bisphosphonates alendronate, residronate and zoledronic acid, the anti-resorptive drug denosumab, the bone-forming agent teriparatide, and (not in the US) strontium ranelate with mild opposite effects on resorption and formation. Although the evidence level for efficacy and safety of these drugs in men is still relatively limited, available data indicate that treatment effects in men are very similar to what has been observed in the treatment of postmenopausal osteoporosis. Denosumab is also approved for treatment in men receiving androgen deprivation therapy for non-metastatic prostate cancer; bisphosphonates and teriparatide are also available to clinicians for treatment of glucocorticoid-induced osteoporosis in men. Testosterone treatment may be indicated in men with documented symptomatic hypogonadism, but osteoporosis is neither a sufficient nor a specific indication for testosterone treatment. New compounds with well advanced clinical development include odanacatib, a selective inhibitor of the cysteine protease cathepsin-K, and romosozumab, a monoclonal antibody against sclerostin.
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Affiliation(s)
- Jean-Marc Kaufman
- Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.
| | - Bruno Lapauw
- Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - Stefan Goemaere
- Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
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Laurent M, Antonio L, Sinnesael M, Dubois V, Gielen E, Classens F, Vanderschueren D. Androgens and estrogens in skeletal sexual dimorphism. Asian J Androl 2014; 16:213-22. [PMID: 24385015 PMCID: PMC3955330 DOI: 10.4103/1008-682x.122356] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bone is an endocrine tissue expressing androgen and estrogen receptors as well as steroid metabolizing enzymes. The bioactivity of circulating sex steroids is modulated by sex hormone-binding globulin and local conversion in bone tissue, for example, from testosterone (T) to estradiol (E2) by aromatase, or to dihydrotestosterone by 5α-reductase enzymes. Our understanding of the structural basis for gender differences in bone strength has advanced considerably over recent years due to increasing use of (high resolution) peripheral computed tomography. These microarchitectural insights form the basis to understand sex steroid influences on male peak bone mass and turnover in cortical vs trabecular bone. Recent studies using Cre/LoxP technology have further refined our mechanistic insights from global knockout mice into the direct contributions of sex steroids and their respective nuclear receptors in osteoblasts, osteoclasts, osteocytes, and other cells to male osteoporosis. At the same time, these studies have reinforced the notion that androgen and estrogen deficiency have both direct and pleiotropic effects via interaction with, for example, insulin-like growth factor 1, inflammation, oxidative stress, central nervous system control of bone metabolism, adaptation to mechanical loading, etc., This review will summarize recent advances on these issues in the field of sex steroid actions in male bone homeostasis.
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Affiliation(s)
- Michaël Laurent
- Laboratory of Molecular Endocrinology, Department of Cellular and Molecular Medicine; Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven; Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
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43
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Song HK, Yoon HK, Yang KH. Presence of a nail in the medullary canal; is it enough to prevent femoral neck shortening in trochanteric fracture? Yonsei Med J 2014; 55:1400-5. [PMID: 25048503 PMCID: PMC4108830 DOI: 10.3349/ymj.2014.55.5.1400] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/09/2014] [Accepted: 04/15/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Presence of a cephalomedullary nail (CMN) in the medullary canal has been thought as advantageous in the control of femoral neck shortening (FNS) and lag screw sliding in trochanteric fracture compared to extramedullary fixation system. However, researches on the factors that influence the degree of FNS after cephalomedullary nailing are lacking. MATERIALS AND METHODS We observed 95 patients (mean age, 75±2.8 years) with trochanteric fractures who were treated with a CMN, and evaluated the relationship between FNS and patient factors including age, gender, fracture type (AO/OTA), bone mineral density, medullary canal diameter, canal occupancy ratio (COR=nail size/canal diameter), and tip-apex distance using initial, immediate postoperative, and follow-up radiography. RESULTS Univariate regression analyses revealed that the degree of FNS was significantly correlated with fracture type (A1 versus A3, p<0.001), medullary canal diameter (p<0.001), and COR (p<0.001). Multiple regression analyses revealed that FNS was strongly correlated with fracture type (p<0.001) and COR (p<0.001). CONCLUSION Presence of a CMN in the medullary canal could not effectively prevent FNS in patients with low COR and in A3 type fracture.
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Affiliation(s)
- Hyung Keun Song
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Han Kuk Yoon
- Department of Orthopedic Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyu Hyun Yang
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea.
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Cöster MC, Rosengren BE, Karlsson C, von Schevelow T, Magnusson H, Brudin L, Karlsson MK. Bone mass and anthropometry in patients with osteoarthritis of the foot and ankle. Foot Ankle Surg 2014; 20:52-6. [PMID: 24480501 DOI: 10.1016/j.fas.2013.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/10/2013] [Accepted: 10/14/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patients with hip and knee osteoarthritis (OA) have high bone mineral density (BMD) and high BMI. If the same accounts for patients with foot or ankle OA is unknown. METHODS We measured BMD and femoral neck (FN) width by dual-energy X-ray absorptiometry in 42 women and 19 men with idiopathic OA in the foot or ankle, and in 99 women and 82 men as controls. RESULTS Women with OA had significant higher BMI than controls. Women with OA had higher BMI-adjusted BMD (p<0.01) and smaller BMI-adjusted FN width (p<0.01) than controls. Men with OA had higher BMI adjusted-BMD (p<0.05) and smaller BMI-adjusted FN width (p<0.01) than controls. CONCLUSION Patients with OA in the foot or ankle have higher BMD and smaller bone size than being expected by their BMI. This phenotype may provide unfavourable forces across the joint and is hypothetically important for development of OA.
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Affiliation(s)
- M C Cöster
- Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö; Department of Orthopedics, Kalmar Hospital, Kalmar, Sweden.
| | - B E Rosengren
- Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö
| | - C Karlsson
- Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö
| | - T von Schevelow
- Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö
| | - H Magnusson
- Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö
| | - L Brudin
- Department of Orthopedics, Kalmar Hospital, Kalmar, Sweden
| | - M K Karlsson
- Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö
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Abstract
Osteoporosis is a prevalent disease that typically reduces bone strength and predisposes to fractures. It is a multifactorial disorder resulting from the interaction of genetic and acquired factors. Candidate gene studies and, more recently, genome-wide studies have identified a number of polymorphisms significantly associated with bone mass and fractures. Anti-resorptive drugs, which inhibit the differentiation and activity of osteoclasts, are frequently used to treat patients with osteoporosis.Several candidate gene studies have explored the association of genetic factors with drug response, including some common polymorphisms of the gene encoding FDPS (Farnesyl diphosphate synthase), an enzyme that is the main target of aminobisphosphonates. Although scarce data are available, interesting opportunities are open for a better understanding of the pharmacogenetics of osteoporosis and osteoporotic fractures. They include the reanalysis of data already available from epidemiological studies and clinical trials, as well as obtaining pharmacogenetic data in new studies. However, based upon the experience with previous genome-wide association studies, large collaborative efforts would be likely needed to obtain meaningful results.
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Affiliation(s)
- José A Riancho
- Bone Laboratory, Department of Internal Medicine, Hospital U.M. Valdecilla-IDIVAL, University of Cantabria, Av. Valdecilla s/n, Santander, 39008, Spain,
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46
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Sheu Y, Cauley JA, Patrick AL, Wheeler VW, Bunker CH, Zmuda JM. Risk factors for fracture in middle-age and older-age men of African descent. J Bone Miner Res 2014; 29:234-41. [PMID: 23775783 PMCID: PMC3830695 DOI: 10.1002/jbmr.2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/17/2013] [Accepted: 06/03/2013] [Indexed: 11/06/2022]
Abstract
Although fracture rates are lower in individuals of African descent compared to individuals of European ancestry, morbidity and mortality following a fracture may be greater in individuals of African ancestry. However, fracture risk and associated clinical risk factors have not been well-defined among African ancestry populations, especially among men of African ancestry. We used data collected from the Tobago Bone Health Study to examine potential clinical risk factors for incident fractures, including demographic information, anthropometric measurements, medical history, lifestyle factors, bone mineral density (BMD), and hip structural geometry. Among 1933 Afro-Caribbean men aged ≥40 years at study entry (mean age: 57.2 ± 11.0 years), 65 reported at least one new fracture during 10 years of subsequent follow-up. Younger age, mixed Afro-Caribbean ancestry, prior fracture history, BMD, and hip structural geometry were statistically significant risk factors for incident fractures. A 1-SD change in several skeletal parameters (hip BMD, cross-sectional area, outer diameter, cortical thickness, and buckling ratio) were each associated with a 35% to 56% increase in incident fracture risk after adjusting for age. Men with a prior fracture history were three times more likely to experience a new fracture during follow-up, and the association remained strong after adjusting for age, mixed Afro-Caribbean ancestry, and skeletal parameters (hazard ratios ranged from 2.72 to 2.82). Our findings suggest that except for age, risk factors for fracture in men of African ancestry are similar to established risk factors in white populations. Prior fracture history is a powerful and independent risk factor for incident fractures among men of African ancestry and could easily be incorporated into clinical risk evaluation.
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Affiliation(s)
- Yahtyng Sheu
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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47
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Abstract
Over the last decade, the increasingly significant problem of osteoporosis in men has begun to receive much more attention than in the past. In particular, recent observations from large scale population studies in males led to an advance in the understanding of morphologic basis of growth, maintenance and loss of bone in men, as well as new insights about the pathophysiology and treatment of this disorder. While fracture risk consistently increases after age 65 in men (with up to 50 % of cases due to secondary etiologies), osteoporosis and fractures may also occur in young or middle aged males in the absence of an identifiable etiology. For this category (so called idiopathic osteoporosis), there are still major gaps in knowledge, particularly concerning the etiology and the clinical management. This article provides a summary of recent developments in the acquisition and maintenance of bone strength in men, as well as new insights about the pathogenesis, diagnosis, and treatment of idiopathic osteoporosis.
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Affiliation(s)
- Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, Viale Bracci, 53100, Siena, Italy,
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Lee SG, Lee YH, Kim KJ, Lee W, Kwon OH, Kim JH. Additive association of vitamin D insufficiency and sarcopenia with low femoral bone mineral density in noninstitutionalized elderly population: the Korea National Health and Nutrition Examination Surveys 2009-2010. Osteoporos Int 2013; 24:2789-99. [PMID: 23652463 DOI: 10.1007/s00198-013-2378-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/23/2013] [Indexed: 11/27/2022]
Abstract
UNLABELLED Vitamin D insufficiency and sarcopenia are crucial risk factors for osteoporosis. In a study of noninstitutionalized elderly subjects, we investigated the simultaneous effect of vitamin D and sarcopenia on bone mineral density (BMD) and found that sarcopenia was associated with low BMD in the femur, especially in those with suboptimal vitamin D levels. INTRODUCTION Although vitamin D insufficiency and sarcopenia are prevalent in the elderly population worldwide, their possible influence on BMD has not been determined. We aimed to investigate the different effect of vitamin D insufficiency and sarcopenia on BMD in the elderly Korean population. METHODS Individuals aged 60 or older were selected from those who participated in the Fourth and Fifth Korea National Health and Nutrition Examination Surveys conducted in 2009 and 2010; 1,596 males and 1,886 females were analyzed. Appendicular skeletal muscle mass (ASM) and BMD were assessed by dual-energy X-ray absorptiometry; serum 25-hydroxyvitamin D [25(OH)D] and a panel of clinical and laboratory parameters were also measured. RESULTS The study population was divided into four groups according to their vitamin D and sarcopenic status. BMD in total femur and in the femoral neck but not the lumbar spine was markedly decreased in sarcopenic subjects with vitamin D insufficiency [25(OH)D < 20 ng/ml] comparing to other groups, regardless of gender. Multivariable linear regression models showed that BMD was significantly associated with ASM and high daily calcium intake as well as conventional risk factors such as age, body mass index (BMI), and history of fracture. Independent predictors for low femur BMD included sarcopenia, low daily calcium intake, low 25(OH)D levels, age, and BMI. CONCLUSIONS These data showed that an association between vitamin D insufficiency and low BMD was more prominent in elderly subjects with sarcopenia.
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Affiliation(s)
- S-G Lee
- Department of Laboratory Medicine, Armed Forces Capital Hospital, Seongnam, South Korea
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Vale AC, Aleixo IP, Lúcio M, Saraiva A, Caetano-Lopes J, Rodrigues A, Amaral PM, Rosa LG, Monteiro J, Fonseca JE, Vaz MF, Canhão H. At the moment of occurrence of a fragility hip fracture, men have higher mechanical properties values in comparison with women. BMC Musculoskelet Disord 2013; 14:295. [PMID: 24131745 PMCID: PMC4015558 DOI: 10.1186/1471-2474-14-295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 10/01/2013] [Indexed: 02/04/2023] Open
Abstract
Background It is well established that males have lower fracture risk in comparison with females, which suggests a higher bone resistance in men. The aim of our study was to find out if in older patients with hip fragility fractures, gender has also an impact on trabecular bone material behaviour, specifically to determine whether trabecular mechanical properties under compressive loading differ between men and women who suffered a fragility hip fracture. Methods Femoral epiphyses were consecutively collected during hip replacement surgery due to proximal femur fragility fracture. Trabecular bone cylinders were drilled and submitted to uniaxial compression tests and mechanical properties were assessed. Results Seventy-three patients, 55 women (mean age 81 years and standard deviation of 7 years) and 18 men (mean age 81 years and standard deviation of 8 years) were evaluated. The ultimate stress of trabecular bone was significantly higher in men than in women: the median values and the interquartile range (IQR) were respectively 8.04(5.35-10.90) MPa vs. 4.46(3.02-7.73) MPa, (p-value = 0.005). The same difference between male and female was observed in the Young’s modulus: 293.68(166.67-538.18) MPa vs. 174.26(73.07-322.28) MPa, (p-value = 0.028), and also in the energy to failure: 0.25(0.07-0.42) MJ/m3 vs. 0.11(0.05-0.25) MJ/m3, (p-value = 0.058). These differences were also verified after adjusting the analysis for age in a multivariate model analysis. Conclusions Our observations demonstrated that, even in a population who suffered a fragility hip fracture, men still have higher trabecular bone mechanical properties in comparison with women.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - João E Fonseca
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
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Amin S, Melton LJ, Achenbach SJ, Atkinson EJ, Dekutoski MB, Kirmani S, Fischer PR, Khosla S. A distal forearm fracture in childhood is associated with an increased risk for future fragility fractures in adult men, but not women. J Bone Miner Res 2013; 28:1751-9. [PMID: 23456800 PMCID: PMC3909660 DOI: 10.1002/jbmr.1914] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 01/20/2013] [Accepted: 02/04/2013] [Indexed: 11/11/2022]
Abstract
Distal forearm fractures are among the most common fractures during childhood, but it remains unclear whether they predict an increased fracture risk later in life. We studied a population-based cohort of 1776 children ≤18 years of age, from Olmsted County, MN, USA, who had a distal forearm fracture in 1935-1992. Incident fractures occurring at age ≥35 years were identified through review of complete medical records using the linkage system of the Rochester Epidemiology Project. Observed nonpathologic fractures resulting from no more than moderate trauma (fragility fractures) were compared with expected numbers estimated from fracture site-specific incidence rates, based on age, sex, and calendar year, for Olmsted County (standardized incidence ratios [SIR]). In 1086 boys (mean ± SD age; 11 ± 4 years) and 690 girls (10 ± 4 years) followed for 27,292 person-years after the age of 35 years, subsequent fragility fractures were observed in 144 (13%) men and 74 (11%) women. There was an increased risk for future fragility fractures in boys who had a distal forearm fracture (SIR, 1.9; 95% CI, 1.6-2.3) but not girls (SIR, 1.0; 95% CI, 0.8-1.2). Fragility fractures at both major osteoporotic (hip, spine, wrist, and shoulder) sites (SIR, 2.6; 95% CI, 2.1-3.3) and remaining sites (SIR, 1.7; 95% CI, 1.3-2.0) were increased in men, irrespective of age at distal forearm fracture as boys. A distal forearm fracture in boys, but not girls, is associated with an increased risk for fragility fractures as older adults. It is necessary to determine whether the increased fractures observed in men is due to persistent deficits of bone strength, continued high fracture risk activity, or both. Until then, men should be asked about a childhood distal forearm fracture and, if so, warrant further screening and counseling on measures to optimize bone health and prevent fractures.
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Affiliation(s)
- Shreyasee Amin
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA.
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