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Shi Y, Fang J, Li J, Yu K, Zhu J, Lu Y. Fracture risk prediction in diabetes patients based on Lasso feature selection and Machine Learning. Comput Methods Biomech Biomed Engin 2024:1-17. [PMID: 39257307 DOI: 10.1080/10255842.2024.2400325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 08/12/2024] [Accepted: 08/21/2024] [Indexed: 09/12/2024]
Abstract
Fracture risk among individuals with diabetes poses significant clinical challenges due to the multifaceted relationship between diabetes and bone health. Diabetes not only affects bone density but also alters bone quality and structure, thereby increases the susceptibility to fractures. Given the rising prevalence of diabetes worldwide and its associated complications, accurate prediction of fracture risk in diabetic individuals has emerged as a pressing clinical need. This study aims to investigate the factors influencing fracture risk among diabetic patients. We propose a framework that combines Lasso feature selection with eight classification algorithms. Initially, Lasso regression is employed to select 24 significant features. Subsequently, we utilize grid search and 5-fold cross-validation to train and tune the selected classification algorithms, including KNN, Naive Bayes, Decision Tree, Random Forest, AdaBoost, XGBoost, Multi-layer Perceptron (MLP), and Support Vector Machine (SVM). Among models trained using these important features, Random Forest exhibits the highest performance with a predictive accuracy of 93.87%. Comparative analysis across all features, important features, and remaining features demonstrate the crucial role of features selected by Lasso regression in predicting fracture risk among diabetic patients. Besides, by using a feature importance ranking algorithm, we find several features that hold significant reference values for predicting early bone fracture risk in diabetic individuals.
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Affiliation(s)
- Yu Shi
- School of Computer Science & Technology, Soochow University, Suzhou, China
| | - Junhua Fang
- School of Computer Science & Technology, Soochow University, Suzhou, China
| | - Jiayi Li
- School of Computer Science & Technology, Soochow University, Suzhou, China
| | - Kaiwen Yu
- Orthopedics Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jingbo Zhu
- Orthopedics Department, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Lu
- Orthopedics Department, The First Affiliated Hospital of Soochow University, Suzhou, China
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Liang Z, Sun X, Shi J, Tian Y, Wang Y, Cheng Y, Liu Y. Association of the live microbe intake from foods with all-cause and cardiovascular disease-specific mortality: a prospective cohort study. Eur J Nutr 2024; 63:2327-2337. [PMID: 38775828 DOI: 10.1007/s00394-024-03409-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/21/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Live dietary microbes have been hypothesized to promoting human health. However, there has been lacking perceptions to crystallize nexus between consumption of foods with live microbes and mortality. OBJECTIVE To investigate the association of consumption of foods with medium to high amounts of live microbes with all-cause, cancer-specific, and cardiovascular disease (CVD)-specific mortality. METHODS The data were obtained from the National Health and Nutrition Examination Survey 1999-2018 at baseline linked to the 2019 National Death Index records. Based on consumption of foods that were categorized as either having medium or high microbial content (MedHi foods), participants were classified into three groups. Kaplan-Meier survival curves and multivariable Cox regression models were used to estimate the association of consumption of MedHi foods with mortality. Population-attributable fractions (PAFs) of consumption of MedHi foods in relation to mortality risk were also estimated. RESULTS A total of 35,299 adults aged ≥ 20 years were included in this study. During a median follow-up of 9.67 years, compared with adults in G1, those in G3 had 16% (hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.77-0.90) reduced risk of all-cause mortality, and 23% (HR, 0.77; 95% CI, 0.67-0.89) reduced risk of CVD-specific mortality. The PAF of high (G3) vs. intermediate or low consumption of MedHi foods (G1 + G2) with all-cause and CVD-specific mortality was 3.4% and 4.3%, respectively. CONCLUSIONS Consumption of foods with higher microbial concentrations is associated with a reduced risk of all-cause and CVD-specific mortality in US adults.
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Affiliation(s)
- Zhuoshuai Liang
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China
| | - Xiaoyue Sun
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China
| | - Jikang Shi
- Department of Clinical Nutrition, Peking University Shenzhen Hospital, Shenzhen, 518036, China
| | - Yuyang Tian
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China
| | - Yujian Wang
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China
| | - Yi Cheng
- The Cardiovascular Center, the First Hospital of Jilin University, Changchun, 130021, China.
| | - Yawen Liu
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China.
- State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Diseases, Key Laboratory for Zoonosis Research of the Ministry of Education, School of Public Health, Jilin University, Changchun, 130062, China.
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Xie H, Gu C, Zhang W, Zhu J, He J, Huang Z, Zhu J, Xu Z. A few-shot learning framework for the diagnosis of osteopenia and osteoporosis using knee X-ray images. J Int Med Res 2024; 52:3000605241274576. [PMID: 39225007 PMCID: PMC11375658 DOI: 10.1177/03000605241274576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE We developed a few-shot learning (FSL) framework for the diagnosis of osteopenia and osteoporosis in knee X-ray images. METHODS Computer vision models containing deep convolutional neural networks were fine-tuned to enable generalization from natural images (ImageNet) to chest X-ray images (normal vs. pneumonia, base images). Then, a series of automated machine learning classifiers based on the Euclidean distances of base images were developed to make predictions for novel images (normal vs. osteopenia vs. osteoporosis). The performance of the FSL framework was compared with that of junior and senior radiologists. In addition, the gradient-weighted class activation mapping algorithm was used for visual interpretation. RESULTS In Cohort #1, the mean accuracy (0.728) and sensitivity (0.774) of the FSL models were higher than those of the radiologists (0.512 and 0.448). A diagnostic pipeline of FSL model (first)-radiologists (second) achieved better performance (0.653 accuracy, 0.582 sensitivity, and 0.816 specificity) than radiologists alone. In Cohort #2, the diagnostic pipeline also showed improved performance. CONCLUSIONS The FSL framework yielded practical performance with respect to the diagnosis of osteopenia and osteoporosis in comparison with radiologists. This retrospective study supports the use of promising FSL methods in computer-aided diagnosis tasks involving limited samples.
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Affiliation(s)
- Hua Xie
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, Changzhou, China
| | - Chenqi Gu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Wenchao Zhang
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, Changzhou, China
| | - Jiacheng Zhu
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, Changzhou, China
| | - Jin He
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, Changzhou, China
| | - Zhou Huang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jinzhou Zhu
- Department of Gastroenterology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhonghua Xu
- Department of Orthopedics, Jintan Hospital Affiliated to Jiangsu University, Changzhou, China
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Runting H, Qingyue L, Yining Y, Huiyu S, Shu Y, Xixi F. Is bone mineral density in middle-aged and elderly individuals associated with their dietary patterns? A study based on NHANES. Front Nutr 2024; 11:1396007. [PMID: 39246404 PMCID: PMC11378718 DOI: 10.3389/fnut.2024.1396007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 08/05/2024] [Indexed: 09/10/2024] Open
Abstract
Introduction Bone mineral density (BMD) is a crucial index for predicting fracture risk and diagnosing osteoporosis. With the global rise in osteoporosis prevalence, understanding the relationship between dietary patterns and BMD is vital for public health. This study aimed to explore the association between various dietary patterns and BMD among adults using data from the National Health and Nutrition Examination Survey (NHANES). Methods Data were analyzed from 8,416 NHANES participants aged 40 years and older across three non-consecutive survey cycles from 2013 to 2020. Dietary patterns were identified using a combination of factor analysis and cluster analysis. BMD measurements were then assessed, and associations with the identified dietary patterns were analyzed, with adjustments made for demographic variables. Results The analysis identified three distinct dietary patterns: "Low protein-High Dietary fiber-Vitamin A-Magnesium (LP-HDF-Vit A-Mg)", "High macronutrient-Choline-Selenium (HM-Cho-Se)", and "Low macronutrient-Vitamin D-Calcium (LM-Vit D-Ca)", and then we found that women, older adults, and certain ethnic groups were at higher risk for low BMD. Participants adhering to the "HM-Cho-Se" and "LP-HDF-Vit A-Mg" dietary patterns exhibited significantly higher BMD compared to those following the "LM-Vit D-Ca" pattern. After adjusting for demographic variables, the "HM-Cho-Se" pattern remained positively associated with BMD, while the "LM-Vit D-Ca" pattern showed no significant association with BMD or the risk of low BMD. Discussion The findings suggest that adherence to the "HM-Cho-Se" dietary pattern may reduce the risk of low BMD, indicating potential synergies between these nutrients for bone health. However, the study has limitations, including the cross-sectional design and potential subjectivity in factor analysis. Future research should focus on longitudinal studies involving diverse age groups to better understand the causal relationship between dietary patterns and BMD. Despite these limitations, the study highlights the importance of dietary factors in maintaining bone health and suggests potential dietary interventions to reduce the risk of low BMD and osteoporosis.
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Affiliation(s)
- Huang Runting
- Department of Public Health, Chengdu Medical College, Chengdu, China
| | - Luo Qingyue
- Department of Public Health, Chengdu Medical College, Chengdu, China
| | - Yuan Yining
- Department of Public Health, Chengdu Medical College, Chengdu, China
| | - Shu Huiyu
- Department of Public Health, Chengdu Medical College, Chengdu, China
| | - Yang Shu
- School of Medical Information Engineering, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Feng Xixi
- Department of Public Health, Chengdu Medical College, Chengdu, China
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Leungsuwan DS, Chandran M. Bone Fragility in Diabetes and its Management: A Narrative Review. Drugs 2024:10.1007/s40265-024-02078-5. [PMID: 39103693 DOI: 10.1007/s40265-024-02078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/07/2024]
Abstract
Bone fragility is a serious yet under-recognised complication of diabetes mellitus (DM) that is associated with significant morbidity and mortality. Multiple complex pathophysiological mechanisms mediating bone fragility amongst DM patients have been proposed and identified. Fracture risk in both type 1 diabetes (T1D) and type 2 diabetes (T2D) continues to be understated and underestimated by conventional risk assessment tools, posing an additional challenge to the identification of at-risk patients who may benefit from earlier intervention or preventive strategies. Over the years, an increasing body of evidence has demonstrated the efficacy of osteo-pharmacological agents in managing skeletal fragility in DM. This review seeks to elaborate on the risk of bone fragility in DM, the underlying pathogenesis and skeletal alterations, the approach to fracture risk assessment in DM, management strategies and therapeutic options.
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Affiliation(s)
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, 20 College Road, ACADEMIA, Singapore, 169856, Singapore.
- DUKE NUS Medical School, Singapore, Singapore.
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Chen H, Hu J, Li J, Li Q, Lan L. Association between triglyceride-glucose index and femoral bone mineral density in community-dwelling, nondiabetic men and women: a NHANES analysis of 1,928 US individuals. Menopause 2024; 31:626-633. [PMID: 38814194 DOI: 10.1097/gme.0000000000002374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To determine the potential association between the triglyceride-glucose (TyG) index and bone mineral density (BMD) in community-dwelling adults without diabetes using a nationally representative database from the United States (US). METHODS Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005-2010, 2013-2014, and 2017-2018. Men and postmenopausal women aged ≥50 years with complete data on femoral neck BMD, triglycerides, and fasting plasma glucose levels were eligible for inclusion. Participants with diabetes, history of malignancy, thyroid disease, underweight status, end-stage kidney disease, rheumatoid arthritis, estrogen/selective estrogen receptor modulators, bisphosphonate or bone resorption inhibitors, or missing dataset weight values were excluded. Univariate and multivariable logistic regression analyses were performed to determine the associations between low BMD, TyG index, and other study variables. RESULTS A total of 1,844 participants (1,161 men and 683 women) were included, representing 31,517,106 community-dwelling individuals in the US. The mean age of the study population was 60.7 years old, and 26.7% of the men and 60.4% of the women had low bone density. In both males and females, the mean TyG index was 8.6. After adjusting for demographic, lifestyle, and clinical factors, no significant association was observed between TyG and femoral neck BMD among men (adjusted odds ratio [aOR] = -0.0002, 95% confidence interval [CI]: -0.02 to 0.02) and women (aBeta = 0.005, 95% CI: -0.02 to 0.04). Similarly, no significant association was observed between TyG index and the odds for low bone density among men (aOR = 1.09, 95% CI: 0.73-1.63) and women (aOR = 0.99, 95% CI: 0.49-2.01). CONCLUSIONS Based on data from a large sample in the US, this study did not find an association between the TyG index and femoral neck BMD or the occurrence of low bone density in community-dwelling males and females without diabetes.
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Affiliation(s)
- Hailing Chen
- From the Department of Osteoporosis, Beijing Jishuitan Hospital, Capital Medical University, 4th Medical College of Peking University, Beijing, China
| | - Jianpeng Hu
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, 4th Medical College of Peking University, Beijing, China
| | - Jufen Li
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, 4th Medical College of Peking University, Beijing, China
| | - Quan Li
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, 4th Medical College of Peking University, Beijing, China
| | - Ling Lan
- Department of Endocrinology, Beijing Jishuitan Hospital, Capital Medical University, 4th Medical College of Peking University, Beijing, China
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Zhang X, Yang L, Zhang J, Lix LM, Leslie WD, Kan B, Yang S. Secular Trends in Peak Bone Mineral Density: The National Health and Nutrition Examination Survey 1999-2018. Calcif Tissue Int 2024; 114:480-489. [PMID: 38522039 DOI: 10.1007/s00223-024-01198-0] [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: 11/24/2023] [Accepted: 02/19/2024] [Indexed: 03/25/2024]
Abstract
Peak bone mineral density (BMD) is one of the most important factors influencing the development of osteoporosis. It was predicted that a 10% increase in peak BMD will delay the onset of osteoporosis by 13 years. However, changes in peak BMD over time are unknown. This study aimed to investigate secular trends in peak BMD among young adults in the United States. Based on the National Health and Nutrition Examination Survey from 1999-2018, 3,975 males aged 19-28 years and 2370 females aged 31-40 years were our target population for estimating peak lumbar spine BMD. BMD was measured by dual-energy X-ray absorptiometry. Generalized linear models adjusted for multiple covariates were used to examine the secular trends in peak BMD in males and females, respectively. Secular trends for peak lumbar spine BMD from 1999-2000 to 2017-2018 were not statistically significant in males or females (all Plinear and Pquadratic > 0.05). Similar results were observed in race/ethnicity subgroups (all Plinear and Pquadratic > 0.05). However, in stratified analyses by obesity category, peak lumbar spine BMD in obese males and females increased from 1999-2000 to 2009-2010 and then decreased until 2017-2018, while peak lumbar spine BMD in non-obese females decreased from 1999-2000 to 2005-2006 and then increased until 2017-2018 (all Pquadratic < 0.05). Peak lumbar spine BMD was greater in obese males and females than in non-obese males and females up to 2009-2010, but not from 2011-2012 onwards. Overall, there were no significant secular trends in peak lumbar spine BMD. However, secular trends differed between obese and non-obese groups.
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Affiliation(s)
- Xiaohua Zhang
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Linghua Yang
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Juan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China
| | - Lisa M Lix
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Bo Kan
- Department of Clinical Laboratory, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Shuman Yang
- Department of Orthopedics, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China.
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 232-1163 Xinmin Street, Changchun, 130021, Jilin, China.
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Shi D, Liu W, Hang J, Chen W. Whole egg consumption in relation to bone health of the US population: a cross-sectional study. Food Funct 2024; 15:1369-1378. [PMID: 38206082 DOI: 10.1039/d3fo04248k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
Abstract
Osteoporosis, a condition that is characterized by low bone mineral density (BMD), is a serious health concern worldwide. This study aims to explore the relationship between whole egg consumption and BMD levels in the US population. This study involves 19 208 participants with valid BMD and egg consumption data from the National Health and Nutrition Examination Survey (NHANES) during 2005-2006, 2007-2008, 2009-2010, 2013-2014 and 2017-2018. Linear regression analysis was conducted to evaluate the association between whole egg consumption and BMD levels. Mediation analysis was used to investigate the role of serum alkaline phosphatase (ALP) in the above relationship. After multivariate adjustment, participants consuming whole eggs over 3.53 ounce per day in their diet were found to have elevated BMD levels in the femur (0.013 g cm-2 with 95% CI: 0.004, 0.022) and lumbar spine (0.013 g cm-2 with 95% CI: 0.002, 0.024) (Ptrend < 0.05). The additive interaction of egg consumption and body mass index (BMI) on the BMD of both the femur and lumbar spine (Pinteraction < 0.05) was also analyzed. The association between whole egg consumption and BMD of both the femur and lumbar spine were significantly mediated by ALP with 71.8% and 83.3% mediation proportion, respectively. In general, higher whole egg consumption is positively related to an increase in the BMD scores of both the femur and lumbar spine among the US population.
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Affiliation(s)
- Da Shi
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Wei Liu
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
| | - Jiayi Hang
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Weihong Chen
- Department of Occupational and Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China.
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Lee SW, Heu JY, Kim JY, Kim J, Han K, Kwon HS. Association between Smoking Status and the Risk of Hip Fracture in Patients with Type 2 Diabetes: A Nationwide Population-Based Study. Endocrinol Metab (Seoul) 2023; 38:679-689. [PMID: 38053226 PMCID: PMC10764993 DOI: 10.3803/enm.2023.1760] [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: 06/15/2023] [Revised: 08/12/2023] [Accepted: 09/06/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGRUOUND Limited longitudinal evidence exists regarding the potential association between smoking status and hip fracture among individuals with type 2 diabetes. We investigated this association using large-scale, nationwide cohort data for the Korean population. METHODS This nationwide cohort study included 1,414,635 adults aged 40 and older who received Korean National Health Insurance Service health examinations between 2009 and 2012. Subjects with type 2 diabetes were categorized according to their smoking status, amount smoked (pack-years), number of cigarettes smoked per day, and duration of smoking. The results are presented as hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between smoking status parameters and risk of hip fracture in multivariable Cox proportional hazard regression analysis. RESULTS Compared with never-smokers, an increased adjusted HR (aHR) for hip fracture was observed in current smokers (1.681; 95% CI, 1.578 to 1.791), and a comparable aHR for hip fracture was found in former smokers (1.065; 95% CI, 0.999 to 1.136). For former smokers who had smoked 20 pack-years or more, the risk was slightly higher than that for never-smokers (aHR, 1.107; 95% CI, 1.024 to 1.196). The hip fracture risk of female former smokers was similar to that of female current smokers, but the hip fracture risk in male former smokers was similar to that of male never-smokers. CONCLUSION Smoking is associated with an increased risk of hip fracture in patients with type 2 diabetes. Current smokers with diabetes should be encouraged to quit smoking because the risk of hip fracture is greatly reduced in former smokers.
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Affiliation(s)
- Se-Won Lee
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Young Heu
- Department of Orthopedic Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Ju-Yeong Kim
- Department of Orthopedic Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Jinyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Hyuk-Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Viggers R, Rasmussen NH, Vestergaard P. Effects of Incretin Therapy on Skeletal Health in Type 2 Diabetes-A Systematic Review. JBMR Plus 2023; 7:e10817. [PMID: 38025038 PMCID: PMC10652182 DOI: 10.1002/jbm4.10817] [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: 06/05/2023] [Revised: 08/11/2023] [Accepted: 08/16/2023] [Indexed: 12/01/2023] Open
Abstract
Diabetes poses a significant risk to bone health, with Type 1 diabetes (T1D) having a more detrimental impact than Type 2 diabetes (T2D). The group of hormones known as incretins, which includes gastric inhibitory peptide (GIP) and glucagon-like peptide 1 (GLP-1), play a role in regulating bowel function and insulin secretion during feeding. GLP-1 receptor agonists (GLP-1 RAs) are emerging as the primary treatment choice in T2D, particularly when atherosclerotic cardiovascular disease is present. Dipeptidyl peptidase 4 inhibitors (DPP-4is), although less potent than GLP-1 RAs, can also be used. Additionally, GLP-1 RAs, either alone or in combination with GIP, may be employed to address overweight and obesity. Since feeding influences bone turnover, a relationship has been established between incretins and bone health. To explore this relationship, we conducted a systematic literature review following the PRISMA guidelines. While some studies on cells and animals have suggested positive effects of incretins on bone cells, turnover, and bone density, human studies have yielded either no or limited and conflicting results regarding their impact on bone mineral density (BMD) and fracture risk. The effect on fracture risk may vary depending on the choice of comparison drug and the duration of follow-up, which was often limited in several studies. Nevertheless, GLP-1 RAs may hold promise for people with T2D who have multiple fracture risk factors and poor metabolic control. Furthermore, a potential new area of interest is the use of GLP-1 RAs in fracture prevention among overweight and obese people. Based on this systematic review, existing evidence remains insufficient to support a positive or a superior effect on bone health to reduce fracture risk in people with T2D. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Rikke Viggers
- Steno Diabetes Center North DenmarkAalborgDenmark
- Department of EndocrinologyAalborg University HospitalAalborgDenmark
| | | | - Peter Vestergaard
- Steno Diabetes Center North DenmarkAalborgDenmark
- Department of EndocrinologyAalborg University HospitalAalborgDenmark
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Li L, Cheng S, Xu G. Application of neural network and nomogram for the prediction of risk factors for bone mineral density abnormalities: A cross-sectional NHANES-based survey. Heliyon 2023; 9:e20677. [PMID: 37829807 PMCID: PMC10565773 DOI: 10.1016/j.heliyon.2023.e20677] [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: 04/01/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023] Open
Abstract
Background The risk of bone mineral density abnormalities is inconsistent between eastern and western regions owing to differences in ethnicity and dietary habits. A diet comprising carbohydrates and dietary fiber is not the common daily diet of the American population. Thus far, no studies have assessed the risk of bone mineral density abnormalities in the American population, and no predictive model has considered the intake of carbohydrates, dietary fiber, and coffee, as well as levels of various electrolytes for assessing bone mineral density abnormalities, especially in the elderly. This study conducted a neural network analysis and established a predictive nomogram considering an unusual diet to determine risk factors for bone mineral density abnormalities in the American population, mainly to provide a reference for the prevention and treatment of related bone mineral density abnormalities. Methods Overall, 9871 patients who had complete data were selected from the National Health and Nutrition Examination Survey database during 2017-2020 as the research object, and patients' general clinical characteristics were compared. Neural networks and nomograms were analyzed to screen for and quantify risk factors for bone mineral density abnormalities. Finally, the receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and community indifference curve (CIC) were constructed to comprehensively verify the accuracy, differential ability, and clinical practicability of the neural network and nomogram. Results The important risk factors for bone mineral density abnormalities were caffeine intake, carbohydrate consumption, body mass index (BMI), height, blood sodium, blood calcium, blood phosphorus, blood potassium, dietary fiber, vitamin D, participant age, weight, race, family history, and sex. The nomogram revealed that caffeine intake, carbohydrate consumption, blood potassium, and age were positively correlated with bone mineral density abnormalities, whereas BMI, height, blood phosphate, dietary fiber, and blood sodium were negatively correlated with bone mineral density abnormalities. Women were more prone to these abnormalities than men. The area under the ROC curve values of the neural network and nomogram were 85.8 % and 77.7 %, respectively. The Youden index was 58.04 % and 41.87 %, respectively. The detection sensitivity was 75.73 % and 65.06 %, respectively, and the specificity was 82.31 % and 76.81 %, respectively. Calibration curves of the neural network and nomogram showed better discrimination ability from the standard curve (P > 0.05). DCA and CIC analyses showed that the application of the neural network and nomogram to explore risk factors for bone mineral density abnormalities had certain clinical practicability, and the overall predictive effect of the model was good. Conclusion The outcomes of the neural network and nomogram analyses suggested that diet structure and electrolyte changes are important significant risk factors for bone mineral density abnormalities, especially with increasing carbohydrate and caffeine intake and decreasing dietary fiber intake. The established model can also provide a reference for future risk prediction.
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Affiliation(s)
- LuWei Li
- Department of Rheumatology and Immunology, The First People's Hospital of Nanning, Nanning, Guangxi, China
- Guilin Medical University, Guilin, Guangxi, China
| | - SiShuai Cheng
- Guilin Medical University, Guilin, Guangxi, China
- Department of Cardiovascular, The 924th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army, Guilin, Guangxi, China
| | - GuoQuan Xu
- Guilin Medical University, Guilin, Guangxi, China
- Department of Urology, The First People's Hospital of Qinzhou, Qinzhou, Guangxi, China
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12
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Liang Z, Sun X, Lan J, Guo R, Tian Y, Liu Y, Liu S. Association between pyrethroid exposure and osteoarthritis: a national population-based cross-sectional study in the US. BMC Public Health 2023; 23:1521. [PMID: 37612655 PMCID: PMC10464395 DOI: 10.1186/s12889-023-16225-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/30/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND With the restriction of organophosphorus and other insecticides, pyrethroids are currently the second most-used group of insecticides worldwide due to their advantages such as effectiveness and low toxicity for mammalian. Animal studies and clinical case reports have documented associations between adverse health outcomesand exposure to pyrethroids. At present, the association between chronic pyrethroid exposure and osteoarthritis (OA) remains elusive. METHODS Cross-sectional data from the National Health and Nutrition Examination Survey 1999-2002 and 2007-2014 were used to explore the associations of pyrethroid exposure and OA. Urinary level of 3-phenoxybenzoic acid (3-PBA) in urine samples was used to evaluate the exposure of pyrethroid, and OA was determined on the basis of self-reported physician diagnoses. Multivariable logistic regression models were used to investigate the association between pyrethroid exposure and OA. RESULTS Among the 6528 participants, 650 had OA. The weighted geometric mean of urinary volume-based 3-PBA concentration were 0.45 µg/L. With adjustments for major confounders, compared to participants in the lowest quartile of urinary volume-based 3-PBA, those in the highest quartilehad higher odds of OA (odds ratio, 1.39; 95% confidence interval: 1.01, 1.92). There was no nonlinear relationship between urinary volume-based 3-PBA and OA (P for non-linearity = 0.89). CONCLUSION High urinary 3-PBA concentration was associated with increased OA odds in the US adults. Pyrethroid exposure in the population should be monitored regularly.
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Affiliation(s)
- Zhuoshuai Liang
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China
| | - Xiaoyue Sun
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China
| | - Jia Lan
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China
| | - Ruifang Guo
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China
| | - Yuyang Tian
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China
| | - Yawen Liu
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China.
| | - Siyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun, 130021, China.
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Lee SW, Han K, Kwon HS. Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study (Diabetes Metab J 2023;47:242-54). Diabetes Metab J 2023; 47:439-440. [PMID: 37257911 DOI: 10.4093/dmj.2023.0104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Affiliation(s)
- Se-Won Lee
- Department of Orthopedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Shieh A, Greendale GA, Cauley JA, Karvonen-Gutierrez CA, Karlamangla AS. Prediabetes and Fracture Risk Among Midlife Women in the Study of Women's Health Across the Nation. JAMA Netw Open 2023; 6:e2314835. [PMID: 37219902 PMCID: PMC10208145 DOI: 10.1001/jamanetworkopen.2023.14835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/09/2023] [Indexed: 05/24/2023] Open
Abstract
Importance Whether prediabetes is associated with fracture is uncertain. Objective To evaluate whether prediabetes before the menopause transition (MT) is associated with incident fracture during and after the MT. Design, Setting, and Participants This cohort study used data collected between January 6, 1996, and February 28, 2018, in the Study of Women's Health Across the Nation cohort study, an ongoing, US-based, multicenter, longitudinal study of the MT in diverse ambulatory women. The study included 1690 midlife women in premenopause or early perimenopause at study inception (who have since transitioned to postmenopause) who did not have type 2 diabetes before the MT and who did not take bone-beneficial medications before the MT. Start of the MT was defined as the first visit in late perimenopause (or first postmenopausal visit if participants transitioned directly from premenopause or early perimenopause to postmenopause). Mean (SD) follow-up was 12 (6) years. Statistical analysis was conducted from January to May 2022. Exposure Proportion of visits before the MT that women had prediabetes (fasting glucose, 100-125 mg/dL [to convert to millimoles per liter, multiply by 0.0555]), with values ranging from 0 (prediabetes at no visits) to 1 (prediabetes at all visits). Main Outcomes and Measures Time to first fracture after the start of the MT, with censoring at first diagnosis of type 2 diabetes, initiation of bone-beneficial medication, or last follow-up. Cox proportional hazards regression was used to examine the association (before and after adjustment for bone mineral density) of prediabetes before the MT with fracture during the MT and after menopause. Results This analysis included 1690 women (mean [SD] age, 49.7 [3.1] years; 437 Black women [25.9%], 197 Chinese women [11.7%], 215 Japanese women [12.7%], and 841 White women [49.8%]; mean [SD] body mass index [BMI] at the start of the MT, 27.6 [6.6]). A total of 225 women (13.3%) had prediabetes at 1 or more study visits before the MT, and 1465 women (86.7%) did not have prediabetes before the MT. Of the 225 women with prediabetes, 25 (11.1%) sustained a fracture, while 111 of the 1465 women without prediabetes (7.6%) sustained a fracture. After adjustment for age, BMI, and cigarette use at the start of the MT; fracture before the MT; use of bone-detrimental medications; race and ethnicity; and study site, prediabetes before the MT was associated with more subsequent fractures (hazard ratio for fracture with prediabetes at all vs no pre-MT visits, 2.20 [95% CI, 1.11-4.37]; P = .02). This association was essentially unchanged after controlling for BMD at the start of the MT. Conclusions and Relevance This cohort study of midlife women suggests that prediabetes was associated with risk of fracture. Future research should determine whether treating prediabetes reduces fracture risk.
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Affiliation(s)
- Albert Shieh
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Gail A Greendale
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Arun S Karlamangla
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles
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Chen C, Wang B, Zhang H, Wang Y, Yu S, Zhou S, Chen Y, Xia F, Zhai H, Wang N, Lu Y. Blood Lead Level Is Associated with Visceral Adipose Dysfunction in Patients with Type 2 Diabetes. Biol Trace Elem Res 2023; 201:2266-2273. [PMID: 35851677 DOI: 10.1007/s12011-022-03357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/10/2022] [Indexed: 11/02/2022]
Abstract
We aimed to explore whether an elevated blood lead level (BLL) is associated with visceral adipose dysfunction in patients with type 2 diabetes mellitus (T2DM). Four thousand one hundred and fourteen diabetic participants were enrolled from seven communities in Shanghai in 2018 in the cross-sectional METAL study. BLL was measured by graphite furnace atomic absorption spectrometry. Visceral adiposity index (VAI) and lipid accumulation product (LAP)were calculated by simple anthropometric and biochemical parameters. We found that medians (IQR) of BLL were 26.0 μg/L (18.0-37.0) for men and 25.0 μg/L (18.0-35.0) for women, respectively. In men, each doubling of BLL was associated with a 2.0% higher VAI (95% CI, 0.6 to 3.5%) and 1.8% higher LAP (95% CI, 0.2 to 3.3%) after full adjustment. Using the lowest BLL quartile as the referent group, significant positive trends were observed for BLL with VAI and LAP. In women, each doubling of BLL was associated with a 1.9% higher LAP (95% CI, 0.6 to 3.1%). Additionally, there was a marginally significant positive association between BLL and VAI, either using log2-transformed concentrations as continuous variables or categorized in quartiles. In conclusion, lead exposure is associated with visceral adipose dysfunction in patients with T2DM. Further prospective studies are warranted to confirm our findings.
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Affiliation(s)
- Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639, Zhizaoju Road, Shanghai, 200011, China
| | - Bin Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639, Zhizaoju Road, Shanghai, 200011, China
| | - Haojie Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639, Zhizaoju Road, Shanghai, 200011, China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639, Zhizaoju Road, Shanghai, 200011, China
| | - Shiyan Yu
- Institute of Precision Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shuo Zhou
- Department of Anesthesiology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639, Zhizaoju Road, Shanghai, 200011, China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639, Zhizaoju Road, Shanghai, 200011, China
| | - Hualing Zhai
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639, Zhizaoju Road, Shanghai, 200011, China.
| | - Ningjian Wang
- Department of Endocrinology and Metabolism, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, 639, Zhizaoju Road, Shanghai, 200011, China.
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16
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Lyu H, Zhao SS, Zhang L, Wei J, Li X, Li H, Liu Y, Yin P, Norvang V, Yoshida K, Tedeschi SK, Zeng C, Lei G, Tang P, Solomon DH. Denosumab and incidence of type 2 diabetes among adults with osteoporosis: population based cohort study. BMJ 2023; 381:e073435. [PMID: 37072150 PMCID: PMC10111187 DOI: 10.1136/bmj-2022-073435] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To estimate the effect of denosumab compared with oral bisphosphonates on reducing the risk of type 2 diabetes in adults with osteoporosis. DESIGN Population based study involving emulation of a randomized target trial using electronic health records. SETTING IQVIA Medical Research Data primary care database in the United Kingdom, 1995-2021. PARTICIPANTS Adults aged 45 years or older who used denosumab or an oral bisphosphonate for osteoporosis. MAIN OUTCOME MEASURES The primary outcome was incident type 2 diabetes, as defined by diagnostic codes. Cox proportional hazards models were used to estimate adjusted hazard ratios and 95% confidence intervals, comparing denosumab with oral bisphosphonates using an as treated approach. RESULTS 4301 new users of denosumab were matched on propensity score to 21 038 users of an oral bisphosphonate and followed for a mean of 2.2 years. The incidence rate of type 2 diabetes in denosumab users was 5.7 (95% confidence interval 4.3 to 7.3) per 1000 person years and in oral bisphosphonate users was 8.3 (7.4 to 9.2) per 1000 person years. Initiation of denosumab was associated with a reduced risk of type 2 diabetes (hazard ratio 0.68, 95% confidence interval 0.52 to 0.89). Participants with prediabetes appeared to benefit more from denosumab compared with an oral bisphosphonate (hazard ratio 0.54, 0.35 to 0.82), as did those with a body mass index ≥30 (0.65, 0.40 to 1.06). CONCLUSIONS In this population based study, denosumab use was associated with a lower risk of incident type 2 diabetes compared with oral bisphosphonate use in adults with osteoporosis. This study provides evidence at a population level that denosumab may have added benefits for glucose metabolism compared with oral bisphosphonates.
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Affiliation(s)
- Houchen Lyu
- Department of Orthopaedics, The Chinese PLA General Hospital, Beijing 100853, China
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, The Chinese PLA General Hospital, Beijing, China
| | - Sizheng Steven Zhao
- Centre for Epidemiology Versus Arthritis, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Licheng Zhang
- Department of Orthopaedics, The Chinese PLA General Hospital, Beijing 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, The Chinese PLA General Hospital, Beijing, China
| | - Jie Wei
- Department of epidemiology and health statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxiao Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yi Liu
- Division of Endocrinology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Pengbin Yin
- Department of Orthopaedics, The Chinese PLA General Hospital, Beijing 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, The Chinese PLA General Hospital, Beijing, China
| | - Vibeke Norvang
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kazuki Yoshida
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Sara K Tedeschi
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha, China
| | - Peifu Tang
- Department of Orthopaedics, The Chinese PLA General Hospital, Beijing 100853, China
- National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation, The Chinese PLA General Hospital, Beijing, China
| | - Daniel H Solomon
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA 02115, USA
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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17
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Viggers R, Starup-Linde J, Vestergaard P. Discrepancies in type of first major osteoporotic fracture and anti-osteoporotic therapy in elderly people with type 2 diabetes mellitus: A retrospective Danish cohort study. Bone 2023; 171:116745. [PMID: 36965654 DOI: 10.1016/j.bone.2023.116745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE Subjects with diabetes mellitus have an increased risk of fractures. We aimed to identify discrepancies in the first type of major osteoporotic fracture (MOF) and anti-osteoporotic therapy between subjects with type 2 diabetes (T2D) and subjects without diabetes. Methods and research design. We conducted a retrospective national cohort study by access to all discharge diagnoses (ICD-10 system) and redeemed drug prescriptions (ATC classification system). We included all subjects alive and Danish citizens in 2010 and identified subjects with T2D diagnosed after the age of 50 between 1998 and 2018. Only subjects with a MOF after the index date were included in the main analysis. The type of MOF was identified by diagnosis codes and categorized into Humerus, Forearm, Spine, and Hip. Multinomial logistic regression modeling was used to assess the predicted probability changes in MOF type between T2D and control subjects. Data on first anti-osteoporotic therapy after the MOF was assessed by redeemed drug prescriptions. Mortality and time to therapy after the MOF were evaluated by cox proportional hazards. RESULT We included 26,588 subjects with T2D and 97,982 subjects without diabetes. The mean age was age 69.33 (±10.34) for T2D and 69.85 (±10.19) for control subjects. The cohort was primarily females (67 %). Subjects with T2D had a higher probability of hip (3.98 % [95 % CI 3.29; 4.67]) and humerus (2.82 % [95 % CI 2.17; 3.46]) fractures as the first MOF compared to control subjects. However, the probability of forearm fractures as the first MOF was 6.77 % (95 % CI 6.08; 7.46) lower among subjects with T2D. The multiple adjusted hazard ratio for anti-osteoporotic treatment after the first MOF was 0.80 (95 % CI 0.77; 0.88) for T2D compared to controls among treatment-naïve subjects. CONCLUSION Forearm fractures were the most frequent type of MOF and were more prevalent in control subjects. Subjects with T2D had a significantly higher probability of hip and humerus fractures as the first MOF but had a 20 % lower chance of anti-osteoporotic treatment afterwards.
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Affiliation(s)
- Rikke Viggers
- Steno Diabetes Center North Denmark, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Jakob Starup-Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Peter Vestergaard
- Steno Diabetes Center North Denmark, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Lin Y, Liang Z, Zhang A, Xu N, Pei X, Wang N, Zheng L, Xu D. Relationship Between Weight-Adjusted Waist Index and Osteoporosis in the Senile in the United States from the National Health and Nutrition Examination Survey, 2017-2020. J Clin Densitom 2023; 26:101361. [PMID: 36922294 DOI: 10.1016/j.jocd.2023.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/05/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND Some studies suggested obesity may be beneficial in preventing bone loss through the negative relationship between body mass index (BMI) and osteoporosis in senile. However, using BMI to measure obesity is unconvincing due to confounding factors such as muscle mass were not taken into account, and few articles have yet taken a better way to evaluate the relationship between obesity and osteoporosis. METHODOLOGY Using a cross-sectional sample of 1,979 participants aged ≥65 years from the National Health and Nutrition Examination Survey (NHANES) 2017 to 2020, we evaluated the relation of weight-adjusted waist index (WWI) with osteoporosis. WWI was calculated as waist (cm) divided by the square root of body weight (kg). Diagnosis of osteoporosis was described as follows: according to the updated reference for calculating bone mineral density T-Scores, we marked the BMD value as X, using the formula T femoral neck= (X g/cm2-0.888 g/cm2)/0.121 g/cm2, T lumbar spine= (X g/cm2- 1.065 g/cm2)/0.122 g/cm2, and defined those with a final T femoral neck <-0.25. T lumbar spine<-0.25 or patients with previously diagnosed OP in other hospitals as osteoporosis. RESULTS All the 1,979 participants were between 65 and 80 years, there were 379 (21.1%) with osteoporosis, 608 (30.7%) with WWI exceeding 12 (cm/√kg) (range 8.85-14.14), and 955 (48.3%) women. Furthermore, the relationship between WWI and osteoporosis was nonlinear with a threshold effect point. Odds of OP significantly increased with the increase of WWI (OR 2.33, 95% CI 11.48-3.38, P = 0.0001) at the right side of the threshold point (WWI≥12) according to the threshold effect study. CONCLUSIONS Found a significant positive relationship between WWI and osteoporosis. Body fat management in the senile may be good to prevent osteoporosis if confirmed by other prospective studies analyzing the longitudinal risk of osteoporosis with obesity.
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Affiliation(s)
- Yuxiang Lin
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zijie Liang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Anxin Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Nuo Xu
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Xuewen Pei
- Health Care Policy and Aging Research, Rutgers Institute for Health, New Brunswick, NJ, United States
| | - Nanbu Wang
- Rehabilitation Centre, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Liang Zheng
- Rehabilitation Centre, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
| | - Danghan Xu
- Rehabilitation Centre, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
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Lee SW, Han K, Kwon HS. Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study. Diabetes Metab J 2023; 47:242-254. [PMID: 36653892 PMCID: PMC10040616 DOI: 10.4093/dmj.2022.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/16/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Body mass index (BMI) is a risk factor for the type 2 diabetes (T2DM), and T2DM accompanies various complications, such as fractures. We investigated the effects of BMI and T2DM on fracture risk and analyzed whether the association varied with fracture locations. METHODS This study is a nationwide population-based cohort study that included all people with T2DM (n=2,746,078) who received the National Screening Program during 2009-2012. According to the anatomical location of the fracture, the incidence rate and hazard ratio (HR) were analyzed by dividing it into four categories: vertebra, hip, limbs, and total fracture. RESULTS The total fracture had higher HR in the underweight group (HR, 1.268; 95% CI, 1.228 to 1.309) and lower HR in the obese group (HR, 0.891; 95% CI, 0.882 to 0.901) and the morbidly obese group (HR, 0.873; 95% CI, 0.857 to 0.89), compared to reference (normal BMI group). Similar trends were observed for HR of vertebra fracture. The risk of hip fracture was most prominent, the risk of hip fracture increased in the underweight group (HR, 1.896; 95% CI, 1.178 to 2.021) and decreased in the obesity (HR, 0.643; 95% CI, 0.624 to 0.663) and morbidly obesity group (HR, 0.627; 95% CI, 0.591 to 0.665). Lastly, fracture risk was least affected by BMI for limbs. CONCLUSION In T2DM patients, underweight tends to increase fracture risk, and overweight tends to lower fracture risk, but association between BMI and fracture risk varied depending on the affected bone lesions.
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Affiliation(s)
- Se-Won Lee
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Orthopaedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
- Corresponding authors: Kyungdo Han https://orcid.org/0000-0002-6096-1263 Department of Statistics and Actuarial Science, Soongsil University, 369 Sangdo-ro, Dongjak-gu, Seoul 06978, Korea E-mail:
| | - Hyuk-Sang Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Hyuk-Sang Kwon https://orcid.org/0000-0003-4026-4572 Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul 07345, Korea E-mail:
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The trajectory of osteoblast progenitor cells in patients with type 2 diabetes and the predictive model for their osteogenic differentiation ability. Sci Rep 2023; 13:2338. [PMID: 36759556 PMCID: PMC9911595 DOI: 10.1038/s41598-023-29677-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
The fate of osteoprogenitor cells along with the progression of type 2 diabetes (T2DM) and factors determining the fate of those cells remains to be elucidated. This cross-sectional study included 18 normoglycemic, 27 prediabetic, and 73 T2DM to determine osteogenic differentiation across the continuum of dysglycemia and to construct a model to predict the fate of osteoprogenitor cells. This study demonstrated a preserved osteogenic differentiation ability of peripheral blood-derived mononuclear cells (PBMC) isolated from normoglycemic and prediabetic but a progressive decline in their osteogenic differentiation during the progression of T2DM. The rate of osteogenic differentiation rapidly declined by 4-7% annually during the first 10 years of diabetes and then slowed down. A predictive model composed of three independent risk factors, including age, duration of diabetes, and glomerular filtration rate, demonstrated an AuROC of 0.834. With a proposed cut-off of 21.25, this model had 72.0% sensitivity, 87.5% specificity, and 78.9% accuracy in predicting the fate of osteoprogenitor cells. In conclusion, this study provided a perspective on the osteogenic differentiation ability of the osteoprogenitor cells across a continuum of dysglycemia and a predictive model with good diagnostic performance for the prediction of the fate of osteoprogenitor cells in patients with T2DM.
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Liu B, Liu J, Pan J, Zhao C, Wang Z, Zhang Q. The association of diabetes status and bone mineral density among US adults: evidence from NHANES 2005-2018. BMC Endocr Disord 2023; 23:27. [PMID: 36721144 PMCID: PMC9890809 DOI: 10.1186/s12902-023-01266-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/03/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUNDS We aimed to explore the relationship between diabetes status and bone mineral density (BMD) among adults with pre-diabetes and diabetes. METHODS We collected and analyzed five cycles (2005-2006, 2007-2008, 2009-2010, 2013-2014, and 2017-2018) data from NHANES. We removed the individuals containing missing values. The linear regression models were used to explore the relationship between diabetes status and bone mineral density. Finally, we performed subgroup analyzes by age, sex and race to find special populations. RESULT Finally, 9661 participants with complete data were involved in the study. 944 were diagnosed with pre-diabetes, and 2043 were with diabetes. We found that bone mineral density in the hip, femoral neck, and lumbar spine showed an upward trend in both prediabetic and diabetic patients in the three linear regression models. Further, after subgroup analysis, we found that this trend was more prominent in whites race, women, and those over 50 years old. CONCLUSION Using NHANES data from 2005 to 2018, we found that patients with abnormal glucose metabolism had increased bone mineral density.
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Affiliation(s)
- Bo Liu
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015 China
| | - Jingshuang Liu
- Department of Emergency Internal Medicine, the Affiliated Hospital of Qingdao University, Qingdao, 266000 Shandong China
| | - Junpeng Pan
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266071 China
| | - Chengliang Zhao
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266071 China
| | - Zhijie Wang
- Department of Spinal Surgery, the Affiliated Hospital of Qingdao University, Qingdao, 266071 China
| | - Qiang Zhang
- Department of Orthopaedics, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015 China
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cao L, Wu W, Deng X, Guo H, Pu F, Shao Z. Association between total cholesterol and total bone mineral density in US adults: National Health and Nutrition Examination Survey (NHANES), 2011-2018. J Orthop Surg Res 2023; 18:40. [PMID: 36642708 PMCID: PMC9841665 DOI: 10.1186/s13018-022-03485-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/30/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Accumulated evidence indicates that cholesterol is offensive to bone metabolism. Therefore, we examined the real-world study among total cholesterol and total bone mineral density (BMD). We investigated the relationship between total cholesterol and total BMD among 10,039 US participants aged 20-59 years old over the period 2011-2018 from the NHANES. METHODS To analyze the relationship among total cholesterol and total BMD, multivariate linear regression models were used. Fitted smoothing curves, generalized additive models, and threshold effect analysis were also conducted. RESULTS After adjusting for additional covariates, weighted multivariable linear regression models indicated total cholesterol concentration levels exhibited a negative relationship with total BMD, particularly among participants aged 20-29 years. Concerning subgroup analysis, stratified by gender, race/ethnicity and age group, the negative correlation of total cholesterol with total BMD dwelled in both female and male as well as in whites and other races (including Hispanic and Multi-Racial), but not in non-Hispanic blacks and Mexican American. In other races, this relationship presented a nonlinear association (inflection point: 6.7 mmol/L) with a U-shaped curve. Among participants aged 40 to 49 years, this relationship also followed a nonlinear association (inflection point: 5.84 mmol/L), indicating a saturation effect. Moreover, the three types of diabetes status were found to have negative, U-shaped, and positive relationships. In participants with borderline diabetes status, the relationship of total cholesterol with total BMD was a U-shaped curve (inflection point: 4.65 mmol/L). CONCLUSIONS For US young adults (20-29 years old), our study revealed a negative relationship between total cholesterol and total BMD. This association followed a U-shaped curve (inflection point: 4.65 mmol/L) in borderline diabetes status participants, a saturation curve (inflection point: 5.84 mmol/L) in participants aged 40-49 years and a nonlinear curve (inflection point: 6.7 mmol/L) in other races (including Hispanic and Multi-Racial). Therefore, keeping total cholesterol concentration at a reasonable level for young adults and diabetic population might be an approach to prevent osteoporosis or osteopenia.
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Affiliation(s)
- Li cao
- grid.33199.310000 0004 0368 7223Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 People’s Republic of China
| | - Wei Wu
- grid.33199.310000 0004 0368 7223Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 People’s Republic of China
| | - Xiangyu Deng
- grid.33199.310000 0004 0368 7223Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 People’s Republic of China
| | - Haoyu Guo
- grid.33199.310000 0004 0368 7223Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 People’s Republic of China
| | - Feifei Pu
- grid.33199.310000 0004 0368 7223Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022 People’s Republic of China
| | - Zengwu Shao
- Department of Orthopaedic, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People's Republic of China.
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Liu Z, Asuzu P, Patel A, Wan J, Dagogo-Jack S. Association of bone mineral density with prediabetes risk among African-American and European-American adult offspring of parents with type 2 diabetes. Front Endocrinol (Lausanne) 2023; 13:1065527. [PMID: 36686435 PMCID: PMC9849381 DOI: 10.3389/fendo.2022.1065527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/19/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction Type 2 diabetes mellitus (T2DM) is associated with alterations in bone mineral density (BMD), but association between prediabetes and BMD is unclear. Methods We analyzed BMD among the initially normoglycemic participants in the Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC) study in relation to incident prediabetes during 5 years of follow-up. Results and Discussion A total of 343 participants (193 Black, 150 White) underwent DEXA during Year 1 of POP-ABC and were followed quarterly for 5 years. The mean age was 44.2 ± 10.6 years; BMI was 30.2 ± 7.23 kg/m2. At baseline, the mean BMD was 1.176 ± 0.135 g/cm2 (1.230 ± 0.124 g/cm2 in men vs. 1.154 ± 0.134 g/cm2 in women, P<0.0001; 1.203 ± 0.114 g/cm2 in Black vs. 1.146 ± 0.150 g/cm2 in White participants, P=0.0003). During 5 years of follow-up, 101 participants developed prediabetes and 10 subjects developed T2DM (progressors); 232 were nonprogressors. Progressors to prediabetes had numerically higher baseline BMD and experienced lower 1-year decline in BMD (P<0.0001) compared with nonprogressors. From Kaplan-Meier analysis, the time to 50% prediabetes survival was 2.15 y among participants in the lowest quartile of baseline BMD, longer than those in higher quartiles (1.31 - 1.41 y). Values for BMD correlated inversely with age and adiponectin levels, and positively with BMI. In logistic regression analysis, BMD z score significantly predicted incident prediabetes: more negative BMD z scores were associated with decreased incident prediabetes (odds ratio 0.598 [95% confidence interval 0.407 - 0.877], P=0.0085), after controlling for age, BMI, change in BMI, ethnicity, blood glucose and adiponectin. Conclusions Among initially normoglycemic individuals, higher baseline BMD was associated with higher risk of incident prediabetes during 5 years of follow-up.
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Affiliation(s)
- Zhao Liu
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Peace Asuzu
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Avnisha Patel
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Jim Wan
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, United States
| | - Sam Dagogo-Jack
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, TN, United States
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Al-Janabi AAHS. The influence of age, menstrual state and body mass index on the relation between osteopenia and osteoporosis associated with breast cancer. J OBSTET GYNAECOL 2022; 42:3368-3373. [PMID: 36151899 DOI: 10.1080/01443615.2022.2125299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Osteoporosis and body mass index (BMI) have been reported to be associated with breast cancer. The correlation between other types of bone loss and breast cancer requires further illustrative evidence. Effect of age and menstrual state on the relationship of osteoporosis, osteopenia and BMI with breast cancer was evaluated in this study. Two hundred breast cancer patients and 200 breast cancer-free patients were included in a case-control study. Bone mineral density (BMD) and BMI were determined in all subjects. Postmenopause was the most frequent menstrual state. osteopenia was found to be significant in breast cancer patients and osteoporosis was significant in another group of women. There was no significant difference between breast cancer patients and control women in terms of age and menstrual status. Obesity was common in all subjects. In conclusion, bone loss rates are significantly low in breast cancer patients relative to healthy women. There was no significant impact of age, menstrual status or BMI on the development of osteopenia or osteoporosis in breast cancer patients. In addition, BMD analytical results may identify the appropriate treatment for bone loss. A routine check-up of osteopenia or osteoporosis is highly recommended for breast cancer patients.Impact StatementWhat is already known on this subject? Breast cancer may be associated with a wide variety of human body parameters. These parameters can include age, body mass index (BMI), obesity and menstrual status. There is also a correlation between osteoporosis and breast cancer.What do the results of this study add? Osteopenia is the most frequent form of bone loss among women with breast cancer. In contrast, osteoporosis as the worst stage of bone loss is unusual in these patients. Factors such as age, menstruation and BMI have no effect on the development of breast cancer.What are the implications of these findings for clinical practice and/or further research? Identification of the type of bone loss in women with breast cancer is essential to determine the appropriate type of therapy.
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Moafian F, Sharifan P, Assaran Darban R, Khorasanchi Z, Amiri Z, Roohi S, Mohseni Nik F, Mohammadi Bajgiran M, Saffar Soflaei S, Darroudi S, Ghazizadeh H, Tayefi M, Rafiee M, Ebrahimi Dabagh A, Shojasiahi M, Yaghoobinezhad M, Talkhi N, Esmaily H, Ferns GA, Dabbagh VR, Sadeghi R, Ghayour-Mobarhan M. Factors Associated With Trabecular Bone Score and Bone Mineral Density; A Machine Learning Approach. J Clin Densitom 2022; 25:518-527. [PMID: 35999152 DOI: 10.1016/j.jocd.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/05/2022] [Accepted: 06/24/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Bone indexes including trabecular bone score (TBS) and bone mineral density (BMD) have been shown to be associated with wide spectrum of variables including physical activity, vitamin D, liver enzymes, biochemical measurements, mental and sleep disorders, and quality of life. Here we aimed to determine the most important factors related to TBS and BMD in SUVINA dataset. METHODS Data were extracted from the Survey of Ultraviolet Intake by Nutritional Approach (SUVINA study) including all 306 subjects entered this survey. All the available parameters in the SUVINA database were included the analysis. XGBoost modeler software was used to define the most important features associated with bone indexes including TBS and BMD in various sites. RESULTS Applying XGBoost modeling for 4 bone indexes indicated that this algorithm could identify the most important variables in relation to bone indexes with an accuracy of 92%, 93%, 90% and 90% respectively for TBS T-score, lumbar Z-score, neck of femur Z-score and Radius Z-score. Serum vitamin D, pro-oxidant-oxidant balance (PAB) and physical activity level (PAL) were the most important factors related to bone indices in different sites of the body. CONCLUSIONS Our findings indicated that XGBoost could identify the most important variables with an accuracy of >90% for TBS and BMD. The most important features associated with bone indexes were serum vitamin D, PAB and PAL.
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Affiliation(s)
- Fahimeh Moafian
- Department of Pure Mathematics, Center of Excellence in Analysis on Algebraic Structures (CEAAS), Ferdowsi University of Mashhad, P.O. Box 1159, Mashhad 91775, Iran; International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Payam Sharifan
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Assaran Darban
- Department of Biology, Faculty of Sciences, Mashhad Branch, Islamic Azad University, Mashhad, Iran
| | - Zahra Khorasanchi
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Amiri
- Department of Pure Mathematics, Center of Excellence in Analysis on Algebraic Structures (CEAAS), Ferdowsi University of Mashhad, P.O. Box 1159, Mashhad 91775, Iran; International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Samira Roohi
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Mohseni Nik
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Mohammadi Bajgiran
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Saffar Soflaei
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Susan Darroudi
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamideh Ghazizadeh
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran; Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Tayefi
- Norwegian Center for e-health Research, University hospital of North Norway, Tromsø, Norway
| | - Mahdi Rafiee
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Ebrahimi Dabagh
- Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Maryam Shojasiahi
- Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Mahdiye Yaghoobinezhad
- Department of Nutrition Sciences, Varastegan Institute for Medical Sciences, Mashhad, Iran
| | - Nasrin Talkhi
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Division of Medical Education, Brighton & Sussex Medical School, Falmer, Brighton, Sussex, UK
| | - Vahid Reza Dabbagh
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ramin Sadeghi
- Nuclear Medicine Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Majid Ghayour-Mobarhan
- International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Zhang Y, Liu W, Yuan W, Cai Z, Ye G, Zheng G, Xu C, Wang X, Zeng C, Mi R, Feng P, Chen F, Wu Y, Shen H, Wang P. Impairment of APPL1/Myoferlin facilitates adipogenic differentiation of mesenchymal stem cells by blocking autophagy flux in osteoporosis. Cell Mol Life Sci 2022; 79:488. [PMID: 35984564 PMCID: PMC9391247 DOI: 10.1007/s00018-022-04511-y] [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: 05/24/2022] [Revised: 07/21/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
An imbalance of human mesenchymal stem cells (hMSCs) adipogenic and osteogenic differentiation is crucial in the pathogenesis of osteoporosis, and elucidation of the underlying mechanism is urgently needed. APPL1, an adaptor protein of the adiponectin receptor, was recently shown to be closely related to bone mass. However, the role of APPL1 in the imbalance of hMSC differentiation in osteoporosis is unclear. Therefore, we aimed to explore the mechanisms by which APPL1 alters hMSCs adipogenic differentiation in osteoporosis. Here, we found that APPL1 expression was downregulated in elderly patients with osteoporosis and in mouse osteoporosis model. APPL1 negatively regulated hMSC adipogenic differentiation in vivo and in vitro. Mechanistically, by enhancing ubiquitination-mediated Myoferlin degradation, downregulated APPL1 expression increased the risk of lysosome dysfunction during hMSCs adipogenic differentiation. Lysosomal dysfunction inhibited autophagy flux by suppressing autophagosome degradation and promoted hMSC differentiation towards the adipocyte lineage. Our findings suggest that APPL1/Myoferlin downregulation promoted hMSCs adipogenic differentiation by inhibiting autophagy flux, further impairing the balance of hMSCs adipogenic and osteogenic differentiation in osteoporosis; the APPL1/ Myoferlin axis may be a promising diagnostic and therapeutic target for osteoporosis.
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Affiliation(s)
- Yunhui Zhang
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Wenjie Liu
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Weiquan Yuan
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Zhaopeng Cai
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Guiwen Ye
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Guan Zheng
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Chenhao Xu
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Xinglang Wang
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Chenying Zeng
- Center for Biotherapy, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Rujia Mi
- Center for Biotherapy, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Pei Feng
- Center for Biotherapy, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Fenglei Chen
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China
| | - Yanfeng Wu
- Center for Biotherapy, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China.
| | - Huiyong Shen
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China.
| | - Peng Wang
- Department of Orthopedics, The Eighth Affiliated Hospital, Sun Yat-Sen University, 3025# Shennan Road, Shenzhen, 518000, People's Republic of China.
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Yin Z, Yan H, Yu Y, Liu Y. Different associations between waist circumference and bone mineral density stratified by gender, age, and body mass index. BMC Musculoskelet Disord 2022; 23:786. [PMID: 35978347 PMCID: PMC9382731 DOI: 10.1186/s12891-022-05736-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/30/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Investigations of the relationship between waist circumference (WC) and bone mineral density (BMD) have inconsistent and incomprehensive results. We explored the association between WC and BMD at various sites in a large-scale population-based study. Methods We screened 5337 participants from National Health and Nutrition Examination Survey (NHANES) database. BMD was measured using dual-energy X-ray absorptiometry at various skeletal sites. The associations of WC with BMD were evaluated by weighted multivariable logistic regression models and conducted subgroup analyses for gender, age, and BMI. A weighted generalized additive model and a smooth curve fitting were performed to address non-linearity. Results Adjustments for all confounders, in males, WC was negatively correlated to BMD in different age and BMI groups (all the p < 0.05), except for in the lowest BMI group; in females, overall trends of relationships between WC and BMD were negative. However, statistical differences were insignificant in some cases. Additionally, every 1 cm increase in WC for individuals of all ages with normal BMI (18.5 ≤ BMI < 25) was associated with decrease in BMD at each skeletal site, as was the case for men with BMI ≥ 25 kg/m2. For women, the negative association of WC with BMD was evident at the lumbar spine in the youngest age group (8 ≤ Age ≤ 18) with normal BMI. Conclusions The nonlinear associations between WC and BMD at various skeletal sites are gender-, age- and BMI-specific in the NHANES (2006–2006). Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05736-5.
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Affiliation(s)
- Zhiqiang Yin
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Haihong Yan
- Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yin Yu
- Administration Office, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Yupeng Liu
- Department of Orthopedics, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
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Gao S, Qian X, Huang S, Deng W, Li Z, Hu Y. Association between macronutrients intake distribution and bone mineral density. Clin Nutr 2022; 41:1689-1696. [PMID: 35777108 DOI: 10.1016/j.clnu.2022.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/05/2022] [Accepted: 05/19/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Although it is well known dietary factors are closely correlated with bone health, the association between macronutrients intake distribution and bone mineral density (BMD) is still unclear. The aims of this study were to investigate how macronutrients distribution was correlated with BMD, and to evaluate how the substitution between macronutrients could be associated with BMD. METHODS We conducted a cross-sectional study based on data from National Health and Nutrition Examination Survey. Dietary recall method was used to assessed the intake of macronutrients. Macronutrient intake distribution including carbohydrate, protein and fat was calculated as percentages of energy intake from total energy. BMD was converted to T-score and low BMD was defined as T-score less than -1.0. The association between the percentages of energy intake from carbohydrate, protein and fat with T-score and risk of low BMD was evaluated using multivariate regression models. Isocaloric substitution analysis was conducted using the multivariate nutrient density method. RESULTS Data form 4447 adults aged 20 years and older who underwent BMD examination were included in this study. Higher percentage of energy intake from carbohydrate was associated with lower T-score (-0.03 [95%CI, -0.05 to -0.01]; P = 0.001) and higher risk of low BMD (1.05 [95%CI, 1.02-1.08]; P = 0.003), while higher percentage of energy intake from protein was associated with higher T-score (0.05 [95%CI, 0.01-0.08]; P = 0.009) and lower odds of low BMD (0.92 [95%CI, 0.87-0.98]; P = 0.007). The percentage of energy intake from fat seemed to be positively correlated with T-score, but the correlation became insignificant after adjusting for metabolism related confounders. Isocaloric substitution analysis showed that only the substitution between carbohydrate and protein was significantly and independently associated with T-score (-0.05 [95%CI, -0.08 to -0.01]; P = 0.01) and the risk of low BMD (1.08 [95%CI, 1.02-1.15]; P = 0.008). CONCLUSIONS Based on the results from this study, we hypothesized that a high-protein diet coupled with low carbohydrate intake would be beneficiary for prevention of bone loss in adults. However, randomized clinical trials or longitudinal studies are needed to further assessed our findings.
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Affiliation(s)
- Shihua Gao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Qian
- Guangzhou University of Chinese Medicine, Guangzhou, China; Department of Traditional Therapy, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Sicong Huang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wanxi Deng
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhe Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yingyu Hu
- Department of Hospital Management, Southern Medical University, Guangzhou, China.
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Lee SW, Han K, Kwon HS. Weight change and the risk of hip fractures in patients with type 2 diabetes: a nationwide cohort study. Osteoporos Int 2022; 33:1755-1767. [PMID: 35438308 DOI: 10.1007/s00198-022-06398-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/04/2022] [Indexed: 01/18/2023]
Abstract
UNLABELLED Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patients. INTRODUCTION In type 2 diabetes, patients are often asked to control their weight in order to reduce their diabetic morbidity. The American Diabetes Association recommends that diabetic patients conduct high-intensity interventions for regulating diet, physical activity, and behavior to reduce weight, followed by long-term comprehensive weight maintenance programs. Although such weight control attempts are required in diabetic patients, there are few studies on the effect of weight change on hip fracture in this population. We aim to investigate the association between body weight change and the incidence of hip fracture in subjects with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. MATERIALS AND METHODS A total of 1,447,579 subjects (894,204 men and 553,375 women) > 40 years of age, who were diagnosed with type 2 diabetes, were enrolled in this study. Weight change within 2 years was divided into five categories: from weight loss ≥ 10% to weight gain ≥ 10%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of hip fracture were analyzed, compared with the reference of the stable weight group (weight change < 5%). RESULTS Among 5 weight change groups, more than 10% weight loss showed the highest HR (HR, 1.605; 95% CI, 1.493 to 1.725), followed by more than 10% weight gain (HR, 1.457; 95% CI, 1.318 to 1.612). The effect of weight change on hip fracture risk was greater in males than in females, and those under 65 years of age were greater than those over 65 years of age. Baseline BMI did not play a role of weight change affecting the risk of hip fracture. The HR for hip fracture of subjects with regular exercise was lower than those without regular exercise. CONCLUSIONS In the type 2 diabetes population, both weight gain and weight loss were significantly associated with a higher risk of hip fracture, whereas maintaining body weight reduced the risk of hip fracture the most.
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Affiliation(s)
- S-W Lee
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Orthopaedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - K Han
- Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-ro, Dongjak-gu, 06978, Seoul, Republic of Korea.
| | - H-S Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, Yuksam-ro, Youngdeungpo-gu, 07345, Seoul, Republic of Korea.
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Shieh A, Greendale GA, Cauley JA, Karvonen-Gutierriez C, Harlow SD, Finkelstein JS, Liao D, Huang MH, Karlamangla AS. Prediabetes and insulin resistance are associated with lower trabecular bone score (TBS): cross-sectional results from the Study of Women's Health Across the Nation TBS Study. Osteoporos Int 2022; 33:1365-1372. [PMID: 35178609 PMCID: PMC9106606 DOI: 10.1007/s00198-022-06325-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/26/2022] [Indexed: 12/04/2022]
Abstract
In pre- and early perimenopausal women, prediabetes (with blood glucose ≥ 110 mg/dL) and greater insulin resistance are associated with worse trabecular bone quality (as assessed by trabecular bone score). PURPOSE Diabetes mellitus (DM) is associated with lower trabecular bone score (TBS) and fracture; less certain is whether the precursor states of prediabetes and increased insulin resistance are also related to adverse bone outcomes. We examined, in women who do not have DM, the associations of glycemic status (prediabetes vs. normal) and insulin resistance with TBS. METHODS This was a cross-sectional analysis of baseline data collected from 42- to 52-year-old, pre- and perimenopausal participants in the Study of Women's Health Across the Nation (SWAN) TBS Study. Women with prediabetes were categorized as having either high prediabetes if their fasting glucose was between 110 and 125 mg/dL or low prediabetes if their fasting glucose was between 100 and 109 mg/dL. Normoglycemia was defined as a fasting glucose below 100 mg/dL. RESULTS In multivariable linear regression, adjusted for age, race/ethnicity, menopause transition stage, cigarette use, calcium and vitamin D supplementation, lumbar spine bone mineral density, and study site, women with high prediabetes had 0.21 (p < 0.0001) standard deviations (SD) lower TBS than those with normoglycemia. Low prediabetes was not associated with lower TBS. When HOMA-IR levels were ≥ 1.62, each doubling of HOMA-IR was associated with a 0.11 SD decrement in TBS (p = 0.0001). CONCLUSION Similar to diabetics, high prediabetics have lower TBS than normoglycemic individuals. Women with greater insulin resistance have lower TBS even in the absence of DM. Future studies should examine the associations of high prediabetes and insulin resistance with incident fracture.
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Affiliation(s)
- Albert Shieh
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA.
| | - Gail A Greendale
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, USA
| | | | - Sioban D Harlow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joel S Finkelstein
- Division of Endocrinology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Diana Liao
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Mei-Hua Huang
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
| | - Arun S Karlamangla
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
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Kindler J, Zhan D, Sattler ELP, Ishikawa Y, Chen X, Gallo S. Bone density in youth with prediabetes: results from the National Health and Nutrition Examination Survey, 2005-2006. Osteoporos Int 2022; 33:467-474. [PMID: 34523010 DOI: 10.1007/s00198-021-06148-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/03/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED Youth with type 2 diabetes might have suboptimal peak bone mass, but it is unknown whether similar effects are evident in youth with prediabetes. Results from this study suggest that diabetes-related effects on peak bone mass likely occur before disease onset, and involve the muscle-bone unit. INTRODUCTION Type 2 diabetes might adversely influence bone health around the age of peak bone mass, but it is unknown whether diabetes-related effects on areal bone mineral density (aBMD) are evident in youth with prediabetes. We compared age-related trends in aBMD and associations between lean body mass (LBM) and aBMD between children and adolescents with prediabetes vs. normal glucose regulation. METHODS Cross-sectional analysis of data from the National Health and Nutrition Examination Survey (2005-2006) in youth ages 12-20 years (49% female, 34% black) with prediabetes (n = 267) and normal glucose regulation (n = 1664). Whole body aBMD and LBM were assessed via DXA. LBM index (LBMI) and Z-scores for aBMD and LBMI were computed. RESULTS Unadjusted between-group comparisons revealed greater mean weight and LBMI Z-scores in youth with prediabetes vs. normal glucose regulation, but similar bone Z-scores between the two groups. While accounting for differences in BMI Z-score, there was a significant interaction between prediabetes status and age with respect to whole body aBMD Z-score (P < 0.05), such that children with prediabetes tended to have increased aBMD but adolescents and young adults with prediabetes tended have lower aBMD. Furthermore, the positive association between LBMI and whole body aBMD was moderated in youth with prediabetes (P < 0.001), who had slightly lower whole body aBMD for a given LBMI (P = 0.068). Lumbar spine bone measures did not differ between the two groups. CONCLUSIONS Type 2 diabetes-related threats to peak bone mass might occur prior to disease onset, therefore potentially impacting a considerable proportion of US youth.
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Affiliation(s)
- J Kindler
- Department of Nutritional Sciences, University of Georgia, 305 Sanford Drive, 279 Dawson Hall, Athens, GA, 30602, USA.
| | - D Zhan
- Department of Statistics, University of Georgia, Athens, GA, USA
| | - E L P Sattler
- Department of Nutritional Sciences, University of Georgia, 305 Sanford Drive, 279 Dawson Hall, Athens, GA, 30602, USA
- Department of Clinical and Administrative Pharmacy, University of Georgia, Athens, GA, USA
| | - Y Ishikawa
- Department of Nutritional Sciences, University of Georgia, 305 Sanford Drive, 279 Dawson Hall, Athens, GA, 30602, USA
| | - X Chen
- Department of Statistics, University of Georgia, Athens, GA, USA
| | - S Gallo
- Department of Nutritional Sciences, University of Georgia, 305 Sanford Drive, 279 Dawson Hall, Athens, GA, 30602, USA
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Phimphilai M, Pothacharoen P, Chattipakorn N, Kongtawelert P. Receptors of Advanced Glycation End Product (RAGE) Suppression Associated With a Preserved Osteogenic Differentiation in Patients With Prediabetes. Front Endocrinol (Lausanne) 2022; 13:799872. [PMID: 35237235 PMCID: PMC8882829 DOI: 10.3389/fendo.2022.799872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/18/2022] [Indexed: 11/18/2022] Open
Abstract
Type 2 diabetes is widely documented for osteogenic differentiation defect and impaired bone quality, which is related to the skeletal accumulation of advanced glycation end products (AGEs). Prediabetes is a condition in which hyperglycemia is lower than the threshold for the diagnosis of diabetes. Prediabetic animal models consistently demonstrate impaired osteogenic differentiation and deteriorated bone microarchitecture. However, no evidence shows defects in osteoblast development and skeletal effects of AGEs in prediabetic individuals. Therefore, it remains to be elucidated whether impaired osteogenic differentiation ability and altered cellular response to AGEs occur in patients with prediabetes. This cross-sectional study included 28 patients with prediabetes as defined by impaired fasting glucose criteria, fasting plasma glucose (FPG) between 100-125 mg/dl and 17 age-matched normoglycemic controls to elucidate osteogenic differentiation and AGER expression in the PBMC derived from those individuals. The PBMC-isolated from both groups showed similar rates of expression of osteoblast-specific genes, namely, ALPL, BGLAP, COL1A1, and RUNX2/PPAR (89.3% and 88.2%, p = 1.000), and showed comparable levels of expression of those genes. By using age- and pentosidine-matched normoglycemic individuals as references, the PBMC-isolated from prediabetic patients demonstrated lower expression of both AGER and BAX/BCL2. The expression of AGER and BAX/BCL2 significantly correlated to each other (r = 0.986, p <0.0001). The multivariate analysis demonstrated that serum pentosidine is an independent risk factor for AGER expression. With logistic regression analysis, the area under the ROC curve (AUC) for serum pentosidine at the cut-off level of 2.1 ng/ml and FPG at 100 mg/dl, which is a cut-off point for prediabetes, was significantly higher for predicting AGER expression than that of serum pentosidine alone (0.803 vs 0.688, p = 0.048), indicating that serum pentosidine was a good predictor of AGER expression in prediabetic individuals. In conclusion, this study demonstrated a preserved osteogenic differentiation in the PBMC derived from prediabetic individuals. In addition, those PBMC with preserved osteogenic differentiation potential showed the suppression of both cellular RAGE and apoptotic-related signals. Serum pentosidine was an independent risk factor for cellular RAGE expression and is conceivably a good predictor for AGER suppression in prediabetic individuals.
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Affiliation(s)
- Mattabhorn Phimphilai
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- *Correspondence: Mattabhorn Phimphilai,
| | - Peraphan Pothacharoen
- Thailand Excellence Center for Tissue Engineering and Stem Cells, Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Prachya Kongtawelert
- Thailand Excellence Center for Tissue Engineering and Stem Cells, Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Fu YH, Liu WJ, Lee CL, Wang JS. Associations of insulin resistance and insulin secretion with bone mineral density and osteoporosis in a general population. Front Endocrinol (Lausanne) 2022; 13:971960. [PMID: 36204101 PMCID: PMC9530363 DOI: 10.3389/fendo.2022.971960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/06/2022] [Indexed: 11/28/2022] Open
Abstract
We investigated the associations of insulin resistance and β-cell secretion with bone mineral density (BMD) and osteoporosis using data from the National Health and Nutrition Examination Survey. Data on BMD assessed using dual-energy x-ray absorptiometry from 5292 participants were analyzed. Insulin resistance and β-cell secretion were assessed using the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) and β-cell function (HOMA-β), respectively. We divided the study population into four groups according to HOMA-IR (<2 vs. ≥ 2) and HOMA-β (<100 vs. ≥ 100). BMD and T score at the lumbar spine, hip joint, and femur were used for analyses. Osteoporosis was defined as a T score ≤ -2.5. Logistic regression analyses were conducted to examine the associations of HOMA-IR and HOMA-β with osteoporosis, and the joint effects of HOMA-IR and HOMA-β on osteoporosis. We found a positive association between HOMA-IR and osteoporosis in participants with a HOMA-β ≥ 100 (OR 8.773, 95% CI 2.160-35.637, p=0.002 at the femoral neck). A negative association between HOMA-β and osteoporosis was noted in those with a HOMA-IR <2 (OR 0.183, 95% CI 0.038-0.882, p=0.034 at the femoral neck). Compared with participants who had HOMA-IR <2 and HOMA-β <100, those with HOMA-IR <2 and HOMA-β ≥ 100 had a lower risk of osteoporosis (OR 0.126, 95% CI 0.020-0.805, p=0.032 at the femoral neck). In conclusion, the association between HOMA-β and BMD/osteoporosis changed as HOMA-IR increased. HOMA-β was negatively associated with osteoporosis when HOMA-IR <2. The association was not significant when HOMA-IR ≥ 2.
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Affiliation(s)
- Yi-Hsiu Fu
- Department of Education, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Ju Liu
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chia-Lin Lee
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- *Correspondence: Jun-Sing Wang, ; Chia-Lin Lee,
| | - Jun-Sing Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Rong Hsing Research Center for Translational Medicine, Institute of Biomedical Science, National Chung Hsing University, Taichung, Taiwan
- *Correspondence: Jun-Sing Wang, ; Chia-Lin Lee,
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Sur YJ. The risk of hip fractures in individuals over 50 years old with prediabetes and type 2 diabetes - A longitudinal nationwide population-based study. Bone 2022; 154:116224. [PMID: 34601174 DOI: 10.1016/j.bone.2021.116224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yoo Joon Sur
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Qing Y, Yang J, Chen Y, Shi C, Zhang Q, Ning Z, Yu Y, Li Y. Urinary cadmium in relation to bone damage: Cadmium exposure threshold dose and health-based guidance value estimation. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 226:112824. [PMID: 34592522 DOI: 10.1016/j.ecoenv.2021.112824] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 05/24/2023]
Abstract
Cadmium (Cd) is a widespread heavy metal with osteotoxicity, and bone mineral density (BMD) is often used as an early sensitive biomarker of bone damage. This study retrieved worldwide epidemiological studies to conduct a systematic meta-analysis to explore the association between Cd exposure and bone damage. A random effect model was used to establish the relationship between urinary Cd (U-Cd) and BMD and explore the influence of covariate factors. The benchmark dose method was used to calculate the safety threshold of U-Cd when the BMD decrease within an acceptable range. Toxicokinetic (TK) model was used to estimate the health-based guidance value (HBGV) of dietary Cd exposure based on the U-Cd threshold. The 95% lower confidence interval of benchmark dose of U-Cd derived in this study was 1.71 μg/g Cr, and the HBGV of dietary Cd exposure was determined to be 0.64 μg/kg bw/day. Gender had the greatest influence on BMD, followed by body mass index (BMI), age, and race. This study conducted a comprehensive systematic analysis of global research and was the first exploration to quantify the decreased BMD caused by Cd exposure in a large-scale population. The results provided reference for the risk assessment of Cd exposure and the formulation of dietary exposure standards.
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Affiliation(s)
- Ying Qing
- College of Medical Technology, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
| | - Jiaqi Yang
- School of Public Health/Key Laboratory of Public Health Safety, Ministry of Education, Department of Nutrition and food science, Fudan University, Shanghai 200032, China
| | - Yanfeng Chen
- College of Medical Technology, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
| | - Chengjie Shi
- College of Medical Technology, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
| | - Qianrong Zhang
- College of Medical Technology, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
| | - Zhongping Ning
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai 201300, China
| | - Ying Yu
- Shanghai University of Medicine & Health Sciences, Shanghai 201318, China.
| | - Yanfei Li
- Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Shanghai 201300, China.
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Shi L, Meng J, Zhang B, Chen J, Chen J, Zhang J. Elevated Serum Levels of Carbohydrate Antigen 72-4 in Diabetic Kidney Disease. Exp Clin Endocrinol Diabetes 2021; 130:400-405. [PMID: 34607374 DOI: 10.1055/a-1532-4576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study was to determine whether carbohydrate antigen 72-4 (CA72-4) is elevated in diabetic kidney disease (DKD), and examine the association between urinary albumin-to-creatinine ratio (UACR) and CA72-4 in patients with type 2 diabetes mellitus (T2DM). Non-dialysis patients with T2DM (n=296) and 90 healthy controls were recruited in this study. CA72-4 level was measured by electrochemiluminescence immunoassay. DKD was defined as UACR≥ 30 mg/g in the absence of a urinary infection or other renal diseases. We found that patients with DKD had significantly higher serum CA72-4 levels compared to those with normoalbuminuria and healthy controls. Positive rates of CA72-4 increased gradually and markedly from normoalbuminuria to microalbuminuria and to macroalbuminuria in diabetic patients (7.5, 11.2, and 17.4%, respectively; P for trend< 0.05). CA72-4 also showed a positive correlation with UACR (r=0.288, P< 0.01). Logistic regression analysis revealed the association of increased UACR with an increased odds ratio of elevation of CA72-4 levels (P for trend< 0.05) after multivariable adjustment. In conclusion, serum levels of CA72-4 increase abnormally with the increase in urinary albumin excretion, which affects the specificity of diagnosis of malignancies. An appropriate interpretation of CA72-4 is essential to prevent unnecessary and even hazardous diagnostic procedures in patients with T2DM.
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Affiliation(s)
- Lei Shi
- Department of Clinical Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiali Meng
- Department of Clinical Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bin Zhang
- Department of Clinical Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiandong Chen
- Department of Clinical Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jianzhong Chen
- Department of Clinical Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jue Zhang
- Department of Clinical Laboratory, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Chen Q, Wang W, Xia MF, Lu YL, Bian H, Yu C, Li XY, Vadas MA, Gao X, Lin HD, Xia P. Identification of circulating sphingosine kinase-related metabolites for prediction of type 2 diabetes. J Transl Med 2021; 19:393. [PMID: 34530846 PMCID: PMC8447705 DOI: 10.1186/s12967-021-03066-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/02/2021] [Indexed: 12/23/2022] Open
Abstract
Background Sphingosine Kinase (SphK) that catalyzes sphingosine (Sph) to sphingosine 1-phosphate (S1P), plays a key role in both sphingolipid metabolism and cellular signaling. While SphK has been implicated in type 2 diabetes mellitus (T2DM), it is unexplored in humans. Herein, we investigated whether circulating SphK-related metabolites are associated with T2DM incidence in an established prospective cohort. Methods Levels of SphK-related sphingolipid metabolites, including Sph, S1P, dihydrosphingosine (dhSph) and dihydro-S1P (dhS1P) in serum were measured by targeted-lipidomic analyses. By accessing to an established prospective cohort that involves a total of 2486 non-diabetic adults at baseline, 100 subjects who developed T2DM after a mean follow-up of 4.2-years, along with 100 control subjects matched strictly with age, sex, BMI and fasting glucose, were randomly enrolled for the present study. Results Comparison with the control group, medians of serum dhS1P and dhS1P/dhSph ratio at baseline were elevated significantly prior to the onset of T2DM. Each SD increment of dhS1P and dhS1P/dhSph ratio was associated with 53.5% and 54.1% increased risk of incident diabetes, respectively. The predictive effect of circulating dhS1P and dhS1P/dhSph ratio on T2DM incidence was independent of conventional risk factors in multivariate regression models. Furthermore, combination of serum dhS1P and dhS1P/dhSph ratio with conventional clinical indices significantly improved the accuracy of T2DM prediction (AUROC, 0.726), especially for normoglycemic subjects (AUROC, 0.859). Conclusion Circulating levels of dhS1P and dhS1P/dhSph ratio are strongly associated with increased risk of T2DM, and could serve as a useful biomarker for prediction of incident T2DM in normoglycemic populations.
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Affiliation(s)
- Qi Chen
- Department of Endocrinology and Metabolism, Fudan Institute for Metabolic Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Wei Wang
- Department of Endocrinology and Metabolism, Fudan Institute for Metabolic Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Ming-Feng Xia
- Department of Endocrinology and Metabolism, Fudan Institute for Metabolic Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - You-Li Lu
- Central Laboratory, Xuhui Central Hospital, Shanghai, China
| | - Hua Bian
- Department of Endocrinology and Metabolism, Fudan Institute for Metabolic Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Chen Yu
- Central Laboratory, Xuhui Central Hospital, Shanghai, China
| | - Xiao-Ying Li
- Department of Endocrinology and Metabolism, Fudan Institute for Metabolic Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Mathew A Vadas
- Centenary Institute, The University of Sydney, Sydney, Australia
| | - Xin Gao
- Department of Endocrinology and Metabolism, Fudan Institute for Metabolic Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Huan-Dong Lin
- Department of Endocrinology and Metabolism, Fudan Institute for Metabolic Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
| | - Pu Xia
- Department of Endocrinology and Metabolism, Fudan Institute for Metabolic Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Altered Secretome of Diabetic Monocytes Could Negatively Influence Fracture Healing-An In Vitro Study. Int J Mol Sci 2021; 22:ijms22179212. [PMID: 34502120 PMCID: PMC8430926 DOI: 10.3390/ijms22179212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is a main risk factor for delayed fracture healing and fracture non-unions. Successful fracture healing requires stimuli from different immune cells, known to be affected in diabetics. Especially, application of mononuclear cells has been proposed to promote wound and fracture healing. Thus, aim was to investigate the effect of pre-/diabetic conditions on mononuclear cell functions essential to promote osteoprogenitor cell function. We here show that pre-/diabetic conditions suppress the expression of chemokines, e.g., CCL2 and CCL8 in osteoprogenitor cells. The associated MCP-1 and MCP-2 were significantly reduced in serum of diabetics. Both MCPs chemoattract mononuclear THP-1 cells. Migration of these cells is suppressed under hyperglycemic conditions, proposing that less mononuclear cells invade the site of fracture in diabetics. Further, we show that the composition of cytokines secreted by mononuclear cells strongly differ between diabetics and controls. Similar is seen in THP-1 cells cultured under hyperinsulinemia or hyperglycemia. The altered secretome reduces the positive effect of the THP-1 cell conditioned medium on migration of osteoprogenitor cells. In summary, our data support that factors secreted by mononuclear cells may support fracture healing by promoting migration of osteoprogenitor cells but suggest that this effect might be reduced in diabetics.
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Xu Y, Wu Q. Trends in osteoporosis and mean bone density among type 2 diabetes patients in the US from 2005 to 2014. Sci Rep 2021; 11:3693. [PMID: 33580184 PMCID: PMC7881186 DOI: 10.1038/s41598-021-83263-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
This study aimed to examine how bone health changed among T2DM patients in the past decade. Continuous National Health and Nutrition Examination Survey (NHANES) data from 2005-2006 to 2013-2014 were analyzed to examine the trends of bone mineral density (BMD) and the prevalence trends of osteoporosis osteopenia among T2DM patients and non-diabetic people aged 40 years and older. The age- and BMI-adjusted mean BMD of the femur neck for the four NHANES cycles decreased linearly in both T2DM patients and non-diabetic people (both Plinear trend ≤ 0.009). Among women with T2DM, the mean BMD in 2013-2014 was significantly lower than that in 2005-2006, even after adjusting for multiple covariates. During 2005-2014, the prevalence of osteoporosis among T2DM patients and non-diabetic people increased but with no significant linear trend (both Plinear trend > 0.05), while the prevalence of osteopenia in the two populations increased linearly (both Plinear trend < 0.04). Age- and BMI-adjusted mean BMD decreased in 2013-2014 in patients with T2DM and non-diabetic people, while the prevalence of osteoporosis and osteopenia increased in both groups.
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Affiliation(s)
- Yingke Xu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, 89154, USA
- Nevada Institute of Personalized Medicine, College of Science, University of Nevada, Las Vegas, Las Vegas, NV, 89154, USA
| | - Qing Wu
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Las Vegas, NV, 89154, USA.
- Nevada Institute of Personalized Medicine, College of Science, University of Nevada, Las Vegas, Las Vegas, NV, 89154, USA.
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An Y, Liu S, Wang W, Dong H, Zhao W, Ke J, Zhao D. Low serum levels of bone turnover markers are associated with the presence and severity of diabetic retinopathy in patients with type 2 diabetes mellitus. J Diabetes 2021; 13:111-123. [PMID: 32671958 DOI: 10.1111/1753-0407.13089] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/18/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Accumulating evidence demonstrates an association of type 2 diabetes mellitus (T2DM) and its microvascular complications with increased fracture risk. In this study, we aimed to evaluate the relationships between serum concentrations of bone turnover markers and the presence and/or severity of diabetic retinopathy (DR) among patients with T2DM. METHODS A total of 285 patients with T2DM comprising 168 patients without DR and 117 patients with DR were enrolled in the cross-sectional study. In the latter group, patients were further divided into patients of mild and severe DR stages. The biochemical parameters and bone turnover markers were determined in all participants. RESULTS This study found that serum levels of procollagen type 1 N-terminal propeptide (P1NP), a bone formation marker, and the bone resorption marker serum β-cross-linked C-telopeptide of type I collagen (β-CTX) were more decreased in diabetic patients with DR than in those without DR, with differences remaining significant (P < .05) in multivariate linear regression models after adjustments for multiple confounding factors. Osteocalcin and β-CTX levels were further reduced along with the severity of DR among participants with DR. Moreover, multivariate logistic regression analysis revealed that lower serum levels of P1NP and β-CTX were associated with higher odds for the presence of DR, while β-CTX was associated with the severity of DR. CONCLUSION Our results suggest that the development of DR might be involved in the progression of T2DM-induced deficits in bone formation and resorption or vice versa. Follow-up studies and further research are necessary to validate the associations and elucidate the underlying mechanisms.
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Affiliation(s)
- Yaxin An
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| | - Simo Liu
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| | - Wenbo Wang
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| | - Huan Dong
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| | - Wenying Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| | - Jing Ke
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
| | - Dong Zhao
- Center for Endocrine Metabolism and Immune Diseases, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Diabetes Research and Care, Beijing, China
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Ma CM, Yin FZ. The Relationship Between Prediabetes and Bone Mass in Adolescents: Analysis of the National Health and Nutrition Examination Survey From 2005 to 2010. Front Endocrinol (Lausanne) 2021; 12:749998. [PMID: 34754289 PMCID: PMC8572624 DOI: 10.3389/fendo.2021.749998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/04/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE The purpose of this study was to observe the relationship between impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and bone mineral density (BMD) in different sites in adolescents. METHODS A retrospective study was conducted on adolescents age 12-19 years of the United States. Data were extracted from the National Health and Nutrition Examination Survey (NHANES) 2005-2006, 2007-2008, and 2009-2010 cycles. IFG was defined as fasting plasma glucose (FPG) levels that were ≥5.6 and <7.0 mmol/L. IGT was defined as 2-h plasma glucose levels that were ≥7.8 and <11.1 mmol/L after the oral glucose tolerance test (OGTT). RESULTS After controlling for age, gender, race, and body mass index (BMI) Z-score, adolescents in different categories of IGT had significantly different levels of areal BMD (aBMD) and bone mineral apparent density (BMAD) (IGT main effect: P < 0.05 for all, two-way ANOVA). There was no main effect between different categories of IFG with regard to aBMD and BMAD (P > 0.05). There was no interaction between IFG and IGT with regard to aBMD and BMAD (P > 0.05). In multiple regression analysis, the 2-h plasma glucose maintained an independent association with femoral neck aBMD (β = -0.011, 95% CI: -0.017~-0.006, P < 0.001, R2 = 0.012), total femur aBMD (β = -0.015, 95% CI: -0.021~-0.009, P < 0.001, R2 = 0.018), total spine aBMD (β = -0.015, 95% CI: -0.020~-0.010, P < 0.001, R2 = 0.018), and total spine BMAD (β = -0.002, 95% CI: -0.003~0.000, P = 0.006, R2 = 0.003). CONCLUSION The present study demonstrates that BMD was decreased in adolescents with IGT. Two-hour plasma glucose, not FPG, negatively correlated with BMD. The effect of 2-h plasma glucose was consistent across the sites of bone.
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Park HY, Han K, Kim Y, Kim YH, Sur YJ. The risk of hip fractures in individuals over 50 years old with prediabetes and type 2 diabetes - A longitudinal nationwide population-based study. Bone 2021; 142:115691. [PMID: 33069920 DOI: 10.1016/j.bone.2020.115691] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/07/2020] [Accepted: 10/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The present study aimed to investigate the association between type 2 diabetes mellitus (T2DM) and hip fractures using a large-scale nationwide population-based cohort that is representative of the Republic of Korea. We determined the risks of hip fractures in individuals with prediabetes and T2DM with different diabetes durations, and compared them with the risks of hip fractures in individuals without T2DM. METHODS A total of 5,761,785 subjects over 50 years old who underwent the National Health Insurance Service medical checkup in 2009-2010 were included. Subjects were classified into 5 groups based on the diabetes status; Normal, Prediabetes, Newly-diagnosed T2DM, T2DM less than 5 years, and T2DM more than 5 years. They were followed from the date of the medical checkup to the end of 2016. The endpoint was a new development of hip fracture during follow-up. The hazard ratios (HRs) and 95% confidence intervals (CIs) of hip fractures for each group were analyzed using Cox proportional hazard regression models after adjusting for age, sex, smoking, alcohol drinking, regular exercise, body mass index, hypertension, dyslipidemia, and chronic kidney disease. RESULTS The HRs of hip fractures were 1 in the Normal group, 1.032 (95% CI: 1.009, 1.056) in the Prediabetes group, 1.168 (95% CI: 1.113, 1.225) in the Newly-diagnosed T2DM2, 1.543 (95% CI: 1.495, 1.592) in the T2DM less than 5 years and 2.105 (95% CI: 2.054, 2.157) in the T2DM more than 5 years. The secular trend of the HRs of hip fractures according to the duration of T2DM was statistically significant (P < .001). Subgroup analyses also showed the same increasing pattern of the HRs of hip fractures according to the duration of T2DM in both sexes and all age groups (50-64 years, 65-74 years, over 75 years). CONCLUSIONS In summary, this large-scale, retrospective, longitudinal, nationwide population-based cohort study of 5,761,785 subjects demonstrated that the risks of hip fractures started to increase in prediabetes and was associated linearly with the duration of T2DM. The secular trend of risks of hip fractures according to the duration of T2DM was consistent in both sexes and all age groups.
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Affiliation(s)
- Ho Youn Park
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Youngwoo Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon Hwan Kim
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo Joon Sur
- Department of Orthopedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Wang N, Wang Y, Zhang H, Guo Y, Chen C, Zhang W, Wan H, Han J, Lu Y. Association of bone mineral density with nine urinary personal care and consumer product chemicals and metabolites: A national-representative, population-based study. ENVIRONMENT INTERNATIONAL 2020; 142:105865. [PMID: 32585503 DOI: 10.1016/j.envint.2020.105865] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/15/2020] [Accepted: 05/16/2020] [Indexed: 06/11/2023]
Abstract
Personal care and consumer products are extensively used and contain various chemicals that are recognized as endocrine disrupting chemicals. Few epidemiological studies measured the associations of these chemicals and metabolites, especially phenols, with bone health. We measured the associations between nine urinary phenol biomarkers and BMD and the subsequent prevalence of osteopenia/osteoporosis. National representative data from US adults aged over 20 years who participated in the National Health and Nutrition Examination Survey from 2005 to 2010 were used. 2,267 men, 1,145 premenopausal women and 1,033 postmenopausal women were included in the final analyses. Bisphenol A, benzophenone-3, triclosan, butylparaben, ethylparaben, methylparaben, propylparaben, 2,5-dichlorophenol and 2,4-dichlorophenol were measured by high-performance liquid chromatography-isotope dilution tandem mass spectrometry. Paraben concentrations, especially ethyl-, methyl- and propylparabens, were related to greater BMD in the femoral neck and intertrochanter and lumbar spine in men and premenopausal women. 2,4-dichlorophenol concentrations was associated with lower BMD and a higher prevalence of osteopenia + osteoporosis in men. Bisphenol A was associated with a higher prevalence of osteopenia + osteoporosis in the lumbar spine in postmenopausal women. Benzophenone-3 tended to be associated with a higher BMD of femur in men and premenopausal women. In conclusion, certain urinary personal care and consumer product chemicals and metabolites were significantly associated with BMD or osteopenia + osteoporosis. These results further indicate that, in future research, determination of the causal relationships and detection of undelying mechanism could be next important directions.
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Affiliation(s)
- Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haojie Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuyu Guo
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junli Han
- Department of General Dentistry, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Chen C, Chen Y, Zhai H, Xia F, Han B, Zhang W, Wang Y, Wan H, Wang N, Lu Y. Iodine nutrition status and its association with microvascular complications in urban dwellers with type 2 diabetes. Nutr Metab (Lond) 2020; 17:70. [PMID: 32821267 PMCID: PMC7433180 DOI: 10.1186/s12986-020-00493-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
Background The principal function of iodine acts on thyroid function, but in recent years, the role of iodine deficiency in metabolism has also been gradually revealed. We aimed to investigate the current status of iodized salt consumption and urinary iodine concentration (UIC) in an urban Chinese population with type 2 diabetes, and to further explore whether UIC was associated with diabetic microvascular complications. Methods Four thousand five hundred fifty-nine subjects with diabetes from 7 communities in downtown Shanghai were enrolled in the cross-sectional Metal Study in 2018. UIC was detected using an inductively coupled plasma-mass spectrometer. Diabetic kidney disease (DKD) was defined as urinary albumin-to-creatinine ratio (UACR) > 30 mg/g or estimated glomerular filtration rate < 60 mL/min/1.73 m2. Diabetic retinopathy (DR) was evaluated by high-quality fundus photographs and was remotely read by ophthalmologist. Results The median UIC of subjects with diabetes was 115.4 μg/L (78.9–170.8) in downtown Shanghai. Among all the subjects, 52.7% consumed non-iodized salt and 40.4% were iodine deficient. Iodine deficiency (UIC < 100 μg/L) was associated with an increased odds of DKD (OR 1.17; 95%CI 1.01–1.37) after adjustment for age, sex, education, current smokers, BMI, HbA1c, duration of diabetes, dyslipidemia, thyroid-stimulating hormone and free thyroxine. No association was observed between UIC and DR after multivariable adjustment. Conclusions A concerning number of subjects with diabetes consumed non-iodized salt and suffered from iodine deficiency in coastal regions of China. Low UIC might be a risk factor for DKD, which should be further confirmed by longitudinal prospective studies.
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Affiliation(s)
- Chi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011 China
| | - Yi Chen
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011 China
| | - Hualing Zhai
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011 China
| | - Fangzhen Xia
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011 China
| | - Bing Han
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011 China
| | - Wen Zhang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011 China
| | - Yuying Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011 China
| | - Heng Wan
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011 China
| | - Ningjian Wang
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011 China
| | - Yingli Lu
- Institute and Department of Endocrinology and Metabolism, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200011 China
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