BMI and BMD: The Potential Interplay between Obesity and Bone Fragility. Int J Environ Res Public Health. 2016;13. [PMID: 27240395 PMCID: PMC4924001 DOI: 10.3390/ijerph13060544]

Obesity induced caveolin-1 impairs osteogenesis via activating mitophagy and inhibiting Sirt1 signaling

Obesity has become a major global health problem and the effect on bone formation has received increasing attention. However, the interaction between obesity and bone metabolism is complex and still not fully understood. Here, we show that caveolin-1 (Cav1), a membrane scaffold protein involved in regulating a variety of cellular processes, plays a key regulatory role as a bridge connecting obesity and bone metabolism. High-fat diet (HFD)-induced obese C57BL/6J mouse displayed a significant increase in Cav1 expression and lower osteogenic activity; In vitro treatment of osteoblastic MC3T3-E1 cells with 1 mM free fatty acids (FFA) significantly promoted Cav1 expression and PINK1/Parkin regulated mitophagy, but inhibited the expression of osteogenic marker genes. Conversely, reduced expression of the Cav1 gene prevented these effects. Both endogenous oxidative stress and Sirt1 pathway were also significantly reduced after Cav1 knockdown in FFA-treated cells. Finally, Cav1-Sirt1 docking and co-immunoprecipitation results showed that Cav1 interacted with Sirt1 and FFA enhanced the interaction. Taken together, these results suggest that obesity impairs bone development and formation through up-regulation of the Cav1 gene, which lead to inhibition of Sirt1/FOXO1 and Sirt1/PGC-1α signaling pathways through interacting with Sirt1 molecule, and an increase of mitophagy level.

Relationship between Femoral Proximal Bone Quality Assessment by MRI IDEAL-IQ Sequence and Body Mass Index in Elderly Men

BACKGROUND

Bone assessment using the MRI DEAL-IQ sequence may have the potential to serve as a substitute for evaluating bone strength by quantifying the bone marrow hematopoietic region (R2*) and marrow adiposity (proton density fat fraction: PDFF). Higher body mass index (BMI) is associated with increased bone mineral density (BMD) in the proximal femur; however, the relationship between BMI and R2* or PDFF remains unclear. Herein, we investigated the correlation between BMI and MRI IDEAL-IQ based R2* or PDFF of the proximal femur.

METHODS

A retrospective single-cohort study was conducted on 217 patients diagnosed with non-metastatic prostate cancer between September 2019 and December 2022 who underwent MRI. The correlation between BMI and R2* or PDFF of the proximal femur was analyzed using Spearman's rank correlation test.

RESULTS

Among 217 patients (median age, 74 years; median BMI, 23.8 kg/m2), there was a significant positive correlation between BMI and R2* at the right and left proximal femur (r = 0.2686, p < 0.0001; r = 0.2755, p < 0.0001, respectively). Furthermore, BMI and PDFF showed a significant negative correlation (r = -0.239, p = 0.0004; r = -0.2212, p = 0.001, respectively).

CONCLUSION

In elderly men, the increased loading on the proximal femur due to elevated BMI was observed to promote a decrease in bone marrow adiposity in the proximal femur, causing a tendency for a transition from fatty marrow to red marrow with hematopoietic activity. These results indicate that the MRI IDEAL-IQ sequence may be valuable for assessing bone quality deterioration in the proximal femur.

Prevalence of Diabetes Mellitus and Clinical Differences in Patients with Severe Osteoporosis and Fragility Fractures

Background: Diabetes mellitus (DM) and osteoporosis are two of the most widespread metabolic diseases in the world. The aim of this study is to investigate the prevalence of DM among patients affected by osteoporosis and fragility fractures, and to search for differences in clinical characteristics. Methods: This is a single-center retrospective, case-controlled study. A total of 589 patients attending CTO Bone Unit between 2 January 2010 and 31 May 2023, due to osteoporosis and fragility fractures, were divided into two groups, according to the diagnosis of DM. The clinical and bone characteristics of patients were compared. Results: Prevalence of DM was 12.7%. Compared to patients without DM, the median age at the time of first fracture was similar: 72 years ± 13.5 interquartile range (IQR) vs. 71 years ± 12 IQR; prevalence of combination of vertebral and hip fractures was higher (p = 0.008), as well as prevalence of males (p = 0.016). Bone mineral density (BMD) at all sites was higher in DM group; trabecular bone score (TBS), instead, was significantly lower (p < 0.001). Conclusions: Patients with fragility fractures and DM more frequently show combination of major fractures with higher BMD levels. In these patients, TBS could be a better indicator of bone health than BMD and, therefore, might be used as a diagnostic tool in clinical practice.

Exploring the Interplay between Vitamin D, Insulin Resistance, Obesity and Skeletal Health

Vitamin D (ViD), plays an important role in calcium absorption and bone mineralization, is associated with bone mineral density. Severe deficiency in ViD has long been linked to conditions such as rickets in children and osteomalacia in adults, revealing its substantial role in skeletal health. Additionally, investigations show an existing interconnection between ViD and insulin resistance (Ins-R), especially in patients with type 2 diabetes mellitus (T2DM). Obesity, in conjunction with Ins-R, may augment the risk of osteoporosis and deterioration of skeletal health. This review aims to examine recent studies on the interplay between ViD, Ins-R, obesity, and their impact on skeletal health, to offer insights into potential therapeutic strategies. Cochrane Library, Google Scholar, and Pubmed were searched to investigate relevant studies until December 2023. Current research demonstrates ViD's impact on pancreatic β-cell function, systemic inflammation, and insulin action regulation. Our findings highlight an intricate association between ViD, Ins-R, obesity, and skeletal health, providing a perspective for the prevention and/or treatment of skeletal disorders in patients with obesity, Ins-R, and T2DM.

Optimal body mass index for protecting middle-aged and elderly patients with fatty liver from future fractures

OBJECTIVE

Previous studies have suggested that body mass index (BMI) should be considered when assessing the relationship between fatty liver (FL) and osteoporosis. The aim of this study was to investigate future fracture events in people with FL, focusing on the effect of BMI in both sexes.

METHODS

This retrospective cohort study from 2011 to 2019 enrolled 941 people, including 441 women and 500 men, aged 50 years or older who underwent liver imaging (ultrasound, computed tomography, or magnetic resonance image) and dual-energy X-ray absorptiometry (DXA, for bone mineral density measurements). The study examined predictors of osteoporosis in both sexes, and the effect of different ranges of BMI (18.5-24, 24-27, and ≥27 kg/m2 in women; 18.5-24, 24-27, 27-30 and ≥30 kg/m2 in men) on the risk of future fractures in FL patients.

RESULTS

The average follow-up period was 5.3 years for women and 4.2 years for men. Multivariate analysis identified age and BMI as independent risk factors for osteoporosis in both sexes. Each unit increase in BMI decreased the risk of osteoporosis by ≥10%. In both women and men with FL, a BMI of 24-27 kg/m2 offered protection against future fractures, compared to those without FL and with a BMI of 18.5-24 kg/m2.

CONCLUSION

The protective effect of a higher BMI against future fractures in middle-aged and elderly women and men with FL is not uniform and decreases beyond certain BMI ranges.

Exposure to perfluoroalkyl substances and longitudinal changes in bone mineral density in adolescents and young adults: A multi-cohort study

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) may impair bone development in adolescence, which impacts life-long bone health. No previous studies have examined prospective associations of individual PFAS and their mixture with bone mineral density (BMD) changes in Hispanic young persons, a population at high risk of osteoporosis in adulthood.

OBJECTIVES

To examine associations of individual PFAS and PFAS mixtures with longitudinal changes in BMD in an adolescent Hispanic cohort and examine generalizability of findings in a mixed-ethnicity young adult cohort (58.4% Hispanic).

METHODS

Overweight/obese adolescents from the Study of Latino Adolescents at Risk of Type 2 Diabetes (SOLAR; n = 304; mean follow-up = 1.4 years) and young adults from the Southern California Children's Health Study (CHS; n = 137; mean follow-up = 4.1 years) were included in this study. Plasma PFAS were measured at baseline and dual x-ray absorptiometry scans were performed at baseline and follow-up to measure BMD. We estimated longitudinal associations between BMD and five PFAS via separate covariate-adjusted linear mixed effects models, and between BMD and the PFAS mixture via quantile g-computation.

RESULTS

In SOLAR adolescents, baseline plasma perfluorooctanesulfonic acid (PFOS) was associated with longitudinal changes in BMD. Each doubling of PFOS was associated with an average -0.003 g/cm2 difference in change in trunk BMD per year over follow-up (95% CI: -0.005, -0.0002). Associations with PFOS persisted in CHS young adults, where each doubling of plasma PFOS was associated with an average -0.032 g/cm2 difference in total BMD at baseline (95% CI -0.062, -0.003), though longitudinal associations were non-significant. We did not find associations of other PFAS with BMD; associations of the PFAS mixture with BMD outcomes were primarily negative though non-significant.

DISCUSSION

PFOS exposure was associated with lower BMD in adolescence and young adulthood, important periods for bone development, which may have implications on future bone health and risk of osteoporosis in adulthood.

Association between triglyceride glucose index and total bone mineral density: a cross-sectional study from NHANES 2011-2018

The Homeostatic Model Assessment for Triglyceride Glucose Index (TyG) and its related indices, including triglyceride glucose-waist circumference (TyG-WC), triglyceride glucose-waist-to-height ratio (TyG-WHtR) and triglyceride glucose-body mass index (TyG-BMI), has emerged as a practical tool for assessing insulin resistance in metabolic disorders. However, limited studies have explored the connection between TyG, TyG-related indices and osteoporosis. This population-based study, utilizing data from the National Health and Nutrition Examination Survey 2011-2018, involved 5456 participants. Through weighted multivariate linear regression and smoothed curve fitting, a significant positive correlation was found between TyG, TyG-related indices and total bone mineral density (BMD) after adjusting for covariates [β = 0.0124, 95% CI (0.0006, 0.0242), P = 0.0390; β = 0.0004, 95% CI (0.0003, 0.0004), P < 0.0001; β = 0.0116, 95% CI (0.0076, 0.0156), P < 0.0001; β = 0.0001, 95% CI (0.0001, 0.0001), P < 0.0001]. In subgroup analysis, race stratification significantly affected the relationship between TyG and total BMD. Additionally, gender and race were both significant for TyG-related indices. Non-linear relationships and threshold effects with inflection points at 9.106, 193.9265, 4.065, and 667.5304 (TyG, TyG-BMI, TyG-WHtR, TyG-WC) were identified. Saturation phenomena were observed between TyG-BMI, TyG-WC and total BMD with saturation thresholds at 314.177 and 1022.0428. These findings contributed to understanding the association between TyG, TyG-related indices and total BMD, offering insights for osteoporosis prevention and treatment.

Improved femoral micro-architecture in adult male individuals with overweight: fracture resistance due to regional specificities

BACKGROUND

It is still unclear whether femoral fracture risk is positively or negatively altered in individuals with overweight. Considering the lack of studies including men with overweight, this study aimed to analyze regional specificities in mechano-structural femoral properties (femoral neck and intertrochanteric region) in adult male cadavers with overweight compared to their normal-weight age-matched counterparts.

METHODS

Ex-vivo osteodensitometry, micro-computed tomography, and Vickers micro-indentation testing were performed on femoral samples taken from 30 adult male cadavers, divided into the group with overweight (BMI between 25 and 30 kg/m2; n = 14; age:55 ± 16 years) and control group (BMI between 18.5 and 25 kg/m2; n = 16; age:51 ± 18 years).

RESULTS

Better quality of trabecular and cortical microstructure in the inferomedial (higher trabecular bone volume fraction, trabecular thickness, and cortical thickness, coupled with reduced cortical pore diameter, p < 0.05) and superolateral femoral neck (higher trabecular number and tendency to lower cortical porosity, p = 0.043, p = 0.053, respectively) was noted in men with overweight compared to controls. Additionally, the intertrochanteric region of men with overweight had more numerous and denser trabeculae, coupled with a thicker and less porous cortex (p < 0.05). Still, substantial overweight-induced change in femoral osteodensitometry parameters and Vickers micro-hardness was not demonstrated in assessed femoral subregions (p > 0.05).

CONCLUSIONS

Despite the absence of significant changes in femoral osteodensitometry, individuals with overweight had better trabecular and cortical femoral micro-architecture implying higher femoral fracture resistance. However, the microhardness was not significantly favorable in the individuals who were overweight, indicating the necessity for further research.

The nonlinear association between triglyceride glucose-body mass index and femoral neck BMD in nondiabetic elderly men: NHANES 2005-March 2020

BACKGROUND

The triglyceride glucose-body mass index (TyG-BMI) has been considered a surrogate marker for assessing insulin resistance. We aimed to correlate the TyG-BMI, triglyceride glucose combined with body mass index, with femoral neck bone mineral density (FN BMD) in non-diabetic elderly men.

METHODS

Using data from the National Health and Nutrition Examination Survey (NHANES) database, totally, 1182 eligible men aged ≥ 50 years without diabetes were included in the current study. Smoothed curves were obtained by a two-piecewise linear regression model and the threshold effects were explored by using a smoothing function.

RESULTS

TyG-BMI was positive related with and FN BMD with or without adjustment for confounders. However, no typical dose-dependent positive association between TyG-BMI and FN BMD was observed across the TyG-BMI tertiles, indicating a non-linear association. Further analysis by the weighted two-piecewise linear regression model and recursive algorithm suggested that per SD increase in TyG-BMI increased FN BMD by 0.266 gm/cm2 when TyG-BMI lower than 168.20. However, when TyG-BMI is higher than 168.20, FN BMD only increased 0.046 gm/cm2 for per SD increase of TyG-BMI after fully adjustment (OR = 11.258, 95%CI: 6.034, 16.481). Moreover, subgroup analyses showed that higher TyG-BMI levels were related to elevated FN BMD in all groups, suggesting the consistency of the positive association within these stratas.

CONCLUSIONS

This study demonstrated that TyG-BMI is positively associated with FN BMD in a nonlinear fashion among elderly men without diabetes, which may be a reliable marker for the early identification of individuals with lower FN BMD.

The Influence of Obesity on Bone Health in Post-COVID-19 Recovery- Single-Center Experience

Introduction

The ongoing repercussions of the COVID-19 pandemic include potentially deleterious impacts on bone health.

Aim

This research aimed to ascertain the effects of COVID-19 on the bone health of obese and non-obese Indian individuals.

Methods

We executed a case-control study enrolling individuals who recovered from COVID-19. Participants were stratified into obese and non-obese groups based on their BMI. Comprehensive assessments encompassed anthropometric evaluations, laboratory tests, and bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry (DEXA).

Results

From April to July 2022, we enrolled obese (n = 27, mean BMI = 30.54 ± 4.51 kg/m 2) and non-obese (n = 23, mean BMI = 21.97 ± 2.20 kg/m 2) individuals. The cohort's average age was 36.08 ± 15.81 years, with a male-to-female ratio of 1.6:1. There was a difference in BMD, especially at the total hip, between the two groups. BMD at the spine (L1-L4), the neck of the femur, and ultra-distal radius were consistent across both groups. Weight exhibited a significant positive correlation with BMD at L1-L4 (r = 0.40, p = 0.003) and the left femur total (r = 0.27, p = 0.001). Haemoglobin levels were lower in the obese group compared to their non-obese counterparts (12.3 ± 2.0 vs 13.6 ± 1.9, p = 0.01). Multivariate analysis underscored weight as a crucial predictor for BMD at the spine (L1-L4, p = 0.003) and total hip (p = 0.001).

Conclusion

Even with advanced age, obese post-COVID-19 individuals demonstrate a higher bone mineral density (BMD) at the hip than non-obese subjects.

Assessment of Bone Health Using Dual-Energy X-Ray Absorptiometry (DEXA) And Its Association with Dietary Intakes, Serum Vitamin D Levels, and Anthropometric Measures in Healthy Urban Preschool Children

OBJECTIVES

To generate reference data for bone mineral content (BMC) and bone mineral density (BMD) measures among apparently healthy children aged 4-5 y and to study the relationship of BMC and BMD with age, sex, anthropometric measures, dietary intakes, and serum vitamin D levels.

METHODS

This cross-sectional study was conducted among 219 urban preschool children, aged 4.0-5.11 y. Bone health (BMC and BMD) was measured using dual energy X-ray absorptiometry (DEXA). Anthropometric parameters were measured using standard methodology. The 24-h dietary recall method was used to assess the dietary intake of the children. Serum vitamin D levels were assessed using the ELISA kit method. Percentiles for BMC and BMD for each age and sex were constructed using the lambda-mu-sigma (LMS) method.

RESULTS

The mean BMD and BMC among children was 0.75 ± 0.04 g/cm2 and 544.9 ± 87.6 g, respectively, and were significantly different by age and sex category. The BMC and BMD values of boys and girls increased with age, with boys having significantly higher values. A significant positive correlation was observed for BMC and BMD with anthropometric measures and dietary intake of calcium, phosphorous, protein, zinc, and B vitamins.

CONCLUSION

This study developed smoothed percentile curves for BMC and BMD in preschool children, which could be used as reference values for children from India.

Peak Bone Mass Formation: Modern View of the Problem

Peak bone mass is the amount of bone tissue that is formed when a stable skeletal state is achieved at a young age. To date, there are no established peak bone mass standards nor clear data on the age at which peak bone mass occurs. At the same time, the level of peak bone mass at a young age is an important predictor of the onset of primary osteoporosis. The purpose of this review is to analyze the results of studies of levels of peak bone mass in general, the age of its onset, as well as factors influencing its formation. Factors such as hormonal levels, body composition, physical activity, nutrition, heredity, smoking, lifestyle, prenatal predictors, intestinal microbiota, and vitamin and micronutrient status were considered, and a comprehensive scheme of the influence of these factors on the level of peak bone mass was created. Determining the standards and timing of the formation of peak bone mass, and the factors affecting it, will help in the development of measures to prevent its shortage and the consequent prevention of osteoporosis and concomitant diseases.

Association between Metabolic Syndrome and the Musculoskeletal System

Metabolic syndrome (MetS) and osteoporosis are chronic health disorders worldwide [...].

Impact of leptin deficiency on male tibia and vertebral body 3D bone architecture independent of changes in body weight

Leptin an adipokine with potent effects on energy balance and body weight plays an important role in defining bone architecture in growing mammals. However, major changes in body weight can also influence morphology of trabecular and cortical bone. Therefore, we examined the impact of leptin deficiency on tibia and vertebral body 3D bone architecture independent of changes in body weight. Furthermore, advances in computational 3D image analysis suggest that average morphological values may mask regional specific differences in trabecular bone thickness. The study utilized leptin-deficient Ob/Ob mice (n = 8) weight-paired to C57BL/6 (C57) control mice (n = 8) which were split into either lean or obese groups for 24 ± 2 weeks. Whole tibias and L3 vertebrae were fixed before high resolution microcomputed tomography (μCT) scanning was performed. Leptin deficiency independent of body weight reduced tibia cortical bone volume, trabecular bone volume/tissue volume, number, and mineral density. Mean tibia trabecular thickness showed no significant differences between all groups; however, significant changes in trabecular thickness were found when analyzed by region. This study demonstrates that leptin deficiency significantly impacts tibia and vertebral body trabecular and cortical bone 3D architecture independent of changes in body weight.

Effect of regional body composition changes on bone density remodeling after sleeve gastrectomy

Background

Sleeve gastrectomy (SG) results in bone mineral density (BMD) loss and varying body composition parameters. However, the effects of body compositions on bone health are controversial. In order to accurately demonstrate their relationship and provide new insights into the causes of BMD loss after sleeve gastrectomy, this study is aimed to investigate the role of changes in body composition in BMD loss 12 months after SG.

Methods

41 Chinese individuals with obesity (25 women and 16 men) who underwent SG were prospectively examined for at least 12 months. Measurements of anthropometrics, body composition, BMD and blood samples were collected.

Results

For 12 months, the femoral neck (FN) BMD and total hip (TH) BMD decreased significantly compared with baseline in both sexes but not lumbar spine (LS) BMD. Greater TH BMD loss was observed in men than in women. For the first 6 months post-SG, the FN BMD loss was positively associated with the estimated fat free mass index (eFFMI) reduction in women (adjusted β = 0.77, P = 0.004) and positively associated with reduction of subcutaneous fat area (SFA) in men (r = 0.931, P = 0.007). For 12 months post-SG, the FN BMD loss was negatively associated with visceral fat area (VFA) reduction in women (adjusted β = -0.58, P = 0.027) and men (adjusted β = -0.68, P = 0.032). TH BMD loss was positively associated with waist circumference reduction in women (r = 0.448, P = 0.028).

Conclusion

FN and TH BMD decrease after SG in both women and men. The changes in body compositions are associated with BMD loss at different time points and bone sites. Our data emphasize the limitation of simply taking the total weight loss (% TWL) as an influencing factor of bone mineral density and the necessity of delineating body composition in relevant studies.

Linking metabolic syndrome with low bone mass through insights from BMI and health behaviors

The objective of this study is to investigate the relationship between metabolic syndrome (MetS), and bone density in a 30- to 50-year-old Taiwanese population, and to explore the combined effects of BMI and health behaviors on this association. A total of 52,912 individuals aged 30-50 years from the Taiwan Biobank were included in this cross-sectional study. Bone density status was assessed using quantitative ultrasound (QUS). The joint effect was assessed by including an interaction term in the multi-logistic regression models to test the association between MetS, BMI, and bone density while controlling for potential confounders. MetS was associated with reduced bone density, with the risk of severe low bone density (SLBD) higher among BMI < 24 kg/m2 individuals with MetS (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.09-2.16), while the risk was not significant among BMI ≥ 24 kg/m2 individuals with MetS. Smoking, alcohol consumption, and lack of regular exercise among individuals with a BMI < 24 kg/m2 and MetS were associated with higher risk of severe low bone density (SLBD), the aORs (95%CI) were 2.9 (1.59-5.20), 2.1 (1.06-4.22), and 1.8 (1.24-2.54) respectively. Our study suggests that metabolic syndrome could increase the risk of severe low bone density, but this risk can be minimized through higher BMI, non-smoking, no alcohol consumption, and regular exercise. Conversely, smoking, alcohol consumption or lack of regular exercise may exacerbate the risk of severe low bone density. These findings highlight the importance of a multifactorial approach in managing bone healthcare.

Noninvasive and Microinvasive Nanoscale Drug Delivery Platforms for Hard Tissue Engineering

Bone tissue plays a crucial role in protecting internal organs and providing structural support and locomotion of the body. Treatment of hard tissue defects and medical conditions due to physical injuries, genetic disorders, aging, metabolic syndromes, and infections is more often a complex and drawn out process. Presently, dealing with hard-tissue-based clinical problems is still mostly conducted via surgical interventions. However, advances in nanotechnology over the last decades have led to shifting trends in clinical practice toward noninvasive and microinvasive methods. In this review article, recent advances in the development of nanoscale platforms for bone tissue engineering have been reviewed and critically discussed to provide a comprehensive understanding of the advantages and disadvantages of noninvasive and microinvasive methods for treating medical conditions related to hard tissue regeneration and repair.

Association between Adiposity and Bone Mineral Density in Adults: Insights from a National Survey Analysis

Adiposity and bone mineral density (BMD) are closely associated. The aim of this research was to investigate the association between BMD and adiposity measures in adults, including gynoid percent fat (GPF), android percent fat (APF), total percent fat (TPF), visceral adipose tissue percent (VAT%), and total lean mass percent (TLM%). Participants (n = 11,615) aged 18 years and older were analyzed using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. Associations between BMD and adiposity measures were investigated, and potential differences based on gender and age were explored. Significant negative associations were observed among TPF, APF, GPF, VAT%, and BMD in the fully adjusted models, while TLM% and BMD were positively associated. Stratifying by age and sex, TPF, GPF, and VAT% consistently demonstrated a negative correlation with BMD. In the young adult group, a TPF of 38.2% eliminated the negative correlation between BMD and TPF. Male BMD exhibited an inverted U-shaped relationship with APF, peaking at 35.6%, while a similar pattern was observed for the middle-aged group BMD and APF, with a peak at 31.7%. This large-sample research found a significant negative association between adiposity measures and BMD, providing valuable revelations regarding the intricate connection between adiposity and bone health.

Association of visceral and subcutaneous fat with bone mineral density in US adults: a cross-sectional study

The relationship between the accumulation of fat in visceral or subcutaneous tissue and bone mineral density (BMD) remains unclear. Our primary objective in this study was to illuminate this relationship by conducting an investigation on a vast scale, encompassing a nationally representative population in the United States. A weighted multiple linear regression model was established to evaluate the relationship between visceral fat, subcutaneous fat, and BMD. Additionally, the exploration of the potential nonlinear relationship was conducted employing the methodology of smooth curve fitting. In order to determine potential inflection points, a two-stage linear regression model was utilized. A total of 10,455 participants between the ages of 20 and 59 were included in this study. Various weighted multiple linear regression models revealed a negative correlation between lumbar BMD and visceral mass index (VMI) and subcutaneous mass index (SMI). However, the association between VMI and lumbar BMD displayed a U-shaped pattern upon employing the smooth curve fitting, and the inflection point of 0.304 kg/m2was determined using a two-stage linear regression model. Our findings indicated a negative association between subcutaneous fat and BMD. A U-shaped relationship was observed between visceral fat and BMD.

Age-specific effects of weight-based body size on fracture risk in later life: a lifecourse Mendelian randomisation study

Musculoskeletal conditions, including fractures, can have severe and long-lasting consequences. Higher body mass index in adulthood is widely acknowledged to be protective for most fracture sites. However, sources of bias induced by confounding factors may have distorted previous findings. Employing a lifecourse Mendelian randomisation (MR) approach by using genetic instruments to separate effects at different life stages, this investigation aims to explore how prepubertal and adult body size independently influence fracture risk in later life.Using data from a large prospective cohort, univariable and multivariable MR were conducted to simultaneously estimate the effects of age-specific genetic proxies for body size (n = 453,169) on fracture risk (n = 416,795). A two-step MR framework was additionally applied to elucidate potential mediators. Univariable and multivariable MR indicated strong evidence that higher body size in childhood reduced fracture risk (OR, 95% CI: 0.89, 0.82 to 0.96, P = 0.005 and 0.76, 0.69 to 0.85, P = 1 × 10- 6, respectively). Conversely, higher body size in adulthood increased fracture risk (OR, 95% CI: 1.08, 1.01 to 1.16, P = 0.023 and 1.26, 1.14 to 1.38, P = 2 × 10- 6, respectively). Two-step MR analyses suggested that the effect of higher body size in childhood on reduced fracture risk was mediated by its influence on higher estimated bone mineral density (eBMD) in adulthood.This investigation provides novel evidence that higher body size in childhood reduces fracture risk in later life through its influence on increased eBMD. From a public health perspective, this relationship is complex since obesity in adulthood remains a major risk factor for co-morbidities. Results additionally indicate that higher body size in adulthood is a risk factor for fractures. Protective effect estimates previously observed are likely attributed to childhood effects.

More Prevalent and Severe Low Bone-Mineral Density in Boys with Severe Adolescent Idiopathic Scoliosis Than Girls: A Retrospective Study of 798 Surgical Patients

INTRODUCTION

A total of 0.1-0.8% of AIS patients progress to severe stages without clear mechanisms, and AIS girls are more prone to curve progression than boys. Recent studies suggest that AIS girls have systemic and persistent low bone-mineral density (BMD), which has been shown to be a significant prognostic factor of curve progression in AIS. The present study aimed to (a) investigate the prevalence of low BMD in patients with severe AIS and (b) assess the sexual dimorphism and independent risk factors of low BMD in severe AIS patients.

MATERIALS AND METHODS

A total of 798 patients (140 boys vs. 658 girls) with AIS who reached surgical threshold (Cobb ≥ 40°) were recruited. BMD were assessed using BMD Z-scores from dual-energy X-ray absorptiometry (DXA). Demographic, clinical, and laboratory values of the subjects were collected from their medical records. Logistic regression analysis was performed to identify independent risk factors of low BMD.

RESULTS

The overall prevalence of BMD Z-score ≤ -2 and ≤ -1 were 8.1% and 37.5%, respectively. AIS boys had significantly lower BMD Z-scores (-1.2 ± 0.96 vs. -0.57 ± 0.92) and higher prevalence of low BMD (Z-score ≤ -2: 22.1% vs. 5.2%, p < 0.001; Z-score ≤ -1: 59.3% vs. 32.8%, p < 0.001) than girls. Sex, BMI, serum alkaline phosphatase, and potassium were independent factors of low BMD in the severe AIS patients.

CONCLUSIONS

The present large cohort of surgical AIS patients revealed that low BMD is more prevalent and severe in boys than in girls with severe curves. Low BMD may serve as a more valuable predictive factor for curve progression to the surgical threshold in boys than girls with AIS.

Increased Dietary Intakes of Total Protein, Animal Protein and White Meat Protein Were Associated with Reduced Bone Loss—A Prospective Analysis Based on Guangzhou Health and Nutrition Cohort, South China

In this study, we aimed to prospectively investigate the relationships between different types of dietary protein and changes in bone mass in Chinese middle-aged and elderly people. Dietary intakes were evaluated by means of a validated food frequency questionnaire. Bone mineral density (BMD) was measured using a dual-energy bone densitometer at multiple bone sites. Multivariable regression models were applied to investigate the associations of the participants’ dietary intakes of total protein, intakes of protein from various sources, and amino acid intakes with the annualized changes in BMD during a 3-year follow-up. A total of 1987 participants aged 60.3 ± 4.9 years were included in the analyses. Multivariable linear regression results showed that dietary intakes of total protein, animal protein, and protein from white meat were positively correlated with BMD changes, with standardized coefficients (β) of 0.104, 0.073, and 0.074 at the femur neck (p < 0.01) and 0.118, 0.067, and 0.067 at the trochanter (p < 0.01), respectively. With each increase of 0.1g·kg−1·d−1 in animal protein and white meat protein intakes, the BMD losses were reduced by 5.40 and 9.24 mg/cm2 at the femur neck (p < 0.05) and 1.11 and 1.84 mg/cm2 at the trochanter (p < 0.01), respectively. Our prospective data, obtained from Chinese adults, showed that dietary total and animal protein, especially protein from white meat, could significantly reduce bone loss at the femur neck and trochanter.

Aerobic training improves bone fragility by reducing the inflammatory microenvironment in bone tissue in type 2 diabetes

Aerobic training (AT) is indicated in type 2 diabetes mellitus (T2DM) to control hyperglycaemia and inflammation. AT improves bone microarchitecture and resistance to fracture. The intensity of AT and the mechanisms that lead to the improvement in bone quality are still unknown. Using a mouse model of T2DM, we evaluated the effects of two intensities of forced AT. We divided mice into: sedentary (SED), T2DM-SED, low runners (LOW), T2DM-LOW, high runners (HIGH) and T2DM-HIGH. The AT for low was 8 m/minute (m/min); 5° slope or high 18 m/min; 15° slope for 2 months. We measured metabolic parameters, the serum cytokines concentration, lipocalin-2 (LCN-2) and adiponectin; and the tibial concentrations of LCN-2, tumour necrosis factor alpha (TNF-α) and protein carbonylation (CO). We evaluated femur morphometry and biomechanical properties. We performed multiple correlation analysis. The T2DM-LOW versus T2DM-SED group, shown an increase of interleukin (IL)-10 (417 ± 90 vs 102 ± 25 pg/mL) and improved trabecular bone (BV/TV: 31.8 ± 2.3 vs 19.25 ± 1.4%; Tb.Sp.: 1.62 ± 0.02 vs 2.0 ± 0.07 mm), by a decrease bone CO (3.4 ± 0.1 vs 6.0 ± 0.5 nmol/mg), bone TNF-α (84 ± 4 vs 239 ± 13 pg/mL) and LCN-2 (2887 ± 23 vs 3418 ± 105 pg/mL). The T2DM-HIGH versus T2DM-SED group showed a greater hypoglycaemic effect (228 ± 10 vs 408 ± 5 mg/dL), with improved cortical bone density (0.26 ± 0.012 vs 0.21 ± 0.007 mm) and fracture resistance (102 ± 8 vs 78 ± 5 MPa), by a reduction of bone TNF-α (77 ± 34 vs 239 ± 13 pg/mL); LCN-2 (2768 ± 20 vs 3418 ± 105 pg/mL) and CO (4.8 ± 0.5 vs 6.0 ± 0.5 nmol/mg). In conclusion, AT improves bone morphometry and biomechanical properties by reducing the bone inflammatory microenvironment.

Elucidating the relationship between dyslipidemia and osteoporosis: A multicenter, prospective cohort study protocol

Background

A previous study has shown similar factors in dyslipidemias (DL) and osteoporosis (OP). However, no cohort study has been reported on the association between DL and OP in the postmenopausal population in China. This study aims to provide epidemiological and pathophysiological evidence regarding the association between DL and bone mass and fracture risk.

Methods

This is a multicenter, prospective cohort study that will have approximately 1,100 representative participants enrolled from multiple hospitals or communities in China. They will be divided into two groups according to whether or not they are exposed to dyslipidemia and will be epidemiologically investigated. Each participant will be visited continuously once every year with a minimum follow-up of 3 years to track incidences of OP. Meanwhile, free bone density screening, questionnaires, and blood sample collection will also be completed during this period.

Conclusion

The current study is likely to provide greater insight into the relationship between lipid metabolism and bone metabolism in postmenopausal women. Furthermore, the research result maybe fed into public health strategies with regard to metabolic disease prevention.

Combination of Caloric Restriction and a Mixed Training Protocol as an Effective Strategy to Counteract the Deleterious Effects in Trabecular Bone Microarchitecture Caused by a Diet-Induced Obesity in Sprague Dawley Rats

The association of obesity with changes in bone mass is not clear. Obese individuals tend to have an increased bone mineral density, but other studies have shown that obesity is a major risk factor for fractures. The mechanisms of bone response during a weight loss therapy as well as the possible osteoprotective effect of exercise should be analyzed. The aim of this study was to test the effects of a weight-loss program based on the combination of caloric restriction and/or a mixed training protocol on different parameters of bone morphology and functionality in a DIO rat model. Three stages were established over a 21-week period (obesity induction 0–12 w, weight loss intervention 12–15 w, weight maintenance intervention 15–21 w) in 88 male Sprague Dawley rats. Bone microarchitecture, total mineral and elemental composition, and bone metabolism parameters were assessed. Weight loss interventions were associated to healthy changes in body composition, decreasing body fat and increasing lean body mass. On the other hand, obesity was related to a higher content of bone resorption and inflammatory markers, which was decreased by the weight control interventions. Caloric restriction led to marked changes in trabecular microarchitecture, with a significant decrease in total volume but no changes in bone volume (BV). In addition, the intervention diet caused an increase in trabeculae number and a decrease in trabecular spacing. The training protocol increased the pore diameter and reversed the changes in cortical porosity and density of BV induced by the high protein diet at diaphysis level. Regarding the weight-maintenance stage, diminished SMI values indicate the presence of more plate-like spongiosa in sedentary and exercise groups. In conclusion, the lifestyle interventions of caloric restriction and mixed training protocol implemented as weight loss strategies have been effective to counteract some of the deleterious effects caused by a dietary induction of obesity, specifically in trabecular bone morphometric parameters as well as bone mineral content.

An effective automatic segmentation of abdominal adipose tissue using a convolution neural network

BACKGROUND AND AIMS

Computer-aided diagnosis and prognosis rely heavily on fully automatic segmentation of abdominal fat tissue using Emission Tomography images. The identification of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) in abdomen fat faces two main challenges: (1) the great difficulties in comparison to multi-stage semantic segmentation (VAT and SAT), and (2) the subtle differences due to the high similarity of the two classes in abdomen fat and complicated VAT distribution.

METHODS

In this research, we built an automated convolutional neural network (A-CNN) for segmenting Abdominal adipose tissue (AAT) from radiology images.

RESULTS

We developed a point-to-point design for the A-CNN learning process, wherein the representing features might be learned together with a hybrid feature extraction technique. We tested the proposed model on a CT dataset and evaluated it to existing CNN models. Furthermore, our suggested approach, A-CNN, outperformed existing deep learning methods regarding segmentation outcomes, notably in the AAT segment.

CONCLUSIONS

Proposed method is extremely fast with remarkable performance on limited-scale low dose CT-scanning and demonstrates the strength in providing an efficient computer-aimed tool for segmentation of AAT in the clinic.

Fracture risk in breast cancer: does obesity have an effect? A Scoping Review

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Obesity may be associated with increased fracture risk in females with breast cancer.

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Exercise appears to have an inverse association with the risk for fracture.

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At the time of publication, there is no literature that examines the effects of obesity on fracture risk in breast cancer bone metastasis.

Background

Objectives

Design

Data synthesis and results

Conclusions

Obesity and Bone Health: A Complex Relationship

Recent scientific evidence has shown an increased risk of fractures in patients with obesity, especially in those with a higher visceral adipose tissue content. This contradicts the old paradigm that obese patients were more protected than those with normal weight. Specifically, in older subjects in whom there is a redistribution of fat from subcutaneous adipose tissue to visceral adipose tissue and an infiltration of other tissues such as muscle with the consequent sarcopenia, obesity can accentuate the changes characteristic of this age group that predisposes to a greater risk of falls and fractures. Other factors that determine a greater risk in older subjects with obesity are chronic proinflammatory status, altered adipokine secretion, vitamin D deficiency, insulin resistance and reduced mobility. On the other hand, diagnostic tests may be influenced by obesity and its comorbidities as well as by body composition, and risk scales may underestimate the risk of fractures in these patients. Weight loss with physical activity programs and cessation of high-fat diets may reduce the risk. Finally, more research is needed on the efficacy of anti-osteoporotic treatments in obese patients.

A longitudinal analysis of serum adiponectin levels and bone mineral density in postmenopausal women in Taiwan

Since bone and fat mass are derived from mesenchyme in early development, adipokines secreted by adipose tissue may have an effect on bone metabolism. The relationship between adiponectin and bone mineral density (BMD) has been inconsistent in previous reports, with results being dependent on age, gender, menopausal status and bone sites. We investigated the relationship between serum adiponectin levels and the BMD of proximal femur and vertebrae bones in a 96-week longitudinal study of post-menopausal women with repeated measures of both. Linear regression models were used to determine the relation between adiponectin and BMD at each time point cross-sectionally, and a generalized estimating equation (GEE) model was used to investigate the longitudinal trends. Among 431 subjects, 376 (87%) provided baseline adiponectin measurements and 373 provided more than two measurements for longitudinal analysis. The means of serum adiponectin and BMD decreased with time. In linear regression models, adiponectin at baseline, the 48th week and the 96th week appeared to be inversely associated with BMD of proximal femur bone, but not lumbar spine after adjusting for age and various confounders. However, they all turn insignificant with further adjustment of body mass index. The inverse association between adiponectin and BMD of proximal femur is substantiated by all generalized equation models. Before adding the BMI in the model, the increase of 1 mg/dL of adiponectin can accelerate the decrease of proximal femur BMD by 0.001 (SE = 0.0004, p = 0.008). With BMI in the model, the drop rate was 0.0008 (SE = 0.0004, p = 0.026) and remained similar with further adjustment of two bone turnover markers. In this longitudinal analysis with both adiponectin and BMD measured at three time points, we demonstrate that with the increase of adiponectin level, the decline of proximal femur BMD in postmenopausal women accelerated during a period of 96 weeks.

The relationship between central obesity and bone mineral density: a Mendelian randomization study

BACKGROUND

The relationship between obesity and osteoporosis is an important public health issue. The goal of this study was to investigate whether and to what extent central obesity traits affect bone mineral density (BMD).

METHODS

We conducted a two-sample Mendelian randomization analysis. Genomewide significant single nucleotide polymorphisms associated with waist circumference, hip circumference, waist-to-hip ratio, waist circumference adjusted by body mass index (WCadjBMI), hip circumference adjusted by BMI (HCadjBMI) and waist-to-hip ratio adjusted by BMI (WHRadjBMI) were obtained from a large-scale database containing 224,459 samples. The BMD summary dataset was obtained from a UK Biobank database including 265,627 participants.

RESULTS

The results provided strong evidence that the HCadjBMI trait was causally and negatively associated with BMD (β: - 0.135, 95% CI - 0.216 to - 0.054; P = 0.001), while the WHR trait was causally and positively associated with BMD (β: 0.194, 95% CI 0.062 to 0.325, P = 0.004). No significant effects were observed for other traits on BMD.

CONCLUSIONS

This study indicates variations in the abilities of different central obesity traits to influence BMD. These results should be considered in further studies and public health measures on obesity and osteoporosis prevention strategies.

Associations of variability in body weight and glucose levels with the risk of hip fracture in people with diabetes

BACKGROUND

Diabetes is associated with a high risk of fragility fracture. However, there are controversies regarding the effect of fluctuations in metabolic parameters on the risk of fracture. We aimed to investigate the associations of body weight or glucose variability or their combination with the risk of hip fracture in people with diabetes.

METHODS

A population-based cohort study with 480,539 subjects over 40 years who had undergone three or more health examinations was performed. The degree of variability was evaluated using variability independent of the mean (VIM, 100 × standard deviation / mean^beta), coefficient of variation (CV), and average real variability (ARV, average of the absolute differences between consecutive values). High variability was defined as having values in the highest quartile. Cox proportional hazards models were used to estimate the risk of hip fracture.

RESULTS

There were 2834 hip fracture events (0.59%) during the mean follow-up of 8.1 years. After multivariable adjustment for age, sex, alcohol consumption, smoking, regular exercise, income, glucose, body mass index, hemoglobin, estimated glomerular filtration rate, diabetes duration, diabetes treatment with multiple agents, and osteoporosis, the HRs (95% CI) of hip fracture were 1.36 (1.24-1.50) and 1.29 (1.16-1.43) for high body weight VIM and high glucose VIM, respectively. The HR (95% CI) of both high VIM group was 1.63 (1.44-1.83), suggesting an additive effect of variabilities in body weight and glucose. The results were consistent when using CV and ARV and in various sensitivity analyses.

CONCLUSIONS

High variability in body weight and glucose levels is associated with an increased incidence rate and risk of hip fracture in people with diabetes.

The advances in nanomedicine for bone and cartilage repair

With the gradual demographic shift toward an aging and obese society, an increasing number of patients are suffering from bone and cartilage injuries. However, conventional therapies are hindered by the defects of materials, failing to adequately stimulate the necessary cellular response to promote sufficient cartilage regeneration, bone remodeling and osseointegration. In recent years, the rapid development of nanomedicine has initiated a revolution in orthopedics, especially in tissue engineering and regenerative medicine, due to their capacity to effectively stimulate cellular responses on a nanoscale with enhanced drug loading efficiency, targeted capability, increased mechanical properties and improved uptake rate, resulting in an improved therapeutic effect. Therefore, a comprehensive review of advancements in nanomedicine for bone and cartilage diseases is timely and beneficial. This review firstly summarized the wide range of existing nanotechnology applications in the medical field. The progressive development of nano delivery systems in nanomedicine, including nanoparticles and biomimetic techniques, which are lacking in the current literature, is further described. More importantly, we also highlighted the research advancements of nanomedicine in bone and cartilage repair using the latest preclinical and clinical examples, and further discussed the research directions of nano-therapies in future clinical practice.

Fracture risk following bariatric surgery: a systematic review and meta-analysis

Bariatric surgery may negatively impact bone health. We aimed to compare fracture risk following bariatric surgery by type (malabsorptive, restrictive), or to non-surgical weight loss, or to controls with obesity. We systematically searched four databases from inception until October 2020. We included observational and interventional studies on adults. We screened articles and abstracted data in duplicate and independently and assessed the risk of bias. We conducted random-effects model meta-analyses (Review Manager v5.3), to calculate the relative risk of any or site-specific fracture (CRD42019128536). We identified four trials of unclear-to-high risk of bias and 15 observational studies of fair-to-good quality. Data on fracture risk following bariatric surgery compared to medical weight loss is scarce and limited by the small number of participants. In observational studies, at a mean/median post-operative follow-up > 2 years, the relative risk of any fracture was 45% (p < 0.001) and 61% (p = 0.04) higher following malabsorptive procedures compared to obese controls and restrictive procedures, respectively, with moderate to high heterogeneity. Site-specific relative fracture risk (hip and wrist) was one- to two-folds higher post malabsorptive procedures compared to obese controls or restrictive procedures. The risks of any and of site-specific fracture were not increased following restrictive procedures compared to obese controls. Fracture risk seems to increase following malabsorptive bariatric surgeries, at a mean/median follow-up > 2 years. The risk is not increased with restrictive surgeries. The available evidence has several limitations. A prospective and rigorous long-term follow-up of patients following bariatric surgery is needed for a better assessment of their fracture risk with aging.

Does Fracture Severity of Intertrochanteric Fracture in Elderly Caused by Low-Energy Trauma Affected by Gluteus Muscle Volume?

Purpose

The aim of this study was to determine whether there is a correlation between the type and stability of intertrochanteric fractures caused by low-energy trauma and gluteus muscle volume.

Materials and Methods

A total of 205 elderly (>65 years) patients with intertrochanteric fractures caused by low-energy trauma treated from January 2018 to December 2020 were included in this study. The mean age of patients was 81.24 years (range, 65-100 years). Fractures were classified according to the Jensen modification of the Evans classification. The cross-sectional area of the contralateral gluteus muscle (minimus, medius, and maximus) was measured in preoperative axial computed tomography slices. An analysis and comparison of age, body mass index (BMI), weight, height, and the gluteus muscle area in each fracture type group was performed.

Results

In the uni-variable analysis, statistically significant taller height was observed in patients in the stable intertrochanteric fracture (modified Evans 1 and 2) group compared with those in the unstable intertrochanteric fracture (modified Evans 3, 4, and 5) group (P<0.05). In addition, significantly higher BMI-adjusted gluteus muscle area (gluteus muscle area/BMI) was observed for the stable intertrochanteric fracture group compared with the unstable intertrochanteric fracture group except for the BMI-adjusted gluteus minimus area (P=0.112). In multivariable analysis, only the BMI-adjusted gluteus maximus (P=0.042) and total gluteus areas (P=0.035) were significantly higher in the stable group.

Conclusion

Gluteal muscularity around the hip, especially the gluteus maximus, had a significant effect on the stability of intertrochanteric fractures.

Circulating SIRT1 and Sclerostin Correlates with Bone Status in Young Women with Different Degrees of Adiposity

Sirtuin1 (SIRT1) and sclerostin play important roles in adipose tissue and bone metabolism. We evaluated the circulating SIRT1 and sclerostin relationship with mass and quality of bone while considering the degree of adiposity. Sixty-six premenopausal women (16 underweight, 25 normal weight and 25 with obesity), aged <50 years, were enrolled. Plasma SIRT1, sclerostin and DXA body composition (total fat mass (FM), abdominal visceral adipose tissue, lean mass, trabecular bone score (TBS) and lumbar spine and femoral neck (FN) bone mineral density (BMD)) were assessed. The patients with obesity showed the lowest SIRT1 and TBS values and the highest sclerostin concentrations; BMD increased with FM and BMI and had an inverse association with SIRT1. Sclerostin was negatively correlated with SIRT1 (ρ = −0.37, p = 0.002). When spine BMD, FN BMD and TBS were standardized for BMI, a positive correlation with SIRT1 and a negative correlation with sclerostin were seen (p < 0.005). In the regression analysis, sclerostin was the best independent, negative predictor for BMD and TBS, while SIRT1 directly predicted TBS (p < 0.05). In conclusion, blood measurement of SIRT1 and sclerostin could represent a snapshot of the bone status that, taking into account the degree of adiposity, may reduce the interference of confounding factors in the interpretation of bone health parameters.

Cognitive determinants of weight control by dietary patterns among postmenopausal women with osteoporosis: An application of theory of planned behavior

Background: In this study, we aimed to assess the cognitive determinants of weight control behaviors by dietary patterns among postmenopausal women with osteoporosis.

Methods: This cross-sectional study, based on the theory of planned behavior (TPB) was conducted from July to December 2017 among 240 postmenopausal women with osteoporosis in Tabriz, Iran. A validated and reliable TPB-based instrument, namely Weight-CuRB, and the food frequency questionnaire (FFQ) were used.

Results: The results of exploratory factor analysis (EFA) indicated three dietary patterns (total variance explained=24.44%); healthy (n=71), mixed (n=78), and western (n=91). In addition, food items consumed by participants were classified into twenty-two food groups for dietary pattern analysis. In the healthy and western dietary patterns, attitude (β: 0.140, P <0.001) and subjective norms (SNs) (β: 0.498, P <0.01) were the only predictors of weight control behavior, respectively. In the women with healthy and western patterns, the TPB-based variables altogether explained 11% and 16% of variations in the behavior, respectively. Among all patients, the TPB-based variables explained 12.2% of variations in weight control behavior, within which SNs were the only significant predictor of the behavior (β=-0.199, P <0.01).

Conclusion: Our findings highlighted the remarkable role of dietary patterns in the associations between weight control and its cognitive determinants. Dietary patterns should be considered while designing weight control educational interventions among women with osteoporosis. In such interventions, promoting SNs and perceived behavioral control (PBC) should be considered as the core strategies to promote the behaviors among the patients who follow an unhealthy diet.

Prevalence and Risk Factors of Osteoporosis in Patients with Type 2 Diabetes Mellitus in Nanchang (China): A Retrospective Cohort Study

OBJECTIVE

To retrospectively review the clinical data of type 2 diabetes mellitus (T2DM) patients hospitalized in Nanchang, China, summarized the prevalence of osteoporosis (OP) in T2DM patients in this area, and analyzed related influencing factors.

METHODS

The clinical data of hospitalized patients with T2DM were collected retrospectively. According to the results of bone mineral density test, the subjects were divided into the normal bone mass group, the osteopenia group, and the OP group. Age, gender, educational background, body mass index (BMI), waist-to-hip ratio (WHR), duration of T2DM, glycosylated hemoglobin, serum lipids, and complications of T2DM in the three groups were analyzed and compared.

RESULTS

The prevalence of OP in patients with T2DM was 35.77%. There were statistically significant differences in age, gender, BMI, WHR, duration of T2DM, educational background, the level of high-density lipoprotein cholesterol (HDL-C), the prevalence of diabetic retinopathy (DR), and diabetic peripheral neuropathy among the three groups (P < 0.05). Logistic regression analysis showed that increasing age, prolonged duration of T2DM, low BMI, high levels of HDL-C, and complicated DR were risk factors for osteopenia and OP.

CONCLUSION

The prevalence of OP in T2DM was high. Risk factors for abnormal bone mass in T2DM might be females, advanced age, long duration of T2DM, low BMI, high levels of HDL-C, and diabetic microangiopathy.

Association between osteoporosis or osteopenia and taking antiplatelet agents in general US population of NHANES

BACKGROUND

Osteoporosis (OP) and osteopenia are common bone disorders in old age, and lots of patients suffering from OP or osteopenia need to take antiplatelet agents to treat basic diseases. However, clinical data on the link between osteopenia or OP and antiplatelet agents are limited.

METHODS

Data in this study were collected and screened from the NHANES from 2013 to 2014 and 2017 to 2018. The variables were extracted from interviews and compared between OP or osteopenia participants and normal. The relationship between OP or osteopenia and taking antiplatelet drugs was analyzed by weighted multivariate logistic regression.

RESULTS

After excluding individuals who were not eligible and had invalid data, we finally identified 894 participants for inclusion in the study. We found a negative association between OP or osteopenia and taking antiplatelet agents (OR = 0.53; 95% CI, 0.33-0.84; p < 0.05). These results did not change on multiple imputations (OR = 0.32, 95% CI, 0.19-0.56; p <0.01). In the subgroup analyses, the associations were more significant in women (OR = 0.18, 95% CI, 0.05-0.62; p <0.05).

CONCLUSION

This study demonstrated that the association between OP or osteopenia and taking antiplatelet agents was significant. Therefore, it is necessary to confirm the result by extending further research.

Association between perfluoroalkyl substances concentration and bone mineral density in the US adolescents aged 12-19 years in NHANES 2005-2010

BACKGROUND

Reports on the association of perfluoroalkyl substances (PFASs) exposure with adolescent bone health are scarce, and studies have primarily targeted maternal serum.

OBJECTIVE

We evaluated the relationship between autologous serum perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) levels and bone mineral density (BMD) in adolescents.

METHODS

We analyzed data from 1228 adolescents aged 12-19 years in the National Health and Nutrition Examination Survey (NHANES) 2005-2010 and used multiple regression analysis to identify the relationship between serum PFOA, PFOS, PFHxS, and PFNA concentrations and total femur, femoral neck, and lumbar spine BMD, in addition to multiple stratified subgroup analyses.

RESULTS

The mean age of participants was 15 years, males had higher serum PFAS concentrations than females. The results of multiple regression analysis showed that the natural log(ln)-transformed serum PFOA, PFOS, and PFNA concentrations were negatively correlated with total femur, femoral neck, and lumbar spine BMD (all p < 0.05), and ln-PFHxS was positively correlated with total femur and femoral neck BMD (all p< 0.05). In males, ln-PFOA was negatively associated with total femur and lumbar spine BMD (all p< 0.05), ln-PFOS was associated with the reduced total femur, femoral neck, and lumbar spine BMD (all p< 0.05), while ln-PFHxS and ln-PFNA were not observed to correlate with BMD at these three sites. In females, both ln-PFOA and ln-PFOS were negatively correlated with total femur and lumbar spine BMD (all p< 0.05), ln-PFHxS is associated with the increased total femur and femoral neck BMD (all p< 0.05), and ln-PFNA was negatively correlated with total femur and femoral neck BMD (all p< 0.05), most of the associations were confined to females. The associations of ln-PFOS with femoral neck BMD and ln-PFNA with total femur BMD were more significant in those who were overweight/obese and had anemia, respectively (all p for interaction < 0.05).

CONCLUSIONS

In this representative sample of US adolescents aged 12-19 years, certain PFAS were associated with lower bone mineral density, and most of the associations were confined to females. The negative effect of PFAS on BMD is more pronounced in those who are overweight/obese and have anemia. However, further studies are needed to confirm this finding.

GCTOF-MS Combined LC-QTRAP-MS/MS Reveals Metabolic Difference Between Osteoarthritis and Osteoporotic Osteoarthritis and the Intervention Effect of Erxian Decoction

PURPOSE

OP and OA are chronic bone diseases with high incidence in the middle-aged and elderly populations. The latest research shows that the pathological environment of OP may be involved in the aggravation of the pathological process of OA, and the pathological state of OP plays an important role in the aggravation of OA pathology. EXD is a traditional Chinese medicine decoction that has been used to treat osteoporosis. Therefore, we further study whether OA will be aggravated in the OP environment and whether EXD can alleviate OA by intervening in the OP environment. The purpose of this study was to analyze the effect of OP on OA metabolites by using metabolomic methods and to explore the intervention mechanism of EXD on osteoporotic OA.

METHOD

Thirty-two SD rats were randomly divided into normal group, OA group, OP-OA group, and EXD group. EXD was administered by gavage. Histopathological evaluation of cartilage tissue was performed using Saffron fast green and HE staining. Western blot and qRT-PCR were used to detect the expression levels of chondrogenesis genes SOX9, COL2A1, and COMP in cartilage tissue. GC-TOFMS and LC-QTRAP-MS/MS metabolomics methods were used to analyze the changes of metabolites in serum samples of rats in each group.

RESULT

The slice results showed that the cartilage damage in the OP-OA group was more serious than that in the OA group, which was significantly relieved after EXD intervention, indicating that the cartilage damage in the OP-OA group was more severe than that in the OA group and further reduced the protein and gene expressions of cartilage markers SOX9, COL2A1, and COMP. Thirty-seven substances were identified, and gentiopicroside, emodin, quercetin, and diosmetin were analyzed as possible active components of EXD. EXD treatment significantly reduced cartilage damage and reversed the expression of these markers. Metabolomics showed that EXD attenuated cartilage destruction by modulating the expression of cystine, chenodeoxycholate, and D-Turanose, involving glycolysis/gluconeogenesis, pantothenate, and CoA biosynthesis metabolic pathways.

CONCLUSION

The OP environment may promote the progression of OA through metabolic factors. The benign intervention of EXD in osteoporotic OA involves cystine, chenodeoxycholate, and D-Turanose, and their associated glycolysis/gluconeogenesis, pantothenate, and CoA biosynthesis metabolic pathways. Therefore, we have a deep understanding of the metabolic-related intervention of EXD in osteoporotic OA and are eager to better understand the mechanism of multi-targeted intervention of EXD in bone metabolic lesions.

Biochemical, hematologic, and skeletal features associated with underweight, overweight, and eating disorders in young Korean women: A population-based study

BACKGROUND

Extreme weight conditions in young women are associated with adverse health outcomes. Closely linked with extreme weight status, eating disorders (EDs) are associated with several medical complications and high mortality rates.

OBJECTIVE

The study aimed to investigate the biochemical, hematologic, and skeletal features of young Korean women with underweight (UW) and overweight/obesity (OW) conditions, and patients with anorexia nervosa (AN) and bulimia nervosa (BN) compared to women with normal-weight (NW).

METHOD

A total of 808 women (mean age 22.3 ± 3.4 years) were recruited for the study, including 144 with UW status [body mass index (BMI) < 18.5 kg/m²], 364 with NW, 137 with OW or obesity (27 with obesity; BMI ≥ 25 kg/m²), 63 patients with anorexia nervosa (AN), and 100 with bulimia nervosa (BN). We measured blood pressure and performed biochemical, hematologic and bone mineral density (BMD) evaluations at the lumbar and femoral neck.

RESULTS

Blood pressure and triiodothyronine levels were found to be lower in both ED groups and higher in the OW group, but no difference in the UW group, compared to the NW group. The aminotransferases and total cholesterol levels were higher in the ED and OW groups, compared to the NW group. Blood cell counts were decreased in the AN group, while increased in the OW group, compared to the NW group. Blood urea nitrogen was elevated in both ED groups. The UW and AN groups had lower BMD, whereas the OW group had higher BMD, compared to the NW group.

CONCLUSION

Our findings suggested that both ED groups were associated with decreases in the resting energy expenditure. OW status was associated with a risk of metabolic syndrome, and UW status with lower BMD in young women. Overall, the medical parameters in Korean patients with ED were similar to the patterns reported in Western samples in previous studies, with few exceptions such as potassium level in BN.

A Study Investigating Whether BMI Is Associated With Acetabular Bone Size: Big Bones or a Big Myth?

Background

There is a common conception held by patients with a high body mass index (BMI) that they have “big bones”. Some people hold the assumption that their weight is attributed to larger bone stock rather than adipose tissue. It was the suspicion of the surgeons at our unit that this is often not the case. We therefore conducted a study investigating if there is any association between BMI and acetabular bone size.

Methods

We conducted a retrospective chart review of all patients undergoing total hip arthroplasty using the Trident acetabular system from Stryker at our tertiary level 1 trauma centre between September 2016 and August 2020. Patient demographic and surgical data were collected, and the association of BMI, height, and weight, with acetabular cup size was investigated using Pearson’s correlation coefficient and chi-square test for independence.

Results

A total of 418 patients were included in this study (52.4% female; age: 20-93 years; mean age: 62.51 years), with a mean BMI of 29.55 kg/m²(range: 14.95-52.32 kg/m²). A weak positive association between BMI and cup size, which was statistically significant (r = 0.107; n = 418; p = 0.02). The chi-square test for independence was used to study the association between obesity and cup size (large vs small), which demonstrated no significant difference (p = 0.08). There was a moderately strong positive association between height and cup size (r = 0.551; n = 418; p < 0.01). There was a weak positive association between weight and cup size, which was statistically significant (r = 0.355; n = 418; p < 0.01).

Conclusion

Our study suggests that there is indeed a weakly positive linear association between BMI and cup size among total hip arthroplasty patients. This effect was, however, more significant for height and weight, and there was no significant association between obese and non-obese groups with small versus large cup size implanted. We therefore conclude that clinically there is no significant relationship between obesity and acetabular bone size and that the “big bones” claim is indeed fallacious.

Obesity and Bone: A Complex Relationship

There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.

The Saturation Effect of Body Mass Index on Bone Mineral Density for People Over 50 Years Old: A Cross-Sectional Study of the US Population

Background: Previous studies had revealed that Body Mass Index (BMI) positively affected Bone Mineral Density (BMD). However, an excessively high BMI was detrimental to health, especially for the elderly. Moreover, it was elusive how much BMI was most beneficial for BMD in older adults to maintain.

Objective: To investigate whether there was a BMI saturation effect value that existed to maintain optimal BMD.

Methods: A cross-sectional study was conducted using the datasets of the National Health and Nutrition Examination Survey (NHANES) 2005–2006, 2007–2008, 2009–2010, 2013–2014, and 2017–2018. After adjusting for covariates, an analysis of the association between BMI and BMD in different femoral regions (Total femur, Femoral neck, Trochanter, Intertrochanter, and Ward's triangle) and lumbar spine regions (Total spine, L1, L2, L3, and L4) in the whole population was performed using the multivariate linear regression models, smoothing curve fitting, and saturation effects analysis models. Then, subgroup analyses were performed according to gender, age, and race.

Results: A total of 10,910 participants (5,654 males and 5,256 females) over 50 years were enrolled in this population-based study. Multivariate linear regression analyses in the population older than 50 years showed that BMI was positively associated with femoral BMD and lumbar spine BMD (P < 0.001, respectively). Smoothing curve fitting showed that the relationship between BMI and BMD was not simply linear and that a saturation value existed. The saturation effect analysis showed that the BMI saturation value was 26.13 (kg/m²) in the total femur, 26.82 (kg/m²) in the total spine, and showed site-specificity in L1 (31.90 kg/m²) and L2 (30.89 kg/m²). The saturation values were consistent with the whole participants in males, while there was high variability in the females. BMI saturation values remained present in subgroup analyses by age and race, showing specificity in some age (60–70 years old) groups and in some races.

Conclusions: Our study showed a saturation value association between BMI and BMD for people over 50 years old. Keeping the BMI in the slightly overweight value (around 26 kg/m²) might reduce other adverse effects while obtaining optimal BMD.

Association between Bone Mineral Density and Metabolic Syndrome among Reproductive, Menopausal Transition, and Postmenopausal Women

The menopausal transition stage brings physiological changes associated with the development of metabolic syndrome (MetS), which can affect bone mineral density (BMD), and may be more evident in the postmenopausal stage. The aim of this study was assessing the association between low BMD and MetS and its components among reproductive/menopausal transition and postmenopausal women in the northeast region of Mexico. A descriptive cross-sectional study was carried out (2015-2016) in 40-60-year-old women (n = 376) who were residents in the metropolitan area of Monterrey, in Nuevo Leon State, Mexico. Anthropometric measurements, blood pressure, a dual-energy X-ray absorptiometry (DXA) evaluation of BMD of two anatomical sites (lumbar spine and dual femur), and a biochemical analysis were obtained. The prevalence of MetS was 57.2%. In participants without MetS, the prevalence of osteopenia was 27.3% in the lumbar spine and 18.6% in the dual femur, while in participants with MetS, the prevalence of osteopenia was 35.8% in the lumbar spine and 14.4% in the dual femur. Osteoporosis in participants without MetS was present in 6.8% in the lumbar spine and in 1.8% in the dual femur, while in women with MetS, its prevalence was 4.7% in the lumbar spine and 0.5% in the dual femur. An association between low BMD at the lumbar spine and dual femur and components of MetS diseases was identified in Mexican women as follows: waist circumference ≥ 88 cm showed an increase risk for low BMD at femoral site in both reproductive/menopausal transition (OR 7.638; 95% CI: 1.607-36.298; p = 0.011) and postmenopausal women (OR 2.600; 95% CI: 1.023-6.609; p = 0.045); HDL < 50 mg/dL was associated with low BMD in both the femur (OR 3.639; 95% CI: 1.039-12.743; p = 0.043) and lumbar spine (OR 2.654; 95% CI: 1.092-6.447; p = 0.031); hypertension in postmenopausal women increased the risk for low BMD in the femur (OR 2.634; 95% CI: 1.150-6.035; p = 0.022). In conclusion, we found that components of the MetS were associated with low BMD, thus indicating that MetS increases the risk for developing osteopenia or osteoporosis. Furthermore, age was found to be an independent risk factor for low BMD.

Liver disease in obesity and underweight: the two sides of the coin. A narrative review

PURPOSE

Malnutrition, whether characterized by not enough or too much nutrient intake, is detrimental to the liver. We herein provide a narrative literature revision relative to hepatic disease occurrence in over or undernourished subjects, to shed light on the paradox where both sides of malnutrition lead to similar liver dysfunction and fat accumulation.

METHODS

Medline, EMBASE, and Cochrane Library were searched for publications up to July 2020. Articles discussing the association between both chronic and acute liver pathology and malnutrition were evaluated together with studies reporting the dietary intake in subjects affected by malnutrition.

RESULTS

The association between overnutrition and non-alcoholic fatty liver disease (NAFLD) is well recognized, as the beneficial effects of calorie restriction and very low carbohydrate diets. Conversely, the link between undernutrition and liver injury is more complex and less understood. In developing countries, early exposure to nutrient deficiency leads to marasmus and kwashiorkor, accompanied by fatty liver, whereas in developed countries anorexia nervosa is a more common form of undernutrition, associated with liver injury. Weight gain in undernutrition is associated with liver function improvement, whereas no study on the impact of macronutrient distribution is available. We hypothesized a role for very low carbohydrate diets in the management of undernutrition derived liver pathology, in addition to the established one in overnutrition-related NAFLD.

CONCLUSIONS

Further studies are warranted to update the knowledge regarding undernutrition-related liver disease, and a specific interest should be paid to macronutrient distribution both in the context of refeeding and relative to its role in the development of hepatic complications of anorexia nervosa.

LEVEL OF EVIDENCE

Narrative review, Level V.

Effects of anthropometric parameters on bone mineral density in women: from perimenopause to old age

AIM

To analyze the influence of body components on bone mineral density (BMD) in women from perimenopause to old age.

MATERIAL AND METHODS

A total of 117 women were allocated into three groups according to the reproductive stage (STRAW): perimenopausal (PEM, N = 28, mean age 44.8 ± 3.6), early postmenopausal (EPM, N = 36, mean age 51.4 ± 2.8) and late postmenopausal (LPM, N = 53; mean age 64.0 ± 1.7). Total body mass, body mass index (BMI), lean mass (LM), fat mass (FM), fat percentage (FP) and BMD at the lumbar spine (lBMD) and femoral neck (fBMD) were assessed.

RESULTS

BMI, FM, LM and BMD values decreased from PEM to LPM. The total effect of FM on fBMD and lBMD was of 42% and 8% for PEM, 28% and 33% for EMP and 9% and 1% for LPM respectively. Additionally, the total effect of LM on fBMD and lBMD was 48% and 3% for PEM, 54% and 53% for EMP and 9% and 11% for LPM women respectively.

CONCLUSION

BMI, LM, and FM decreased with aging. All these components had great influence on both fBMD and lBMD in EMP women. Conversely, in PEM these parameters only had influence on femoral BMD, but not on lumbar spine. These data suggests that LM is the most important component in BMD for women older than 50 years old, particularly in the hip.