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Fuggle NR, Laskou F, Harvey NC, Dennison EM. A review of epigenetics and its association with ageing of muscle and bone. Maturitas 2022; 165:12-17. [PMID: 35841774 DOI: 10.1016/j.maturitas.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 10/31/2022]
Abstract
Ageing is defined as the 'increasing frailty of an organism with time that reduces the ability of that organism to deal with stress'. It has been suggested that epigenetics may underlie the observation that some individuals appear to age faster than others. Epigenetics is the study of changes which occur in an organism due to changes in expression of the genetic code rather than changes to the genetic code itself; that is, epigenetic mechanisms impact upon the function of DNA without changing the DNA sequence. It is important to recognise that epigenetic changes, in contrast to genetic changes, can vary according to different cell types and therefore can demonstrate significant tissue-specificity. There are different types of epigenetic mechanisms: histone modification, non-coding RNAs and DNA methylation. Epigenetic clocks have been developed using statistical techniques to identify the optimal combination of CpG sites (from methylation arrays) to correlate with chronological age. This review considers how epigenetic factors may affect rates of ageing of muscle and bone and provides an overview of current understanding in this area. We discuss studies using first-generation epigenetic clocks, as well as the second-generation iterations, which appear to show stronger associations with the ageing muscle phenotype. We also review epigenome-wide association studies that have been performed in various tissues examining relationships with osteoporosis and fracture. It is hoped that an understanding of this area will lead to interventions that might prevent or reduce rates of musculoskeletal ageing in later life.
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Affiliation(s)
- N R Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, SO16 6YD, United Kingdom of Great Britain and Northern Ireland
| | - F Laskou
- MRC Lifecourse Epidemiology Centre, University of Southampton, SO16 6YD, United Kingdom of Great Britain and Northern Ireland
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, SO16 6YD, United Kingdom of Great Britain and Northern Ireland
| | - E M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, SO16 6YD, United Kingdom of Great Britain and Northern Ireland.
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Parsons CM, Dennison EM, Fuggle N, Breasail MÓ, Deere K, Hannam K, Tobias JH, Cooper C, Ward KA. Assessment of Activity Profiles in Older Adults and Lower Limb Bone Parameters: Observations from the Hertfordshire Cohort Study. Calcif Tissue Int 2022; 111:13-20. [PMID: 35212826 PMCID: PMC9232475 DOI: 10.1007/s00223-022-00953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
As muscle strength and function decline with age the optimal high-impact physical activity (PA) required for bone remodelling is rarely achievable in older adults. This study aimed to explore the activity profiles of community-dwelling older men and women and to assess the relationship between individual PA profiles and lower limb bone parameters. Participants from the Hertfordshire Cohort Study wore triaxial accelerometers for 7 days and counts of low (0.5-1.0 g), medium (1.0-1.5 g), and high (> 1.5 g) vertical-impact activity were calculated. Two years later, participants underwent a pQCT scan of the tibia (4% and 38% sites) to obtain measures of bone mineral density and bone geometry. Linear regression was used to quantify associations between bone and PA loading profiles adjusting for age, sex, loading category, and BMI. Results are presented as β [95% confidence interval]. Bone and PA data were available for 82 participants. The mean (SD) age at follow-up was 81.4(2.7) years, 41.5% (n = 34) were women. The median low-impact PA count was 5281 (Inter-quartile range (IQR) 2516-12,977), compared with a median of only 189 (IQR 54-593) in medium, and 39 (IQR 9-105) in high-impact counts. Positive associations between high-impact PA and cortical area (mm2), polar SSI (mm3), and total area (mm2) at the 38% slice (6.21 [0.88, 11.54]; 61.94 [25.73, 98.14]; 10.09 [3.18, 16.99], respectively). No significant associations were found at distal tibia. These data suggest that maintaining high (> 1.5 g)-impact activity is difficult for older adults to achieve; however, even small amounts of high-impact PA are positively associated with selected cortical bone parameters 2 years later.
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Affiliation(s)
- C M Parsons
- MRC Lifecourse Epidemiology Centre, Human Health and Development, University of Southampton, Southampton, SO16 6YD, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Centre, Human Health and Development, University of Southampton, Southampton, SO16 6YD, UK
| | - N Fuggle
- MRC Lifecourse Epidemiology Centre, Human Health and Development, University of Southampton, Southampton, SO16 6YD, UK
| | - M Ó Breasail
- MRC Nutrition and Bone Health Research Group, Cambridge, UK
| | - K Deere
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - K Hannam
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - J H Tobias
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, Human Health and Development, University of Southampton, Southampton, SO16 6YD, UK.
- National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
| | - K A Ward
- MRC Lifecourse Epidemiology Centre, Human Health and Development, University of Southampton, Southampton, SO16 6YD, UK
- MRC Nutrition and Bone Health Research Group, Cambridge, UK
- National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Laskou F, Westbury LD, Fuggle N, Harvey NC, Patel HP, Cooper C, Ward K, Dennison EM. 738 DETERMINANTS OF MUSCLE DENSITY IN OLDER PEOPLE: FINDINGS FROM THE HERTFORDSHIRE COHORT STUDY (HCS). Age Ageing 2022. [DOI: 10.1093/ageing/afac037.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Lower calf muscle density (CMD) as assessed by peripheral quantitative computed tomography (pQCT) is associated with greater hip fracture risk, independent of FRAX, falls and bone mineral density. To date, muscle density has been little studied, and its determinants are unknown. In this study, we examine the lifestyle and anthropometric determinants of future muscle density (MD) in the HCS.
Methods
197 men and 178 women, aged 59–70 years, were recruited. A lifestyle questionnaire collected information on physical activity, smoking, alcohol consumption and dietary patterns. Height and weight were measured. pQCT of the radius and tibia was performed a median of 11.5 (IQR 10.9, 12.3) years later. MD was measured at calf and forearm using standard methodology. Baseline characteristics in relation to MD at follow-up were examined separately using linear regression with sex, baseline age and follow-up time included as covariates in all models.
Results
Mean (SD) age at baseline was 64.7 (2.7) years; mean (SD) MD values (mg/cm3) were as follows: forearm [men 79.9 (3.1), women 77.2 (3.2)], calf [men 80.7 (2.6), women 78.5 (2.6)]. Baseline correlates (p < 0.05) of both lower forearm and CMD included female sex, lower weight, and lower BMI. SD difference in CMD for women compared to men, and per SD lower weight and BMI were − 0.84 [95%CI: −1.13, −0.54]), −0.37 [−0.46, −0.27] and − 0.31 [−0.40, −0.23] respectively. Additional correlates of lower CMD included older age and shorter stature. Relationships between MD and age were stronger at the calf (p < 0.001) than the forearm (p = 0.08). Lifestyle measures were not associated with MD.
Conclusion
Female sex, older age, and lower BMI were associated with lower MD in older community-dwelling adults, highlighting the need for sustained muscle conditioning in older individuals. Further studies in larger cohorts are required.
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Affiliation(s)
- F Laskou
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHSFT, (UHSFT), Southampton, UK
| | - L D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - N Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Alan Turing Institute, London
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - H P Patel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHSFT, (UHSFT), Southampton, UK
- Medicine for Older People, UHSFT
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Victoria University of Wellington, New Zealand
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Bevilacqua G, Laskou F, Jameson K, Fuggle N, Cooper C, Dennison EM, Patel HP. 778 THE IMPACT OF MUSCULOSKELETAL CONDITIONS AND FRAILTY ON THE ABILITY TO SELF-CARE OR BE IN RECEIPT OF CARE: A STUDY OF COMMUNITY-. Age Ageing 2022. [DOI: 10.1093/ageing/afac037.778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Musculoskeletal conditions (MSC) and frailty lead to a significant burden of disease in later life. Living independently remains the aim of older adults but ability to self-care or access care at home may hamper this. Our aim was to consider whether MSC (osteoporosis, sarcopenia, osteoarthritis) and frailty were associated with ability to self-care or influence access to formal/informal care among community-dwelling older adults.
Methods
Participants were recruited from an established cohort study of community-dwelling adults in the UK. Osteoporosis was assessed using Dual-energy X-ray Absorptiometry. Sarcopenia was assessed using EWSGOP2 criteria. Osteoarthritis of the hand, hip or knee was defined by clinical examination. Frailty was assessed using Fried criteria. Ability to self-care and access to formal/informal care were self-reported.
Results
443 men and women (median age 75.5 [IQR 73.5–77.9] years) participated. Osteoporosis affected (n = 74) 21.4% of participants, (n = 115) 26.8% had osteoarthritis, (n = 30) 8.6% had sarcopenia, and (n = 33) 7.6% were identified as frail. Most participants (n = 402 [90.7%]) reported no problems with self-care. Identical proportions of participants received informal (n = 53 [12%]) and formal (n = 53 [12%]) care at home in the previous year. Reporting difficulties with self-care was associated with clinical osteoarthritis (OR 3.48, 95% CI 1.63–7.43, p = 0.001) and frailty (5.29, 2.12–13.2, p < 0.001), but not with osteoporosis or sarcopenia. Receiving informal care at home in the past year was associated with osteoarthritis (2.56, 1.28–5.14, p = 0.008), the coexistence of two or more MSC (6.50, 1.66–25.39, p = 0.007), and frailty (6.25, 2.59–15.08, p < 0.001), but not with osteoporosis or sarcopenia alone. None of the conditions were associated with receiving formal care.
Conclusion
MSC are associated with informal receipt of care. Presence of two or more MSC convey similar informal care requirements to those living with frailty. Early assessment and management of MSC and frailty in clinical practice may reduce need for care and preserve independence.
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Affiliation(s)
- G Bevilacqua
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - F Laskou
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - N Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - H P Patel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Medicine for Older People, University Hospital Southampton, UK
- Academic Geriatric Medicine, University of Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton & University Hospital Southampton NHS Foundation Trust, UK
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Holroyd CR, Carter S, Crozier SR, D'Angelo S, Curtis EM, Moon RJ, Davies JH, Ward KA, Dennison EM, Inskip HM, Godfrey KM, Cooper C, Harvey NC. Differential relationships between parent-child DXA and pQCT bone measures: Results from the Southampton Women's Survey. Bone 2021; 153:116134. [PMID: 34332160 PMCID: PMC7611825 DOI: 10.1016/j.bone.2021.116134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/13/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
AIM To investigate the associations between indices of bone health in childhood and corresponding parental measures. METHODS The Southampton Women's Survey characterised 12,583 non-pregnant women aged 20-34 years; 3158 subsequently had singleton live births. In a subset, dual-energy X-ray absorptiometry (DXA) measurements of bone area (BA), bone mineral content (BMC) and areal bone mineral density (aBMD) lumbar spine and total hip were obtained in the parent/offspring (aged 8-9 years) trios. Another subset of children (aged 6-7 years), and their parents, had peripheral quantitative computed tomography (pQCT; 4% and 38% tibia) measures. Using multivariable linear regression we examined relationships between mother/father and offspring, adjusting for parental age, habitual walking speed and education; offspring age and sex; and the corresponding bone measure in the other parent (β-coefficients (95%CI) unit/unit for each bone measure). RESULTS Data were available for 260 trios with DXA and 99 with pQCT. There were positive associations for BA, BMC and aBMD between either parent and offspring. Mother-child associations were of greater magnitude than father-child; for example, mother-child aBMD (β = 0.26 g·cm-2/g·cm-2 (0.21,0.32)) and father-child aBMD (β = 0.16 g·cm-2/g·cm-2 (0.11,0.21)), P-difference in β = 0.007. In the subset with pQCT there was a positive association for mother-offspring 4% tibial total area (β = 0.33 mm2/mm2 (0.17,0.48)), but little evidence of a father-offspring association (β = -0.06 mm2/mm2 (-0.17,0.06)). In contrast offspring 38% cortical density was more strongly associated with this measure in fathers (β = 0.48 mg·cm-3/mg·cm-3 (0.15,0.82)) than mothers (β = 0.27 mg·cm-3/mg·cm-3 (-0.03,0.56)). In general mother-father differences were attenuated by adjustment for height. CONCLUSIONS Whilst offspring bone measures are independently associated with those of either parent, the magnitude of the association is often greater for maternal than paternal relationships. These findings are consistent with an in utero influence on offspring growth but might also reflect genetic and/or epigenetic parent of origin effects. SUMMARY In an established parent-offspring cohort, associations between parent and offspring bone indices were generally greater in magnitude for mother-offspring than father-offspring relationships.
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Affiliation(s)
- C R Holroyd
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - S Carter
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - S R Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Rheumatology Department, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - R J Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - J H Davies
- Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - H M Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K M Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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6
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Barnsley J, Buckland G, Chan PE, Ong A, Ramos AS, Baxter M, Laskou F, Dennison EM, Cooper C, Patel HP. Pathophysiology and treatment of osteoporosis: challenges for clinical practice in older people. Aging Clin Exp Res 2021; 33:759-773. [PMID: 33742387 PMCID: PMC8084810 DOI: 10.1007/s40520-021-01817-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 02/13/2021] [Indexed: 12/12/2022]
Abstract
Osteoporosis, a common chronic metabolic bone disease is associated with considerable morbidity and mortality. As the prevalence of osteoporosis increases with age, a paralleled elevation in the rate of incident fragility fractures will be observed. This narrative review explores the origins of bone and considers physiological mechanisms involved in bone homeostasis relevant to management and treatment. Secondary causes of osteoporosis, as well as osteosarcopenia are discussed followed by an overview of the commonly used pharmacological treatments for osteoporosis in older people.
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Affiliation(s)
- J Barnsley
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - G Buckland
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - P E Chan
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Ong
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A S Ramos
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Baxter
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - F Laskou
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Oxford, Oxford, UK
| | - Harnish P Patel
- Medicine for Older People, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- MRC Lifecourse Epidemiology Centre, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- Academic Geriatric Medicine, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and The University of Southampton, Southampton, UK.
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Abstract
UNLABELLED Low body mass index (BMI) is an established risk factor for fractures in postmenopausal women but the interaction of obesity with bone microarchitecture is not fully understood. In this study, obesity was associated with more favourable bone microarchitecture parameters but not after parameters were normalised for body weight. INTRODUCTION To examine bone microarchitecture in relation to fat mass and examine both areal bone mineral density (aBMD) and microarchitecture in relation to BMI categories in the UK arm of the Global Longitudinal Study of Osteoporosis in Women. METHODS Four hundred and ninety-one women completed questionnaires detailing medical history; underwent anthropometric assessment; high-resolution peripheral quantitative computed tomography (HRpQCT) scans of the radius and tibia and DXA scans of whole body, proximal femur and lumbar spine. Fat mass index (FMI) residuals (independent of lean mass index) were derived. Linear regression was used to examine HRpQCT and DXA aBMD parameters according to BMI category (unadjusted) and HRpQCT parameters in relation to FMI residuals (with and without adjustment for anthropometric, demographic and lifestyle covariates). RESULTS Mean (SD) age was 70.9 (5.4) years; 35.0% were overweight, 14.5% class 1 obese and 7.7% class 2/3 obese. There were significant increasing trends according to BMI category in aBMD of whole body, hip, femoral neck and lumbar spine (p ≤ 0.001); cortical area (p < 0.001), thickness (p < 0.001) and volumetric density (p < 0.03), and trabecular number (p < 0.001), volumetric density (p < 0.04) and separation (p < 0.001 for decreasing trend) at the radius and tibia. When normalised for body weight, all HRpQCT and DXA aBMD parameters decreased as BMI increased (p < 0.001). FMI residuals were associated with bone size and trabecular architecture at the radius and tibia, and tibial cortical microarchitecture. CONCLUSION Significant trends in HRpQCT parameters suggested favourable bone microarchitecture at the radius and tibia with increasing BMI but these were not proportionate to increased weight.
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Affiliation(s)
- A E Litwic
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - L D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- Victoria University of Wellington, Wellington, New Zealand.
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Woolford SJ, D’Angelo S, Curtis EM, Parsons CM, Ward KA, Dennison EM, Patel HP, Cooper C, Harvey NC. 84 COVID-19 and Associations with Frailty and Multimorbidity: A Prospective Analysis of UK Biobank Participants. Age Ageing 2021. [PMCID: PMC7989607 DOI: 10.1093/ageing/afab030.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease. We therefore investigated whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19 in the UK Biobank. Method 502,640 participants aged 40–69 years at baseline (54–79 years at COVID-19 testing) were recruited across UK 2006–10. A modified assessment of frailty using Fried’s classification was generated from baseline data. COVID-19 test results (England) were available 16/03/2020–01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups.
Results
4,510 participants were tested for COVID-19 (positive = 1,326, negative = 3,184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (≥4 comorbidity groupings vs 0–1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. Furthermore, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants.
Conclusions
Frailty and multimorbidity do not appear to aid risk stratification, in terms of a positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.
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Affiliation(s)
- S J Woolford
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - S D’Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - H P Patel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Medicine for Older People, University Hospital Southampton, Southampton, UK
- Academic Geriatric Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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9
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Woolford SJ, D'Angelo S, Curtis EM, Parsons CM, Ward KA, Dennison EM, Patel HP, Cooper C, Harvey NC. COVID-19 and associations with frailty and multimorbidity: a prospective analysis of UK Biobank participants. Aging Clin Exp Res 2020; 32:1897-1905. [PMID: 32705587 PMCID: PMC7377312 DOI: 10.1007/s40520-020-01653-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/07/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Frailty and multimorbidity have been suggested as risk factors for severe COVID-19 disease. AIMS We investigated, in the UK Biobank, whether frailty and multimorbidity were associated with risk of hospitalisation with COVID-19. METHODS 502,640 participants aged 40-69 years at baseline (54-79 years at COVID-19 testing) were recruited across UK during 2006-10. A modified assessment of frailty using Fried's classification was generated from baseline data. COVID-19 test results (England) were available for 16/03/2020-01/06/2020, mostly taken in hospital settings. Logistic regression was used to discern associations between frailty, multimorbidity and COVID-19 diagnoses, after adjusting for sex, age, BMI, ethnicity, education, smoking and number of comorbidity groupings, comparing COVID-19 positive, COVID-19 negative and non-tested groups. RESULTS 4510 participants were tested for COVID-19 (positive = 1326, negative = 3184). 497,996 participants were not tested. Compared to the non-tested group, after adjustment, COVID-19 positive participants were more likely to be frail (OR = 1.4 [95%CI = 1.1, 1.8]), report slow walking speed (OR = 1.3 [1.1, 1.6]), report two or more falls in the past year (OR = 1.3 [1.0, 1.5]) and be multimorbid (≥ 4 comorbidity groupings vs 0-1: OR = 1.9 [1.5, 2.3]). However, similar strength of associations were apparent when comparing COVID-19 negative and non-tested groups. However, frailty and multimorbidity were not associated with COVID-19 diagnoses, when comparing COVID-19 positive and COVID-19 negative participants. DISCUSSION AND CONCLUSIONS Frailty and multimorbidity do not appear to aid risk stratification, in terms of positive versus negative results of COVID-19 testing. Investigation of the prognostic value of these markers for adverse clinical sequelae following COVID-19 disease is urgently needed.
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Affiliation(s)
- S J Woolford
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - H P Patel
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Medicine for Older People, University Hospital Southampton, Southampton, UK
- Academic Geriatric Medicine, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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Clynes MA, Westbury LD, Dennison EM, Kanis JA, Javaid MK, Harvey NC, Fujita M, Cooper C, Leslie WD, Shuhart CR. Bone densitometry worldwide: a global survey by the ISCD and IOF. Osteoporos Int 2020; 31:1779-1786. [PMID: 32377806 PMCID: PMC7115939 DOI: 10.1007/s00198-020-05435-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/22/2020] [Indexed: 01/08/2023]
Abstract
UNLABELLED In a global survey of fracture liaison services, most reported that DXA access met needs. However, adherence to basic DXA quality and reporting procedures was confirmed by only around 50% of institutions and many required education for operators/interpreters. Overall, there is significant variability in the access to, and quality of, DXA services worldwide. INTRODUCTION While the use of dual-energy X-ray absorptiometry (DXA) has been widely adopted worldwide for the assessment of bone mineral density, the quality of DXA facilities is unknown. To address this, a global survey of fracture liaison services (FLS) was conducted by the International Society for Clinical Densitometry (ISCD) and the International Osteoporosis Foundation (IOF) to assess the quality of their DXA facilities. METHODS A questionnaire for the accessibility and quality of DXA services was co-created by representatives of the ISCD and the IOF and made available to institutions who participated in the Capture the Fracture Best Practice Framework. From a list of 331 contacted invitees, 124 FLS centres responded; analyses were based on 121 centres with suitable data. RESULTS Over 70% of institutions reported that, for over 90% of the time, DXA access met service needs, and the scanning/reporting quality was perceived as excellent. However, 25% of DXA facilities reported not being accredited by a professional/governmental organization, and adherence to some basic DXA quality assurance and reporting procedures was confirmed by < 50% of services. Importantly, in excess of 50% of institutions stated that they desired ongoing education in osteoporosis and DXA for operators and interpreters. CONCLUSION There is significant variability in the access to and quality of DXA services for established FLS worldwide. Despite two decades of training initiatives in osteoporosis densitometry, many centres are falling short of the standards of the IOF-ISCD Osteoporosis Essentials criteria.
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Affiliation(s)
- M A Clynes
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - L D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - J A Kanis
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
- Centre of Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Fujita
- International Osteoporosis Foundation, Nyon, Switzerland
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - W D Leslie
- Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - C R Shuhart
- Swedish Medical Group, Swedish Bone Health and Osteoporosis Center, Seattle, WA, USA
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Litwic AE, Westbury LD, Carter S, Ward KA, Cooper C, Dennison EM. Self-perceived Fracture Risk in the Global Longitudinal Study of Osteoporosis in Women: Its Correlates and Relationship with Bone Microarchitecture. Calcif Tissue Int 2020; 106:625-636. [PMID: 32140759 PMCID: PMC7188698 DOI: 10.1007/s00223-020-00680-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 02/21/2020] [Indexed: 11/13/2022]
Abstract
The purpose of this study is to examine correlates of self-perceived fracture risk (SPR) and relationships between SPR and subsequent bone density and microarchitecture in the UK arm of the Global Longitudinal Study of Osteoporosis in Women. 3912 women completed baseline questionnaires detailing medical history and SPR; 492 underwent HRpQCT scans of the radius and tibia and DXA scans of total body, hip, femoral neck and lumbar spine a median of 7.5 years later. Correlates of SPR were examined and a cluster analysis of potential predictors of SPR performed. SPR in relation to HRpQCT and aBMD parameters was examined using linear regression with and without adjustment for anthropometric, demographic and lifestyle covariates. Mean (SD) baseline age was 69.0 (9.0) years; 56.6% reported a similar SPR; 28.6% lower SPR; 14.9% higher SPR compared to women of similar age. In mutually-adjusted analysis, higher SPR was associated (p < 0.05) with: lower physical activity and educational attainment; use of anti-osteoporosis medications (AOM) and calcium supplements; greater number of falls in the previous year; history of fracture since aged 45; family history of hip fracture; and increased comorbidity. Higher SPR, history of fracture, and use of AOM, calcium and vitamin D clustered together. Even after adjustments that included AOM use, higher SPR was associated with: lower radial trabecular volumetric density and number, and higher trabecular separation; lower tibial cortical area and trabecular volumetric density; and lower aBMD at the femoral neck. Despite greater AOM use, women with higher baseline SPR had poorer subsequent bone health.
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Affiliation(s)
- A E Litwic
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - L D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - S Carter
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- MRC Nutrition and Bone Health Research Group, Cambridge, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- Victoria University of Wellington, Wellington, New Zealand.
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12
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Carter SA, Parsons CM, Robinson SM, Harvey NC, Ward KA, Cooper C, Dennison EM. Infant milk feeding and bone health in later life: findings from the Hertfordshire cohort study. Osteoporos Int 2020; 31:709-714. [PMID: 32062688 DOI: 10.1007/s00198-020-05296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
UNLABELLED Using data from the Hertfordshire cohort study, this study examined the effect of breastfeeding and bottle feeding on adult lumbar spine and femoral neck bone mineral content (BMC) and bone mineral density (BMD). The type of infant milk feeding was significantly associated with lumbar spine BMD in males. INTRODUCTION Using data from the Hertfordshire cohort study (HCS), this study aims to examine the effect of infant milk feeding on bone health in later life by comparing the effect of breastfeeding and bottle feeding on lumbar spine and femoral neck BMC and BMD. METHODS Information about infant milk feeding, birth weight (kg) and weight at 1 (kg) was collected by health visitors between 1931 and 1939 in Hertfordshire. BMC and BMD measurements were taken by DXA scan between 1998 and 2004. Linear regression models adjusted for conditional weight at 1, age at DXA scan, sex, adult BMI, smoking behaviour, alcohol consumption, physical activity, dietary calcium, and prudent diet score. RESULTS Infant milk feeding was significantly associated with lumbar spine BMD (b = - 0.028; 95% CI, - 0.055; - 0.000; p value, 0.047) in males. On average, males who consumed breastmilk alternatives in infancy had lower lumbar spine BMD measurements than those who were fed only breastmilk. These associations remained significant in fully adjusted models. There were no significant associations between infant milk feeding and bone health for females. CONCLUSIONS Significant associations between infant milk feeding and lumbar spine BMD in males indicate that breastmilk may be protective for the bone health of male babies. The evidence presented here underscores the potential lifelong benefits of breastfeeding and may highlight the differences between osteoporotic risk factors for males and females.
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Affiliation(s)
- S A Carter
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - C M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - S M Robinson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- AGE Research Group, Newcastle University, Newcastle upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University, Newcastle upon Tyne, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- MRC Nutrition and Bone Health Research Group, Cambridge, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK.
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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13
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Shere C, Fuggle NR, Edward MH, Parsons CM, Jameson KA, Cooper C, Dennison EM, Ward KA. Jumping Joints: The Complex Relationship Between Osteoarthritis and Jumping Mechanography. Calcif Tissue Int 2020; 106:115-123. [PMID: 31655874 PMCID: PMC6994439 DOI: 10.1007/s00223-019-00622-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/09/2019] [Indexed: 12/31/2022]
Abstract
We investigated the relationship between lower limb osteoarthritis (OA) and muscle strength and power (assessed by jumping mechanography) in UK community-dwelling older adults. We recruited 249 older adults (144 males, 105 females). OA was assessed clinically at the knee according to ACR criteria and radiographically, at the knee and hip, using Kellgren and Lawrence grading. Two-footed jumping tests were performed using a Leonardo Mechanography Ground Reaction Force Platform to assess maximum muscle force, power and Esslinger Fitness Index. Linear regression was used to assess the relationship between OA and jumping outcomes. Results are presented as β (95% confidence interval). The mean age of participants was 75.2 years (SD 2.6). Males had a significantly higher maximum relative power during lift off (mean 25.7 W/kg vs. 19.9 W/kg) and maximum total force during lift off (mean 21.0 N/kg vs. 19.1 N/kg) than females. In adjusted models, we found significant associations in males between clinical knee OA and maximum relative power [- 6.00 (CI - 9.10, - 2.94)] and Esslinger Fitness Index [- 19.3 (- 29.0, - 9.7)]. In females, radiographic knee OA was associated with total maximum power [- 2.0 (- 3.9, - 0.1)] and Esslinger Fitness Index [- 8.2 (- 15.9, - 0.4)]. No significant associations were observed for maximum total force. We observed significant negative associations between maximum relative power and Esslinger Fitness Index and clinical knee OA in males and radiographic knee OA in females. We have used novel methodology to demonstrate relationships between muscle function and OA in older adults.
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Affiliation(s)
- C Shere
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - N R Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - M H Edward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - C M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - K A Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
- National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- MRC Nutrition and Bone Health Research Group, Cambridge, UK
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14
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Dennison EM, Cooper C, Kanis JA, Bruyère O, Silverman S, McCloskey E, Abrahamsen B, Prieto-Alhambra D, Ferrari S. Fracture risk following intermission of osteoporosis therapy. Osteoporos Int 2019; 30:1733-1743. [PMID: 31175404 DOI: 10.1007/s00198-019-05002-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 03/26/2019] [Indexed: 11/27/2022]
Abstract
Given the widespread practice of recommending drug holidays, we reviewed the impact of medication discontinuation of two common anti-osteoporosis therapies (bisphosphonates and denosumab). Trial evidence suggests the risk of new clinical fractures, and vertebral fracture increases when osteoporosis treatment with bisphosphonates or denosumab is stopped. INTRODUCTION The aim of this paper was to review the available literature to assess what evidence exists to inform clinical decision-making with regard to drug holidays following treatment with bisphosphonates (BiP) or denosumab. METHODS Systematic review. RESULTS Differing pharmacokinetics lead to varying outcomes on stopping therapy. Prospective and retrospective analyses report that the risk of new clinical fractures was 20-40% higher in subjects who stopped BiP treatment, and vertebral fracture risk was approximately doubled. Rapid bone loss has been well described following denosumab discontinuation with an incidence of multiple vertebral fractures around 5%. Studies have not identified risk factors for fracture after stopping treatment other than those that provide an indication for treatment (e.g. prior fracture and low BMD). Studies that considered long-term continuation did not identify increased fracture risk, and reported only very low rates of adverse skeletal events such as atypical femoral fracture. CONCLUSIONS The view that patients on long-term treatment with bisphosphonates or denosumab should always be offered a drug holiday is not supported by the existing evidence. Different pharmacokinetic properties for different therapies require different strategies to manage drug intermission. In contrast, long-term treatment with anti-resorptives is not associated with increased risk of fragility fractures and skeletal adverse events remain rare.
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Affiliation(s)
- E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK.
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, University of Sheffield, Sheffield, UK
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, Australia
| | - O Bruyère
- World Health Organization Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - S Silverman
- Cedars-Sinai/UCLA Medical Center and OMC Clinical Research Center, Beverly Hills, CA, USA
| | - E McCloskey
- Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK
| | - B Abrahamsen
- Department of Medicine, Holbaek Hospital, Holbaek, Denmark
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - D Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- GREMPAL Research Group, Idiap Jordi Gol and CIBERFes, Universitat Autonoma de Barcelona and Instituto de Salud Carlos III, Barcelona, Spain
| | - S Ferrari
- Division of Bone Disease, Faculty of Medicine, Geneva University Hospital, Geneva, Switzerland
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15
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Shaw SC, Parsons CM, Fuggle NR, Edwards MH, Robinson SM, Dennison EM, Cooper C, Ward KA. Diet Quality and Bone Measurements Using HRpQCT and pQCT in Older Community-Dwelling Adults from the Hertfordshire Cohort Study. Calcif Tissue Int 2018; 103:494-500. [PMID: 29931462 PMCID: PMC6174074 DOI: 10.1007/s00223-018-0445-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/14/2018] [Indexed: 01/10/2023]
Abstract
There are few data describing associations between dietary patterns and bone microarchitecture. This study investigated the relationship between diet quality and HRpQCT and pQCT measures in older adults. Data were available for 184 men and 166 women. Dietary data were collected at baseline (1998-2003) using an administered food frequency questionnaire. A 'prudent' diet score (PDS) was identified using principal component analysis and used as an indicator of dietary quality. HRpQCT and pQCT images were acquired at follow-up in 2012, from the non-dominant distal radius and tibia using Scanco XtremeCT and Stratec XCT2000 instrument scanners, respectively. The mean (SD) PDS was - 0.24 (1.23) for men and 0.62 (1.14) for women. In women, a significant positive relationship was found between baseline dietary pattern and total and trabecular area at both the radius and the tibia, measured by HRpQCT. Similar trends were observed with pQCT parameters. Positive associations were observed for tibia total area (38% slice). At the radius, significant positive associations were found for total area (4% slice) and polar strength strain index (33% slice). All relationships remained robust to adjustment. For men, although patterns were similar, there were no significant associations for HRpQCT outcomes. Significant associations were observed for baseline PDS and polar strength strain and total area (66% slice) at the radius, measured by pQCT. Our data suggest that diets high in fruit, vegetables, oily fish and whole grain cereals in early old age are associated with greater bone size but not volumetric bone density or microarchitecture in later life in women.
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Affiliation(s)
- S C Shaw
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS FT, Southampton, UK
| | - C M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - N R Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - S M Robinson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS FT, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
- Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS FT, Southampton, UK.
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LE, UK.
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- MRC Elsie Widdowson Laboratory, Cambridge, UK
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16
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Patel A, Edwards MH, Jameson KA, Ward KA, Fuggle N, Cooper C, Dennison EM. Longitudinal Change in Peripheral Quantitative Computed Tomography Assessment in Older Adults: The Hertfordshire Cohort Study. Calcif Tissue Int 2018; 103:476-482. [PMID: 29931460 PMCID: PMC6179140 DOI: 10.1007/s00223-018-0442-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/11/2018] [Indexed: 12/15/2022]
Abstract
There are few longitudinal data on change in bone structure and muscle mass, strength and function in later life. We report these, and consider bone-muscle interrelationships in older men and women. We studied 188 men and 166 women from the Hertfordshire Cohort Study, who underwent peripheral quantitative computed tomography (pQCT) of the radius and tibia in 2004-2005 and then again in 2011-2012. Grip strength and gait speed were also assessed at both timepoints. Percentage change per year was calculated for grip strength, gait speed, muscle cross-sectional area (mCSA), fat cross-sectional area (fCSA) and diaphyseal bone parameters [total area (Tt.Ar), cortical area (Ct.Ar), cortical density (cBMD) and trabecular density (tBMD)]. The mean (SD) age of men and women at baseline was 68.9 (2.5) and 69.2 (2.6) years, respectively. Rates of muscle area and strength loss did not differ by sex. Tt.Ar increased with age and faster in men [mean (SD) 1.78 (1.64) %/year] than women [mean (SD) 1.03 (1.69) %/year] in the radius (p < 0.001). In both the radius (p = 0.006) and tibia (p < 0.001), Ct.Ar reduced more rapidly in women than men. Change in Ct.Ar was associated with change in muscle area in the corresponding limb (radius; men: regression coefficient 0.36, 95% CI 0.20-0.52, p < 0.001; tibia; men: regression coefficient 0.14, 95% CI 0.00-0.27, p = 0.043, women: regression coefficient 0.16, 95% CI 0.01-0.30, p = 0.032). We have demonstrated that muscle strength and function decrease faster than muscle mass and have provided further evidence that changes in bone structure with age differ by sex.
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Affiliation(s)
- A Patel
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - K A Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- MRC Elsie Widdowson Laboratory, Cambridge, UK
| | - Nicholas Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- MRC Elsie Widdowson Laboratory, Cambridge, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- Victoria University, Wellington, New Zealand.
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Fuggle NR, Westbury LD, Syddall HE, Duggal NA, Shaw SC, Maslin K, Dennison EM, Lord J, Cooper C. Relationships between markers of inflammation and bone density: findings from the Hertfordshire Cohort Study. Osteoporos Int 2018; 29:1581-1589. [PMID: 29808230 PMCID: PMC6093277 DOI: 10.1007/s00198-018-4503-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
UNLABELLED Among 365 Hertfordshire Cohort Study participants (aged 59-71 years at baseline), higher adiponectin and adiponectin to leptin ratios were associated with lower baseline lumbar spine and femoral neck bone mineral density (BMD). Lower IL-10 was associated with accelerated decline in lumbar spine BMD. This suggests that bone health can be influenced by changes in immune phenotype and alterations in adipokine homeostasis. INTRODUCTION The aim of this study was to examine the association between indices of inflammation and BMD in a population-based cohort of older adults in the UK. METHODS Analyses were based on a sample of 194 men and 171 women of the Hertfordshire Cohort Study (community-living, older adults). Dual energy X-ray absorptiometry (DXA) was performed at the lumbar spine and proximal femur at baseline and repeated at a median of 4.5 years (inter-quartile range 3.6 to 5.2). Inflammatory markers (CRP, TNF, IL-1β, IL-6, IL-8, IL-10, adiponectin and leptin) were ascertained at baseline using enzyme-linked immunosorbent assay (ELISA) techniques and Bio-Plex Pro Assays. Gender-adjusted linear regression was used to examine the associations between markers of inflammation and outcomes with and without adjustment for anthropometric and lifestyle factors. RESULTS The mean (SD) ages at baseline were 64.4 (2.5) and 66.5 (2.7) years for men and women respectively. Higher levels of adiponectin and adiponectin to leptin ratios were each associated with lower baseline lumbar spine and femoral neck BMD in gender-adjusted (p < 0.01) and fully adjusted (p < 0.05) analyses. Lower levels of IL-10 and TNF were each associated with accelerated decline in lumbar spine BMD in both gender-adjusted (p ≤ 0.05) and fully adjusted (p < 0.05) analyses. CONCLUSIONS In a cohort of older adults, high levels of adiponectin and adiponectin to leptin ratios were both associated with lower BMD at the lumbar spine and femoral neck at baseline, and lower IL-10 was associated with accelerated decline in BMD at the lumbar spine. This adds weight to the theory that bone health can be influenced by changes in immune phenotype and alterations in adipokine homeostasis.
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Affiliation(s)
- N R Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - L D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - H E Syddall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - N A Duggal
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S C Shaw
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - K Maslin
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - J Lord
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
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Patel HP, Dawson A, Westbury LD, Hasnaoui G, Syddall HE, Shaw S, Sayer AA, Cooper C, Dennison EM. Muscle Mass, Muscle Morphology and Bone Health Among Community-Dwelling Older Men: Findings from the Hertfordshire Sarcopenia Study (HSS). Calcif Tissue Int 2018; 103:35-43. [PMID: 29372275 PMCID: PMC6010484 DOI: 10.1007/s00223-018-0388-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/04/2018] [Indexed: 12/21/2022]
Abstract
Sarcopenia and osteoporosis are associated with poor health outcomes in older people. Relationships between muscle and bone have typically been reported at a functional or macroscopic level. The aims of this study were to describe the relationships between muscle morphology and bone health among participants of the Hertfordshire Sarcopenia Study (HSS). 105 older men, mean age 72.5 (SD 2.5) years, were recruited into the HSS. Whole body lean mass as well as appendicular lean mass, lumbar spine and femoral neck bone mineral content (BMC) and bone mineral density (BMD) were obtained through dual-energy X-ray absorptiometry scanning. Percutaneous biopsy of the vastus lateralis was performed successfully in 99 participants. Image analysis was used to determine the muscle morphology variables of slow-twitch (type I) and fast-twitch (type II) myofibre area, myofibre density, capillary and satellite cell (SC) density. There were strong relationships between whole and appendicular lean body mass in relation to femoral neck BMC and BMD (r ≥ 0.43, p < 0.001). Type II fibre area was associated with both femoral neck BMC (r = 0.27, p = 0.01) and BMD (r = 0.26, p = 0.01) with relationships robust to adjustment for age and height. In unadjusted analysis, SC density was associated with whole body area (r = 0.30, p = 0.011) and both BMC (r = 0.26, p = 0.031) and area (r = 0.29, p = 0.017) of the femoral neck. We have demonstrated associations between BMC and changes in muscle at a cellular level predominantly involving type II myofibres. Interventions targeted at improving muscle mass, function and quality may improve overall musculoskeletal health. Larger studies that include women are needed to explore these relationships further.
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Affiliation(s)
- H. P. Patel
- 0000 0004 1936 9297grid.5491.9MRC Lifecourse Epidemiology Unit, University Hospital Southampton, University of Southampton, Tremona Road, Mail point 95, Southampton, SO16 6YD UK
- 0000 0004 1936 9297grid.5491.9Academic Geriatric Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
- grid.430506.4National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD UK
| | - A. Dawson
- 0000 0004 1936 9297grid.5491.9MRC Lifecourse Epidemiology Unit, University Hospital Southampton, University of Southampton, Tremona Road, Mail point 95, Southampton, SO16 6YD UK
| | - L. D. Westbury
- 0000 0004 1936 9297grid.5491.9MRC Lifecourse Epidemiology Unit, University Hospital Southampton, University of Southampton, Tremona Road, Mail point 95, Southampton, SO16 6YD UK
| | - G. Hasnaoui
- 0000 0004 1936 9297grid.5491.9Academic Geriatric Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
| | - H. E. Syddall
- 0000 0004 1936 9297grid.5491.9MRC Lifecourse Epidemiology Unit, University Hospital Southampton, University of Southampton, Tremona Road, Mail point 95, Southampton, SO16 6YD UK
| | - S. Shaw
- 0000 0004 1936 9297grid.5491.9MRC Lifecourse Epidemiology Unit, University Hospital Southampton, University of Southampton, Tremona Road, Mail point 95, Southampton, SO16 6YD UK
| | - A. A. Sayer
- 0000 0004 1936 9297grid.5491.9Academic Geriatric Medicine, University of Southampton, Tremona Road, Southampton, SO16 6YD UK
- AGE Research Group, Institute of Neuroscience, Newcastle, UK
- 0000 0001 0462 7212grid.1006.7NIHR Newcastle Biomedical Research Centre, Newcastle upon-Tyne NHS Foundation Trust and Newcastle University, Newcastle, UK
| | - C. Cooper
- 0000 0004 1936 9297grid.5491.9MRC Lifecourse Epidemiology Unit, University Hospital Southampton, University of Southampton, Tremona Road, Mail point 95, Southampton, SO16 6YD UK
- 0000 0004 1936 8948grid.4991.5National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - E. M. Dennison
- 0000 0004 1936 9297grid.5491.9MRC Lifecourse Epidemiology Unit, University Hospital Southampton, University of Southampton, Tremona Road, Mail point 95, Southampton, SO16 6YD UK
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Westbury LD, Fuggle NR, Syddall HE, Duggal NA, Shaw SC, Maslin K, Dennison EM, Lord JM, Cooper C. Relationships Between Markers of Inflammation and Muscle Mass, Strength and Function: Findings from the Hertfordshire Cohort Study. Calcif Tissue Int 2018; 102:287-295. [PMID: 29101476 PMCID: PMC5818589 DOI: 10.1007/s00223-017-0354-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/19/2017] [Indexed: 12/16/2022]
Abstract
We investigated the longitudinal relationships between inflammation markers and the following outcomes in a UK cohort study: appendicular lean mass (ALM); walking speed; level and change in grip strength; and sarcopenia defined by the European Working Group on Sarcopenia in Older People. Analyses were based on 336 community-dwelling older men and women (aged 59-70 years) who participated in the Hertfordshire Cohort Study (HCS). Inflammation markers were ascertained at baseline using enzyme-linked immunosorbent assay techniques and Bio-Plex Pro Assays. Grip strength was measured at baseline and follow-up [median follow-up time: 10.8 years (inter-quartile range 10.2-11.6)] and change in grip strength was ascertained using a residual change approach. At follow-up, ALM was ascertained using dual-energy X-ray absorptiometry, customary walking speed was measured and sarcopenia status was ascertained. Gender-adjusted linear and Poisson regression was used to examine the associations between inflammation markers and outcomes with and without adjustment for anthropometric and lifestyle factors. Higher C-reactive protein was associated (p < 0.04) with lower grip strength and accelerated decline in grip strength from baseline to follow-up. Higher cortisol was associated with lower ALM (p < 0.05). Higher interleukin-8 (IL-8) was associated with lower ALM (p < 0.05) and increased risk of sarcopenia [fully-adjusted relative risk per SD increase in IL-8: 1.37 (95% CI 1.10, 1.71), p = 0.005]. All associations were robust in fully-adjusted analyses. Inflammation markers were associated with measures of muscle mass, strength and function in HCS. Further work is required to replicate these associations and to delineate the underlying mechanisms.
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Affiliation(s)
- L D Westbury
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - N R Fuggle
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - H E Syddall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - N A Duggal
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - S C Shaw
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - K Maslin
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - J M Lord
- MRC-ARUK Centre for Musculoskeletal Ageing Research, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
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Litwic AE, Westbury LD, Robinson DE, Ward KA, Cooper C, Dennison EM. Bone Phenotype Assessed by HRpQCT and Associations with Fracture Risk in the GLOW Study. Calcif Tissue Int 2018; 102:14-22. [PMID: 28913616 PMCID: PMC5760585 DOI: 10.1007/s00223-017-0325-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 09/05/2017] [Indexed: 11/06/2022]
Abstract
The epidemiology and pathogenesis of fractures in postmenopausal women has previously been investigated in the Global Longitudinal study of Osteoporosis in Women (GLOW). To date, however, relationships between bone imaging outcomes and fracture have not been studied in this cohort. We examined relationships between high-resolution peripheral quantitative computed tomography (HRpQCT) parameters and fracture in the UK arm of GLOW, performing a cluster analysis to assess if our findings were similar to observations reported from older participants of the Hertfordshire Cohort Study (HCS), and extended the analysis to include tibial measurements. We recorded fracture events and performed HRpQCT of the distal radius and tibia and dual-energy X-ray absorptiometry (DXA) of the hip in 321 women, mean age 70.6 (SD 5.4) years, identifying four clusters at each site. We saw differing relationships at the radius and tibia. Two radial clusters (3 and 4) had a significantly lower hip areal bone mineral density (p < 0.001) compared to Cluster 1; only individuals in Cluster 4 had a significantly higher risk of fracture (p = 0.005). At the tibia, clusters 1, 3 and 4 had lower hip areal bone mineral density (p < 0.001) compared to Cluster 2; individuals in Cluster 3 had a significantly higher risk of fracture (p = 0.009). In GLOW our findings at the radius were very similar to those previously reported in the HCS, suggesting that combining variables derived from HRpQCT may give useful information regarding fracture risk in populations where this modality is available. Further data relating to tibial HRpQCT-phenotype and fractures are provided in this paper, and would benefit from validation in other studies. Differences observed may reflect age differences in the two cohorts.
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Affiliation(s)
- A E Litwic
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - L D Westbury
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - D E Robinson
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
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21
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Syddall HE, Westbury LD, Shaw SC, Dennison EM, Cooper C, Gale CR. Correlates of Level and Loss of Grip Strength in Later Life: Findings from the English Longitudinal Study of Ageing and the Hertfordshire Cohort Study. Calcif Tissue Int 2018; 102:53-63. [PMID: 29058059 PMCID: PMC5760591 DOI: 10.1007/s00223-017-0337-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/03/2017] [Indexed: 12/17/2022]
Abstract
Characterisation of grip strength (GS) using isometric dynamometry is central to the definition of sarcopenia. Determinants of low GS include: older age, shorter stature, low physical activity, poor nutrition, socioeconomic disadvantage and multimorbidity. Less is known about risk factors for accelerated loss of GS. We investigated determinants of level and 8-year loss of GS in 3703 men and women (aged 52-82 years) in the English Longitudinal Study of Ageing (ELSA). Four hundred and forty-one men and women (aged 59-71 years) who participated in a 10-year follow-up of the Hertfordshire Cohort Study (HCS) were used for replication. Variables were harmonised between cohorts. Change in GS was characterised using mixed-effects models in ELSA and a residual change approach in HCS and analysed for men and women combined. Men in ELSA and HCS had higher average levels of GS at baseline, and accelerated rates of loss, compared with women. In ELSA, older age, shorter stature and multimorbidity were correlated with lower level, and accelerated rate of loss, of GS in both sexes (accelerated loss of 0.04 (95% CI 0.00-0.08) standard deviation scores per additional morbidity after multivariable adjustment). Socioeconomic disadvantage, low level of physical activity and poorer self-reported health were also correlated with low GS level, but not loss rate, after multivariable adjustment. Analysis in HCS yielded similar results. Our results identify multimorbidity as a modifiable determinant of loss of muscle strength in later life, and raise the possibility that developmental influences may impact on rate of involutional decline in muscle strength.
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Affiliation(s)
- H E Syddall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - L D Westbury
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - S C Shaw
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
| | - C R Gale
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
- Department of Psychology, Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
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Litwic AE, Parsons C, Edwards MH, Jagannath D, Cooper C, Dennison EM. Comment on: Inflammatory mediators in osteoarthritis: A critical review of the state-of-the art, prospects, and future challenges. Bone 2018; 106:28-29. [PMID: 27496069 DOI: 10.1016/j.bone.2016.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/20/2016] [Accepted: 08/01/2016] [Indexed: 11/19/2022]
Affiliation(s)
- A E Litwic
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - C Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - D Jagannath
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK; National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford OX3 7LE, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK.
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Litwic AE, Compston JE, Wyman A, Siris ES, Gehlbach SH, Adachi JD, Chapurlat R, Díez-Pérez A, LaCroix AZ, Nieves JW, Netelenbos JC, Pfeilschifter J, Rossini M, Roux C, Saag KG, Silverman S, Watts NB, Greenspan SL, March L, Gregson CL, Cooper C, Dennison EM. Self-perception of fracture risk: what can it tell us? Osteoporos Int 2017; 28:3495-3500. [PMID: 28861636 PMCID: PMC5759929 DOI: 10.1007/s00198-017-4200-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 08/16/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED In this study, we report that self-perception of fracture risk captures some aspect of fracture risk not currently measured using conventional fracture prediction tools and is associated with improved medication uptake. It suggests that adequate appreciation of fracture risk may be beneficial and lead to greater healthcare engagement and treatment. INTRODUCTION This study aimed to assess how well self-perception of fracture risk, and fracture risk as estimated by the fracture prediction tool FRAX, related to fracture incidence and uptake and persistence of anti-osteoporosis medication among women participating in the Global Longitudinal study of Osteoporosis in Women (GLOW). METHODS GLOW is an international cohort study involving 723 physician practices across 10 countries in Europe, North America and Australia. Aged ≥ 55 years, 60,393 women completed baseline questionnaires detailing medical history, including co-morbidities, fractures and self-perceived fracture risk (SPR). Annual follow-up included self-reported incident fractures and anti-osteoporosis medication (AOM) use. We calculated FRAX risk without bone mineral density measurement. RESULTS Of the 39,241 women with at least 1 year of follow-up data, 2132 (5.4%) sustained an incident major osteoporotic fracture over 5 years of follow-up. Within each SPR category, risk of fracture increased as the FRAX categorisation of risk increased. In GLOW, only 11% of women with a lower baseline SPR were taking AOM at baseline, compared with 46% of women with a higher SPR. AOM use tended to increase in the years after a reported fracture. However, women with a lower SPR who were fractured still reported lower AOM rates than women with or without a fracture but had a higher SPR. CONCLUSIONS These results suggest that SPR captures some aspect of fracture risk not currently measured using conventional fracture prediction tools and is also associated with improved medication uptake.
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Affiliation(s)
- A E Litwic
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | | | - A Wyman
- Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - E S Siris
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - S H Gehlbach
- Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - J D Adachi
- St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - R Chapurlat
- INSERM U831, Division of Rheumatology, Hôpital E. Herriot, Université de Lyon, Lyon, France
| | - A Díez-Pérez
- Hospital del Mar-IMIM-Autonomous, University of Barcelona, Barcelona, Spain
| | - A Z LaCroix
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - J W Nieves
- Helen Hayes Hospital and Columbia University, West Haverstraw, NY, USA
| | - J C Netelenbos
- Department of Endocrinology, VU University Medical Center, Amsterdam, The Netherlands
| | - J Pfeilschifter
- Department of Internal Medicine III, Alfried Krupp Krankenhaus, Essen, Germany
| | - M Rossini
- Department of Rheumatology, University of Verona, Verona, Italy
| | - C Roux
- Cochin Hospital, Paris Descartes University, Paris, France
| | - K G Saag
- University of Alabama-Birmingham, Birmingham, AL, USA
| | - S Silverman
- Department of Rheumatology, Cedars-Sinai/UCLA, Los Angeles, CA, USA
| | - N B Watts
- Bone Health and Osteoporosis Center, University of Cincinnati, Cincinnati, OH, USA
| | | | - L March
- Faculty of Medicine and Department of Public Health, University of Sydney, Sydney, Australia
| | - C L Gregson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- Musculoskeletal Research Unit, Learning and Research Building, Southmead Hospital, University of Bristol, Bristol, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
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Abstract
Sarcopenia is an age-related syndrome characterised by progressive and generalised loss of skeletal muscle mass and strength; it is a major contributor to the risk of physical frailty, functional impairment in older people, poor health-related quality of life and premature death. Many different definitions have been used to describe sarcopenia and have resulted in varying estimates of prevalence of the condition. The most recent attempts of definitions have tried to integrate information on muscle mass, strength and physical function and provide a definition that is useful in both research and clinical settings. This review focuses on the epidemiology of the three distinct physiological components of sarcopenia, and highlights the similarities and differences between their patterns of variation with age, gender, geography and time and the individual risk factors that cluster selectively with muscle mass, strength and physical function. Methods used to measure muscle mass, strength and physical functioning and how differences in these approaches can contribute to the varying prevalence rates will also be described. The evidence for this review was gathered by undertaking a systematic search of the literature. The descriptive characteristics of muscle mass, strength and function described in this review point to the urgent need for a consensual definition of sarcopenia incorporating these parameters.
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Affiliation(s)
- S C Shaw
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD, UK.
- National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO16 6YD, UK.
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, OX3 7LE, UK.
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Patel HP, Dennison EM, Westbury L, Sayer AA, Cooper C. 28SARCOPENIA AND BONE HEALTH IN COMMUNITY DWELLING OLDER ADULTS: FINDINGS FROM THE HERTFORDSHIRE SARCOPENIA STUDY (HSS). Age Ageing 2017. [DOI: 10.1093/ageing/afx117.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Beaudart C, Dawson A, Shaw SC, Harvey NC, Kanis JA, Binkley N, Reginster JY, Chapurlat R, Chan DC, Bruyère O, Rizzoli R, Cooper C, Dennison EM. Nutrition and physical activity in the prevention and treatment of sarcopenia: systematic review. Osteoporos Int 2017; 28:1817-1833. [PMID: 28251287 PMCID: PMC5457808 DOI: 10.1007/s00198-017-3980-9] [Citation(s) in RCA: 306] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/31/2017] [Indexed: 01/06/2023]
Abstract
UNLABELLED This systematic review summarizes the effect of combined exercise and nutrition intervention on muscle mass and muscle function. A total of 37 RCTs were identified. Results indicate that physical exercise has a positive impact on muscle mass and muscle function in subjects aged 65 years and older. However, any interactive effect of dietary supplementation appears to be limited. INTRODUCTION In 2013, Denison et al. conducted a systematic review including 17 randomized controlled trials (RCTs) to explore the effect of combined exercise and nutrition intervention to improve muscle mass, muscle strength, or physical performance in older people. They concluded that further studies were needed to provide evidence upon which public health and clinical recommendations could be based. The purpose of the present work was to update the prior systematic review and include studies published up to October 2015. METHODS Using the electronic databases MEDLINE and EMBASE, we identified RCTs which assessed the combined effect of exercise training and nutritional supplementation on muscle strength, muscle mass, or physical performance in subjects aged 60 years and over. Study selection and data extraction were performed by two independent reviewers. RESULTS The search strategy identified 21 additional RCTs giving a total of 37 RCTs. Studies were heterogeneous in terms of protocols for physical exercise and dietary supplementation (proteins, essential amino acids, creatine, β-hydroxy-β-methylbuthyrate, vitamin D, multi-nutrients, or other). In 79% of the studies (27/34 RCTs), muscle mass increased with exercise but an additional effect of nutrition was only found in 8 RCTs (23.5%). Muscle strength increased in 82.8% of the studies (29/35 RCTs) following exercise intervention, and dietary supplementation showed additional benefits in only a small number of studies (8/35 RCTS, 22.8%). Finally, the majority of studies showed an increase of physical performance following exercise intervention (26/28 RCTs, 92.8%) but interaction with nutrition supplementation was only found in 14.3% of these studies (4/28 RCTs). CONCLUSION Physical exercise has a positive impact on muscle mass and muscle function in healthy subjects aged 60 years and older. The biggest effect of exercise intervention, of any type, has been seen on physical performance (gait speed, chair rising test, balance, SPPB test, etc.). We observed huge variations in regard to the dietary supplementation protocols. Based on the included studies, mainly performed on well-nourished subjects, the interactive effect of dietary supplementation on muscle function appears limited.
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Affiliation(s)
- C Beaudart
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - A Dawson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - S C Shaw
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - J A Kanis
- Centre for Metabolic Bone Disease, Medical School, University of Sheffield, Sheffield, UK
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Australia
| | - N Binkley
- University of Wisconsin Osteoporosis Clinical Center and Research Program, Madison, WI, USA
| | - J Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - R Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, Lyon, France
| | - D C Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Superintendent's Office, National Taiwan University Hospital Chu-Tong Branch, Hsinchu City, Taiwan
| | - O Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
- NIHR Musculoskeletal Biomedical Research Unit, Institute of Musculoskeletal Sciences, University of Oxford, Oxford, UK.
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
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Dennison EM, Dawson A, Westbury L, Shaw S, Cooper C, Sayer AA, Patel HP. 95Relationships Between Muscle Morphology And Bone Health Among Older Adults: Findings From The Hertfordshire Cohort Study. Age Ageing 2017. [DOI: 10.1093/ageing/afx069.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Warner SC, Walsh DA, Laslett LL, Maciewicz RA, Soni A, Hart DJ, Zhang W, Muir KR, Dennison EM, Leaverton P, Rampersaud E, Cooper C, Spector TD, Cicuttini FM, Arden NK, Jones G, Doherty M, Valdes AM. Pain in knee osteoarthritis is associated with variation in the neurokinin 1/substance P receptor (TACR1) gene. Eur J Pain 2017; 21:1277-1284. [PMID: 28493529 DOI: 10.1002/ejp.1027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Substance P (SP) is a pain- and inflammation-related neuropeptide which preferentially binds to the neurokinin receptor 1 (NK1 ). SP and NK1 receptors have been implicated in joint pain, inflammation and damage in animal models and human studies of osteoarthritis (OA). The aim of this study was to test if genetic variation at the neurokinin 1 receptor gene (TACR1) is associated with pain in individuals with radiographic knee OA. METHODS Participants from the Genetics of OA and Lifestyle study were used for the discovery group (n = 1615). Genotype data for six SNPs selected to cover most variation in the TACR1 gene were used to test for an association with symptomatic OA. Replication analysis was performed using data from the Chingford 1000 Women Study, Hertfordshire Cohort Study, Tasmanian Older Adult Cohort Study and the Clearwater OA Study. In total, n = 1715 symptomatic OA and n = 735 asymptomatic OA individuals were analysed. RESULTS Out of six SNPs tested in the TACR1 gene, one (rs11688000) showed a nominally significant association with a decreased risk of symptomatic OA in the discovery cohort. This was then replicated in four additional cohorts. After adjusting for age, gender, body mass index and radiographic severity, the G (minor) allele at rs11688000 was associated with a decreased risk of symptomatic OA compared to asymptomatic OA cases (p = 9.90 × 10-4 , OR = 0.79 95% 0.68-0.90 after meta-analysis). CONCLUSIONS This study supports a contribution from the TACR1 gene in human OA pain, supporting further investigation of this gene's function in OA. SIGNIFICANCE This study contributes to the knowledge of the genetics of painful osteoarthritis, a condition which affects millions of individuals worldwide. Specifically, a contribution from the TACR1 gene to modulating pain sensitivity in osteoarthritis is suggested.
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Affiliation(s)
- S C Warner
- Academic Rheumatology, University of Nottingham, UK.,Department of Cardiovascular Sciences, Leicester Cardiovascular Biomedical Research Unit, University of Leicester and National Institute for Health Research, UK
| | - D A Walsh
- Academic Rheumatology, University of Nottingham, UK.,Arthritis Research UK Pain Centre, School of Medicine, University of Nottingham, UK
| | - L L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - R A Maciewicz
- Respiratory, Inflammation and Autoimmunity Innovative Medicines, AstraZeneca, Cambridge, UK
| | - A Soni
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, UK
| | - D J Hart
- Department of Twin Research, St Thomas' Hospital, King's College London, UK
| | - W Zhang
- Academic Rheumatology, University of Nottingham, UK.,Arthritis Research UK Pain Centre, School of Medicine, University of Nottingham, UK
| | - K R Muir
- Institute of Population Health, University of Manchester, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, UK
| | - P Leaverton
- The Arthritis Research Institute of America, Clearwater, USA
| | - E Rampersaud
- University of Miami Miller School of Medicine, USA
| | - C Cooper
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, UK.,MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, UK
| | - T D Spector
- Department of Twin Research, St Thomas' Hospital, King's College London, UK
| | - F M Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Australia
| | - N K Arden
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, UK.,MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, UK
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - M Doherty
- Academic Rheumatology, University of Nottingham, UK.,Arthritis Research UK Pain Centre, School of Medicine, University of Nottingham, UK
| | - A M Valdes
- Academic Rheumatology, University of Nottingham, UK.,Arthritis Research UK Pain Centre, School of Medicine, University of Nottingham, UK
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Robinson SM, Jameson KA, Bloom I, Ntani G, Crozier SR, Syddall H, Dennison EM, Cooper CR, Sayer AA. Development of a Short Questionnaire to Assess Diet Quality among Older Community-Dwelling Adults. J Nutr Health Aging 2017; 21:247-253. [PMID: 28244562 DOI: 10.1007/s12603-016-0758-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the use of a short questionnaire to assess diet quality in older adults. DESIGN Cross-sectional study. SETTING Hertfordshire, UK. PARTICIPANTS 3217 community-dwelling older adults (59-73 years). MEASUREMENTS Diet was assessed using an administered food frequency questionnaire (FFQ); two measures of diet quality were defined by calculating participants' 'prudent diet' scores, firstly from a principal component analysis of the data from the full FFQ (129 items) and, secondly, from a short version of the FFQ (including 24 indicator foods). Scores calculated from the full and short FFQ were compared with nutrient intake and blood concentrations of vitamin C and lipids. RESULTS Prudent diet scores calculated from the full FFQ and short FFQ were highly correlated (0.912 in men, 0.904 in women). The pattern of associations between nutrient intake (full FFQ) and diet scores calculated using the short and full FFQs were very similar, both for men and women. Prudent diet scores calculated from the full and short FFQs also showed comparable patterns of association with blood measurements: in men and women, both scores were positively associated with plasma vitamin C concentration and serum HDL; in women, an inverse association with serum triglycerides was also observed. CONCLUSIONS A short food-based questionnaire provides useful information about the diet quality of older adults. This simple tool does not require nutrient analysis, and has the potential to be of value to non-specialist researchers.
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Affiliation(s)
- S M Robinson
- SM Robinson; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton. SO16 6YD; Telephone: +44 (0)23 8077 7624; Fax: +44 (0)23 8070 4021; e-mail:
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Paccou J, Edwards MH, Patsch JM, Jameson KA, Ward KA, Moss C, Dennison EM, Cooper C. Lower leg arterial calcification assessed by high-resolution peripheral quantitative computed tomography is associated with bone microstructure abnormalities in women. Osteoporos Int 2016; 27:3279-3287. [PMID: 27325126 PMCID: PMC5040512 DOI: 10.1007/s00198-016-3660-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 06/02/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED In older women, the presence of lower leg arterial calcification assessed by high-resolution peripheral quantitative computed tomography is associated with relevant bone microstructure abnormalities at the distal tibia and distal radius. INTRODUCTION Here, we report the relationships of bone geometry, volumetric bone mineral density (BMD) and bone microarchitecture with lower leg arterial calcification (LLAC) as assessed by high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS We utilized the Hertfordshire Cohort Study (HCS), where we were able to study associations between measures obtained from HR-pQCT of the distal radius and distal tibia in 341 participants with or without LLAC. Statistical analyses were performed separately for women and men. We used linear regression models to investigate the cross-sectional relationships between LLAC and bone parameters. RESULTS The mean (SD) age of participants was 76.4 (2.6) and 76.1 (2.5) years in women and men, respectively. One hundred and eleven of 341 participants (32.6 %) had LLAC that were visible and quantifiable by HR-pQCT. The prevalence of LLAC was higher in men than in women (46.4 % (n = 83) vs. 17.3 % (n = 28), p < 0.001). After adjustment for confounding factors, we found that women with LLAC had substantially lower Ct.area (β = -0.33, p = 0.016), lower Tb.N (β = -0.54, p = 0.013) and higher Tb.Sp (β = 0.54, p = 0.012) at the distal tibia and lower Tb.Th (β = -0.49, p = 0.027) at the distal radius compared with participants without LLAC. Distal radial or tibial bone parameter analyses in men according to their LLAC status revealed no significant differences with the exception of Tb.N (β = 0.27, p = 0.035) at the distal tibia. CONCLUSION In the HCS, the presence of LLAC assessed by HR-pQCT was associated with relevant bone microstructure abnormalities in women. These findings need to be replicated and further research should study possible pathophysiological links between vascular calcification and osteoporosis.
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Affiliation(s)
- J Paccou
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- Department of Rheumatology, Lille University Hospital, Lille 2, 59037, Lille cedex, France
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - J M Patsch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - K A Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - K A Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge, CB1 9NL, UK
| | - C Moss
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
- Victoria University, Wellington, New Zealand
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK.
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, OX3 5UG, UK.
- NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton, SO16 6YD, UK.
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Robinson DE, Dennison EM, Cooper C, van Staa TP, Dixon WG. A review of the methods used to define glucocorticoid exposure and risk attribution when investigating the risk of fracture in a rheumatoid arthritis population. Bone 2016; 90:107-15. [PMID: 27268854 PMCID: PMC4973893 DOI: 10.1016/j.bone.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 05/27/2016] [Accepted: 06/01/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Glucocorticoid therapy is used widely in patients with rheumatoid arthritis (RA) with good efficacy but concerns about safety including fractures. Estimates of fracture risk for any given patient are complicated by the dynamic pattern of glucocorticoid use, where patients vary in their dose, duration and timing of glucocorticoid use. OBJECTIVE To investigate which methods are currently used to attribute fractures to glucocorticoid exposure and investigate whether such methods can consider individual treatment patterns. RESULTS Thirty-eight studies used five common definitions of risk attribution to glucocorticoid exposure: "current use", "ever use", "daily dose", "cumulative dose" and "time variant". One study attempted to combine multiple definitions where "cumulative dose" was nested within "daily dose", covering the effects of dose and duration but not timing. The majority of results demonstrated an equivocal or increased risk of fracture with increased exposure, although there was wide variation, with odds ratios, hazard ratios and relative risks ranging from 0.16 to 8.16. Within definitions there was also variability in the results with the smallest range for "time variant", 1.07 to 2.8, and the largest for "cumulative dose", ranging from risk estimates of 0.88 to 8.12. CONCLUSION Many studies have looked into the effect of glucocorticoids on fracture risk in patients with RA. Despite this, there is no clear consensus about the magnitude of risk. This is a consequence of the varied analysis models and their different assumptions. Moreover, no current analysis method allows consideration of dose, duration and timing of glucocorticoid therapy, preventing a clear understanding of fracture risk for patients and their individual treatment patterns.
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Affiliation(s)
- D E Robinson
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; Victoria University, Wellington, New Zealand
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK; NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 5UG, UK; NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, UK
| | - T P van Staa
- Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, Vaughan House, Portsmouth Road, M13 9PL, UK; Utrecht University, Faculty of Science, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht, The Netherlands
| | - W G Dixon
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute for Inflammation and Repair, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PT, UK; Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, Vaughan House, Portsmouth Road, M13 9PL, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Nowgen Building, 29 Grafton Street, Manchester, M13 9WU, UK; Salford Royal NHS Foundation Trust, Stott Ln, Salford, M6 8HD, UK.
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Abstract
There has been limited success defining environmental factors important to the development of connective tissue diseases such as systemic lupus erythematosus (SLE). Recent work has suggested that the perinatal environment may be important. To investigate this we measured antinuclear antibodies (ANA) in a general population with well-defined early lives to see whether fetal and infant growth and infections were associated with ANA positivity in adult life. Included in our investigation were 1334 individuals (668 men, 666 women) from the Hertfordshire cohort study. ANA was measured using an ANA ELISA and confirmed using immunofluorescence. We investigated associations between the presence of ANA and early growth and infectious exposure in infancy in men and women combined, but with adjustment for gender throughout. A positive ANA was present in 73 (10.9%) of men and 81 (12.2%) women. Of these, 26 women and 14 men were positive using IF on HEP2 cells. Sharing a bedroom during childhood was associated with a higher risk of being ANA positive (odds ratio (OR), 1.42, 95% confidence interval (CI) 1.00-2.01, P = 0.05). A record of diarrhoeal illness (OR 2.12 95% CI 1.07, 4.23, P = 0.03) and rubella or mumps during the first year of life (OR 16.12, 95% CI 2.92, 88.94, P = 0.001) was also significantly associated with ANA in adult life. Higher ANA titres by Inova ELISA were associated with infections in the first year of life from mumps (2.74-fold higher, 95% CI 0.98, 7.64, P = 0.05) and rubella (3.90-fold higher, 95% CI 1.89, 8.04, P < 0.001). In addition, higher ANA titres were also associated with mumps (1.26-fold higher, 95% CI 1.02, 1.56, P = 0.03) between one and five years of age. Our results suggest that a developing immune system exposed to increased infection is more likely to produce ANA in adult life and perhaps begin the pathological process that leads to SLE.
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Affiliation(s)
- C J Edwards
- Medical Research Council Epidemiology Resource Centre, Southampton, UK.
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Edwards MH, Robinson DE, Ward KA, Javaid MK, Walker-Bone K, Cooper C, Dennison EM. Cluster analysis of bone microarchitecture from high resolution peripheral quantitative computed tomography demonstrates two separate phenotypes associated with high fracture risk in men and women. Bone 2016; 88:131-137. [PMID: 27130873 PMCID: PMC4913839 DOI: 10.1016/j.bone.2016.04.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 12/28/2022]
Abstract
Osteoporosis is a major healthcare problem which is conventionally assessed by dual energy X-ray absorptiometry (DXA). New technologies such as high resolution peripheral quantitative computed tomography (HRpQCT) also predict fracture risk. HRpQCT measures a number of bone characteristics that may inform specific patterns of bone deficits. We used cluster analysis to define different bone phenotypes and their relationships to fracture prevalence and areal bone mineral density (BMD). 177 men and 159 women, in whom fracture history was determined by self-report and vertebral fracture assessment, underwent HRpQCT of the distal radius and femoral neck DXA. Five clusters were derived with two clusters associated with elevated fracture risk. "Cluster 1" contained 26 women (50.0% fractured) and 30 men (50.0% fractured) with a lower mean cortical thickness and cortical volumetric BMD, and in men only, a mean total and trabecular area more than the sex-specific cohort mean. "Cluster 2" contained 20 women (50.0% fractured) and 14 men (35.7% fractured) with a lower mean trabecular density and trabecular number than the sex-specific cohort mean. Logistic regression showed fracture rates in these clusters to be significantly higher than the lowest fracture risk cluster [5] (p<0.05). Mean femoral neck areal BMD was significantly lower than cluster 5 in women in cluster 1 and 2 (p<0.001 for both), and in men, in cluster 2 (p<0.001) but not 1 (p=0.220). In conclusion, this study demonstrates two distinct high risk clusters in both men and women which may differ in etiology and response to treatment. As cluster 1 in men does not have low areal BMD, these men may not be identified as high risk by conventional DXA alone.
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Affiliation(s)
- M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom
| | - D E Robinson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom
| | - K A Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, United Kingdom
| | - M K Javaid
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 5UG, United Kingdom
| | - K Walker-Bone
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom; NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 5UG, United Kingdom; NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton SO16 6YD, United Kingdom.
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, United Kingdom; Victoria University, Wellington, New Zealand
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Firth J, Snowden N, Ledingham J, Rivett A, Galloway J, Dennison EM, MacPhie E, Ide Z, Rowe I, Kandala N, Jameson K. The first national clinical audit for rheumatoid arthritis. Br J Nurs 2016; 25:613-7. [PMID: 27281595 PMCID: PMC4941919 DOI: 10.12968/bjon.2016.25.11.613] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The first national audit for rheumatoid and early inflammatory arthritis has benchmarked care for the first 3 months of follow-up activity from first presentation to a rheumatology service. Access to care, management of early rheumatoid arthritis and support for self care were measured against National Institute for Health and Care Excellence quality standards; impact of early arthritis and experience of care were measured using patient-reported outcome and experience measures. The results demonstrate delays in referral and accessing specialist care and the need for service improvement in treating to target, suppression of high levels of disease activity and support for self-care. Improvements in patient-reported outcomes within 3 months and high levels of overall satisfaction were reported but these results were affected by low response rates. This article presents a summary of the national data from the audit and discusses the implications for nursing practice.
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Affiliation(s)
- J Firth
- Consultant Nurse Rheumatology and Director for Service Improvement, Pennine MSK Partnership, Oldham
| | - N Snowden
- Consultant Rheumatologist, Pennine MSK Partnership, Oldham
| | - J Ledingham
- Consultant Rheumatologist, Portsmouth Hospitals NHS Trust
| | - A Rivett
- Director of Clinical Affairs, British Society for Rheumatology, London
| | - J Galloway
- Consultant Rheumatologist, Kings College Hospital, London
| | - E M Dennison
- Professor of Musculoskeletal Epidemiology and Honorary Consultant in Rheumatology, MRC Lifecourse Epidemiology Unit, Southampton University
| | - E MacPhie
- Consultant Rheumatologist, Lancashire Care NHS Foundation Trust, Preston
| | - Z Ide
- Patient representative, Project Working Group, British Society for Rheumatology, London
| | - I Rowe
- Consultant Rheumatologist, c/o British Society for Rheumatology, London
| | - N Kandala
- Statisticians, MRC Lifecourse Epidemiology Unit, Southampton Universitys
| | - K Jameson
- Statisticians, MRC Lifecourse Epidemiology Unit, Southampton Universitys
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van Schoor NM, Zambon S, Castell MV, Cooper C, Denkinger M, Dennison EM, Edwards MH, Herbolsheimer F, Maggi S, Sánchez-Martinez M, Pedersen NL, Peter R, Schaap LA, Rijnhart JJM, van der Pas S, Deeg DJH. Impact of clinical osteoarthritis of the hip, knee and hand on self-rated health in six European countries: the European Project on OSteoArthritis. Qual Life Res 2016; 25:1423-32. [PMID: 26547441 PMCID: PMC4870285 DOI: 10.1007/s11136-015-1171-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE Osteoarthritis (OA) has been shown to be associated with decreased physical function, which may impact upon a person's self-rated health (SRH). Only a few studies have examined the association between OA and SRH in the general population, but to date none have used a clinical definition of OA. The objectives are: (1) To examine the cross-sectional association between clinical OA and fair-to-poor SRH in the general population; (2) To examine whether this association differs between countries; (3) To examine whether physical function is a mediator in the association between clinical OA and SRH. METHODS Baseline data of the European Project on OSteoArthritis (EPOSA) were used, which includes pre-harmonized data from six European cohort studies (n = 2709). Clinical OA was defined according to the American College of Rheumatology criteria. SRH was assessed using one question: How is your health in general? Physical function was assessed using the Western Ontario and McMaster Universities OA Index and Australian/Canadian OA Hand Index. RESULTS The prevalence of fair-to-poor SRH ranged from 19.8 % in the United Kingdom to 63.5 % in Italy. Although country differences in the strength of the associations were observed, clinical OA of the hip, knee and hand were significantly associated with fair-to-poor SRH in five out of six European countries. In most countries and at most sites, the association between clinical OA and fair-to-poor SRH was partly or fully mediated by physical function. CONCLUSIONS Clinical OA at different sites was related to fair-to-poor SRH in the general population. Most associations were (partly) mediated by physical functioning, indicating that deteriorating physical function in patients with OA should be a point of attention in patient care.
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Affiliation(s)
- N M van Schoor
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - S Zambon
- Department of Medical and Surgical Sciences, University of Padova, Padua, Italy
- National Research Council, Aging Branch, Institute of Neuroscience, Padua, Italy
| | - M V Castell
- Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
| | - M Denkinger
- Bethesda Geriatric Clinic, University of Ulm, Ulm, Germany
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, Southampton, UK
| | - F Herbolsheimer
- Institute of the History, Philosophy and Ethics of Medicine, University of Ulm, Ulm, Germany
| | - S Maggi
- National Research Council, Aging Branch, Institute of Neuroscience, Padua, Italy
| | - M Sánchez-Martinez
- Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Madrid, Spain
| | - N L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - R Peter
- Institute of the History, Philosophy and Ethics of Medicine, University of Ulm, Ulm, Germany
| | - L A Schaap
- Department of Health Sciences, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - J J M Rijnhart
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - S van der Pas
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - D J H Deeg
- Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center Research, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Litwic AE, Clynes M, Denison HJ, Jameson KA, Edwards MH, Sayer AA, Taylor P, Cooper C, Dennison EM. Non-invasive Assessment of Lower Limb Geometry and Strength Using Hip Structural Analysis and Peripheral Quantitative Computed Tomography: A Population-Based Comparison. Calcif Tissue Int 2016; 98:158-64. [PMID: 26590812 PMCID: PMC4723614 DOI: 10.1007/s00223-015-0081-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/06/2015] [Indexed: 11/27/2022]
Abstract
Hip fracture is the most significant complication of osteoporosis in terms of mortality, long-term disability and decreased quality of life. In the recent years, different techniques have been developed to assess lower limb strength and ultimately fracture risk. Here we examine relationships between two measures of lower limb bone geometry and strength; proximal femoral geometry and tibial peripheral quantitative computed tomography. We studied a sample of 431 women and 488 men aged in the range 59-71 years. The hip structural analysis (HSA) programme was employed to measure the structural geometry of the left hip for each DXA scan obtained using a Hologic QDR 4500 instrument while pQCT measurements of the tibia were obtained using a Stratec 2000 instrument in the same population. We observed strong sex differences in proximal femoral geometry at the narrow neck, intertrochanteric and femoral shaft regions. There were significant (p < 0.001) associations between pQCT-derived measures of bone geometry (tibial width; endocortical diameter and cortical thickness) and bone strength (strength strain index) with each corresponding HSA variable (all p < 0.001) in both men and women. These results demonstrate strong correlations between two different methods of assessment of lower limb bone strength: HSA and pQCT. Validation in prospective cohorts to study associations of each with incident fracture is now indicated.
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Affiliation(s)
- A E Litwic
- MRC Lifecourse Epidemiology Unit, (University of Southampton) Southampton General Hospital, Southampton, SO16 6YD, UK
| | - M Clynes
- MRC Lifecourse Epidemiology Unit, (University of Southampton) Southampton General Hospital, Southampton, SO16 6YD, UK
| | - H J Denison
- MRC Lifecourse Epidemiology Unit, (University of Southampton) Southampton General Hospital, Southampton, SO16 6YD, UK
| | - K A Jameson
- MRC Lifecourse Epidemiology Unit, (University of Southampton) Southampton General Hospital, Southampton, SO16 6YD, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, (University of Southampton) Southampton General Hospital, Southampton, SO16 6YD, UK
| | - A A Sayer
- MRC Lifecourse Epidemiology Unit, (University of Southampton) Southampton General Hospital, Southampton, SO16 6YD, UK
- Institute for Ageing and Institute of Health & Society, Newcastle University, Callaghan, Australia
| | - P Taylor
- MRC Lifecourse Epidemiology Unit, (University of Southampton) Southampton General Hospital, Southampton, SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, (University of Southampton) Southampton General Hospital, Southampton, SO16 6YD, UK
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, (University of Southampton) Southampton General Hospital, Southampton, SO16 6YD, UK.
- Victoria University of Wellington, Wellington, New Zealand.
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Abstract
Sarcopenia is common in later life and may be associated with adverse health outcomes such as disability, falls and fracture. There is no consensus definition for its diagnosis although diagnostic algorithms have been proposed by the European Working Group for Sarcopenia in Older People (EWGSOP), the International Working Group on Sarcopenia (IWGS) and the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). More recently, Binkley and colleagues devised a score-based system for the diagnosis of "dysmobility syndrome" in an attempt to combine adverse musculoskeletal phenotypes, including sarcopenia and osteoporosis, in order to identify older individuals at particular risk. We applied these criteria to participants from the Hertfordshire Cohort Study to define their prevalence in an unselected cohort of UK community-dwelling older adults and assess their relationships with previous falls and fracture. Body composition and areal bone mineral density were measured using dual-energy X-ray absorptiometry, gait speed was determined by a 3-m walk test and grip strength was assessed with a Jamar hand-held dynamometer. Researcher-administered questionnaires were completed detailing falls and fracture history. The prevalence of sarcopenia in this cohort was 3.3, 8.3 and 2.0% using the EWGSOP, IWGS and related definition of FNIH, respectively; 24.8% of individuals had dysmobility syndrome. Individuals with dysmobility reported significantly higher number of falls (last year and since the age of 45 years) (p < 0.01) than those without it, but no increased fracture rate was observed in this group (p = 0.96). Those with sarcopenia as defined by the IWGS reported significantly higher falls in the last year and prevalent fractures (falls in the last year: OR 2.51; CI 1.09-5.81; p = 0.03; fractures OR 2.50; CI 1.05-5.92; p = 0.04) but these significant associations were not seen when the EWGSOP definition was applied. The IWGS definition of sarcopenia appears to be an effective means of identifying individuals at risk of prevalent adverse musculoskeletal events.
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Affiliation(s)
- M A Clynes
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - B Buehring
- University of Wisconsin Osteoporosis Research Program, Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 2870 University Ave, Suite 100, Madison, WI, 53705, USA
- GRECC, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- Victoria University, Wellington, New Zealand
| | - N Binkley
- University of Wisconsin Osteoporosis Research Program, Division of Geriatrics and Gerontology, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 2870 University Ave, Suite 100, Madison, WI, 53705, USA
- GRECC, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI, 53705, USA
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, OX3 5UG, UK.
- NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton, SO16 6YD, UK.
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Abstract
Osteoporosis and sarcopenia are common in older age and associated with significant morbidity and mortality. Consequently, they are both attended by a considerable socioeconomic burden. Osteoporosis was defined by the World Health Organisation (WHO) in 1994 as a bone mineral density of less than 2.5 standard deviations below the sex-specific young adult mean and this characterisation has been adopted globally. Subsequently, a further step forward was taken when bone mineral density was incorporated into fracture risk prediction algorithms, such as the Fracture Risk Assessment Tool (FRAX®) also developed by the WHO. In contrast, for sarcopenia there have been several diagnostic criteria suggested, initially relating to low muscle mass alone and more recently low muscle mass and muscle function. However, none of these have been universally accepted. This has led to difficulties in accurately delineating the burden of disease, exploring geographic differences, and recruiting appropriate subjects to clinical trials. There is also uncertainty about how improvement in sarcopenia should be measured in pharmaceutical trials. Reasons for these difficulties include the number of facets of muscle health available, e.g. mass, strength, function, and performance, and the various clinical outcomes to which sarcopenia can be related such as falls, fracture, disability and premature mortality. It is imperative that a universal definition of sarcopenia is reached soon to facilitate greater progress in research into this debilitating condition. This article is part of a Special Issue entitled "Muscle Bone Interactions".
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Affiliation(s)
- M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK; Victoria University, Wellington, New Zealand
| | - A Aihie Sayer
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
| | - R Fielding
- Nutrition, Exercise Physiology and Sarcopenia Laboratory, Jean Mayer Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford OX3 5UG, UK; NIHR Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton General Hospital, Southampton SO16 6YD, UK.
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Denison HJ, Dennison EM, Jutel A. P03.12 Recruiting to sexual health studies: possible strategies identified through focus group discussions. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Denison HJ, Jutel A, Patel H, Dennison EM. P03.11 Knowledge about sexually transmitted infections among a new zealand university population. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Paccou J, Edwards MH, Ward KA, Jameson KA, Moss CL, Harvey NC, Dennison EM, Cooper C. Ischemic heart disease is associated with lower cortical volumetric bone mineral density of distal radius. Osteoporos Int 2015; 26:1893-901. [PMID: 25906240 DOI: 10.1007/s00198-015-3132-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 04/07/2015] [Indexed: 10/23/2022]
Abstract
UNLABELLED In this study, high-resolution peripheral quantitative computed tomography (HR-pQCT) was used to investigate geometric, volumetric and microstructural parameters at the distal radius and at the distal tibia in participants with ischaemic heart disease. We found that, compared with participants without ischaemic heart disease, they had substantially lower cortical volumetric bone mineral density (BMD) at the distal radius. INTRODUCTION HR-pQCT captures novel aspects of bone geometry and volumetric bone mineral density (vBMD) and offers the ability to measure bone microarchitecture, but data relating measures obtained from this technique in patients with ischemic heart disease (IHD) are lacking. METHODS Here, we report an analysis from the Hertfordshire Cohort Study, where we were able to study associations between measures obtained from HR-pQCT of distal radius and distal tibia in 350 participants (184 men and 166 women) aged 71.5-80.5 years with or without IHD (e.g. heart attack, angina or heart failure; n = 75 and n = 275, respectively). RESULTS Analyses for all participants (men and women together) revealed that cortical vBMD (Ct.vBMD) was lower (p < 0.001) and cortical thickness (Ct.th) was not different (p = 0.519), whereas cortical porosity (Ct.Po) was higher (p = 0.016) in participants with IHD at the distal radius. Moreover, trabecular microarchitectural parameters were not significantly different in patients with IHD (p > 0.05 for all). Adjustment for a priori confounders (age, gender, body mass index, smoking status, alcohol consumption, high blood pressure and diabetes mellitus) did not materially affect the relationship described for Ct.vBMD (p = 0.002), but differences in Ct.Po were attenuated. Analyses in men alone revealed that only Ct.vBMD was lower at the distal radius in participants with IHD with and without adjustment for a priori confounders (p = 0.0002 and p = 0.004, respectively), whereas no statistical differences were found in women, although patterns of differences were similar in both sexes. Moreover, no association was found between IHD and bone parameters at the distal tibia either in men or women. CONCLUSIONS We have demonstrated that IHD is associated with lower Ct.vBMD of the distal radius.
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Affiliation(s)
- J Paccou
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, UK
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Dulay GS, Cooper C, Dennison EM. Knee pain, knee injury, knee osteoarthritis & work. Best Pract Res Clin Rheumatol 2015; 29:454-61. [PMID: 26612241 DOI: 10.1016/j.berh.2015.05.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/07/2015] [Indexed: 01/06/2023]
Abstract
Symptomatic knee osteoarthritis (OA) can be viewed as the end result of a molecular cascade which ensues after certain triggers occur and ultimately results in irreversible damage to the articular cartilage. The clinical phenotype that knee OA can produce is variable and often difficult to accurately predict. This is further complicated by the often poor relationship between radiographic OA and knee pain. As a consequence, it can be difficult to compare studies that use different definitions of OA. However, the literature suggests that while there are multiple causes of knee OA, two have attracted particular attention over recent years; occupation related knee OA and OA subsequent to previous knee injury. The evidence of a relationship, and the strength of this association, is discussed in this chapter.
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Affiliation(s)
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK; Victoria University, Wellington, New Zealand.
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Hardcastle SA, Dieppe P, Gregson CL, Arden NK, Spector TD, Hart DJ, Edwards MH, Dennison EM, Cooper C, Sayers A, Williams M, Davey Smith G, Tobias JH. Individuals with high bone mass have an increased prevalence of radiographic knee osteoarthritis. Bone 2015; 71:171-9. [PMID: 25445455 PMCID: PMC4289915 DOI: 10.1016/j.bone.2014.10.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/13/2014] [Accepted: 10/23/2014] [Indexed: 02/02/2023]
Abstract
We previously reported an association between high bone mass (HBM) and a bone-forming phenotype of radiographic hip osteoarthritis (OA). As knee and hip OA have distinct risk factors, in this study we aimed to determine (i) whether HBM is also associated with knee OA, and (ii) whether the HBM knee OA phenotype demonstrates a similar pattern of radiographic features to that observed at the hip. HBM cases (defined by DXA BMD Z-scores) from the UK-based HBM study were compared with unaffected family controls and general population controls from the Chingford and Hertfordshire cohort studies. A single blinded observer graded AP weight-bearing knee radiographs for features of OA (Kellgren-Lawrence score, osteophytes, joint space narrowing (JSN), sclerosis) using an atlas. Analyses used logistic regression, adjusting a priori for age and gender, and additionally for BMI as a potential mediator of the HBM-OA association, using Stata v12. 609 HBM knees in 311 cases (mean age 60.8years, 74% female) and 1937 control knees in 991 controls (63.4years, 81% female) were analysed. The prevalence of radiographic knee OA, defined as Kellgren-Lawrence grade≥2, was increased in cases (31.5% vs. 20.9%), with age and gender adjusted OR [95% CI] 2.38 [1.81, 3.14], p<0.001. The association between HBM and osteophytosis was stronger than that for JSN, both before and after adjustment for BMI which attenuated the ORs for knee OA and osteophytes in cases vs. controls by approximately 50%. Our findings support a positive association between HBM and knee OA. This association was strongest for osteophytes, suggesting HBM confers a general predisposition to a subtype of OA characterised by increased bone formation.
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Affiliation(s)
- S A Hardcastle
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK; MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, UK.
| | - P Dieppe
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK; University of Exeter Medical School, Exeter, UK
| | - C L Gregson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
| | - N K Arden
- Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Arthritis Research UK (ARUK) Centre for Sports, Exercise and Osteoarthritis, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - T D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - D J Hart
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Cooper
- Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK
| | - A Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
| | - M Williams
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | - G Davey Smith
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, UK
| | - J H Tobias
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
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Denison HJ, Jameson KA, Baird J, Arora T, Patel HP, Edwards MH, Aihie Sayer A, Dennison EM, Cooper C. PP56 Poor sleep quality and physical performance in older adults. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cooper R, Benzeval M, Deary IJ, Dennison EM, Der G, Gale CR, Inskip HM, Jagger C, Kirkwood TB, Lawlor DA, Robinson SM, Starr JM, Steptoe A, Tilling K, Kuh D, Cooper C, Aihie Sayer A, Dodds RM, Syddall HE. OP02 Grip strength across the life course: normative data from twelve British studies. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dennison EM, Jameson KA, Edwards MH, Denison HJ, Aihie Sayer A, Cooper C. Peripheral quantitative computed tomography measures are associated with adult fracture risk: the Hertfordshire Cohort Study. Bone 2014; 64:13-7. [PMID: 24680720 DOI: 10.1016/j.bone.2014.03.040] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 03/16/2014] [Accepted: 03/18/2014] [Indexed: 11/16/2022]
Abstract
Peripheral quantitative computed tomography (pQCT) captures novel aspects of bone geometry that may contribute to fracture risk and offers the ability to measure both volumetric bone mineral density (vBMD) and a separation of trabecular and cortical compartments of bone, but longitudinal data relating measures obtained from this technique to incident fractures are lacking. Here we report an analysis from the Hertfordshire Cohort Study, where we were able to study associations between measures obtained from pQCT and DXA in 182 men and 202 women aged 60-75 years at baseline with incident fractures over 6 years later. Among women, radial cortical thickness (HR 1.72, 95% CI 1.16, 2.54, p=0.007) and cortical area (HR 1.91, 95% CI 1.27, 2.85, p=0.002) at the 66% slice were both associated with incident fractures; these results remained significant after adjustment for confounders (age, BMI, social class, cigarette smoking and alcohol consumption, physical activity, dietary calcium, HRT and years since menopause). Further adjustment for aBMD made a little difference to the results. At the tibia, cortical area (HR 1.58, 95% CI 1.10, 2.28, p=0.01), thickness (HR 1.49, 95% CI 1.08, 2.07, p=0.02) and density (HR 1.64, 95% CI 1.18, 2.26, p=0.003) at the 38% site were all associated with incident fractures with the cortical area and density relationships remaining robust to adjustment for the confounders listed above. Further adjustment for aBMD at this site did lead to attenuation of relationships. Among men, tibial stress-strain index (SSI) was predictive of incident fractures (HR 2.30, 95% CI 1.28, 4.13, p=0.005). Adjustment for confounding variables and aBMD did not render this association non-significant. In conclusion, we have demonstrated relationships between measures of bone size, density and strength obtained by pQCT and incident fracture. These relationships were attenuated but in some cases remained significant after adjustment for BMD measures obtained by DXA, suggesting that some additional information may be conferred by this assessment.
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Affiliation(s)
- E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK; Victoria University, Wellington, New Zealand.
| | - K A Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
| | - H J Denison
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
| | - A Aihie Sayer
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK
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Azagra R, López-Expósito F, Martin-Sánchez JC, Aguyé A, Moreno N, Cooper C, Díez-Pérez A, Dennison EM. Changing trends in the epidemiology of hip fracture in Spain. Osteoporos Int 2014; 25:1267-74. [PMID: 24322478 PMCID: PMC4890654 DOI: 10.1007/s00198-013-2586-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 11/18/2013] [Indexed: 01/08/2023]
Abstract
UNLABELLED Temporal trends in hip fracture incidence have recently been reported in some developed countries. Such data in Spain has previously been incomplete; this study reports the stratified incidence of hip fractures in people over 65 in Spain during the last 14 years. INTRODUCTION The main objective is to establish whether temporal trends in hip fracture incidence in Spain exist. METHODS Ecological study with data from hospital discharges nationwide. The study includes patients aged ≥ 65 years during a 14-year period (1997-2010). The analysis compares two periods of four years: 1997-2000 (P1) and 2007-2010 (P2). RESULTS There were 119,857 fractures in men and 415,421 in women. Comparing periods (P1 vs P2) over 10 years, the crude incidence rate/100,000 inhabitant/year increased an average of 2.3%/year in men and 1.4% in women. After adjustment, the rate increased an average of 0.4%/year in men (p < 0.0001), but decreased 0.2%/year in women (p < 0.0001). In men, younger than 85, the decrease was not significant except in 70-74 years, and from 80 years, the adjusted rate increases significantly (p < 0.0001). In women under 80 years of age, the decrease in adjusted rate was significant; there was no change in 80-84 years, and the adjusted rate increased significantly in individuals 85 years and older (p < 0.0001). Mortality rates declined by 22% in both sexes, and the index of overaging population rises 30.1 % in men and 25.2% in women. CONCLUSIONS This study supports other international studies by showing changes in the incidence of hip fractures after age-population adjustment, which denotes a decrease in the younger age groups and among women and shows an increase in both groups over 85 years. The increase in the crude incidence rate of hip fracture in Spain reflects changes in population structure.
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Affiliation(s)
- R Azagra
- Department of Medicine, Universitat Autònoma de Barcelona, ps/ Vall d' Hebron 119, 08135, Barcelona, Spain,
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Walker-Bone K, D'Angelo S, Syddall HE, Palmer KT, Cooper C, Coggon D, Dennison EM. Exposure to heavy physical occupational activities during working life and bone mineral density at the hip at retirement age. Occup Environ Med 2014; 71:329-31. [PMID: 24619156 DOI: 10.1136/oemed-2013-101967] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND People in sedentary occupations are at increased risk of hip fracture. Hip fracture is significantly associated with low bone mineral density (BMD) measured at the hip. Physical activity is important in the development and maintenance of BMD, but the effects of occupational physical activity on bone health are unclear. We investigated the influence of lifetime physical activity on BMD at the hip. METHODS This was a cross-sectional epidemiological study of the associations between total hip BMD measured by dual-energy X-ray absorptiometry at retirement age and lifetime exposure to occupational physical workload (standing/walking ≥4 h/day; lifting ≥25 kg; energetic work sufficient to induce sweating and manual work). RESULTS Complete data on occupational exposures were available for 860 adults (488 men and 372 women) who had worked ≥20 years. Their mean age was 65 years, and many reported heavy physical workplace activities over prolonged durations. There were no statistically significant associations between total hip BMD and any of these measures of lifetime occupational physical activity in men or women. CONCLUSIONS Lifetime cumulative occupational activity was not associated with hip BMD at retirement age. Our findings suggest that, if sedentary work conveys an increased risk of hip fracture, it is unlikely that the mechanism is through reductions in BMD at the hip and may relate to other physical effects, such as falls risk. Further studies will be needed to test this hypothesis.
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Affiliation(s)
- K Walker-Bone
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
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50
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Okubo H, Syddall HE, Phillips DIW, Sayer AA, Dennison EM, Cooper C, Robinson SM. Dietary total antioxidant capacity is related to glucose tolerance in older people: the Hertfordshire Cohort Study. Nutr Metab Cardiovasc Dis 2014; 24:301-308. [PMID: 24370447 PMCID: PMC4112602 DOI: 10.1016/j.numecd.2013.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/30/2013] [Accepted: 08/05/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Dietary antioxidants may play a protective role in the aetiology of type 2 diabetes. However, observational studies that examine the relationship between the antioxidant capacity of the diet and glucose metabolism are limited, particularly in older people. We aimed to examine the relationships between dietary total antioxidant capacity (TAC) and markers of glucose metabolism among 1441 men and 1253 women aged 59-73 years who participated in the Hertfordshire Cohort Study, UK. METHODS AND RESULTS Diet was assessed by food frequency questionnaire. Dietary TAC was estimated using published databases of TAC measured by four different assays: oxygen radical absorbance capacity (ORAC), ferric-reducing ability of plasma (FRAP), total radical-trapping antioxidant parameter (TRAP) and trolox equivalent antioxidant capacity (TEAC). Fasting and 120-min plasma glucose and insulin concentrations were measured during a standard 75-g oral glucose tolerance test. In men, dietary TAC estimated by all four assays was inversely associated with fasting insulin concentration and homoeostasis model assessment of insulin resistance (HOMA-IR); with the exception of ORAC, dietary TAC was also inversely related to 120-min glucose concentration. There were no associations with fasting glucose or 120-min insulin concentrations. In women, with the exception of the association between ORAC and 120-min insulin concentration, dietary TAC estimated by all assays showed consistent inverse associations with fasting and 120-min glucose and insulin concentrations and HOMA-IR. These associations were more marked among women with BMI ≥ 30 kg/m(2). CONCLUSION These findings suggest dietary TAC may have important protective effects on glucose tolerance, especially in older obese women.
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Affiliation(s)
- H Okubo
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Department of Social and Preventive Epidemiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - H E Syddall
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - D I W Phillips
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - A A Sayer
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - S M Robinson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
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