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Guðmundsdóttir SL, Berger C, Macdonald H, Adachi JD, Hopman WM, Kaiser SM, Kovacs CS, Davison KS, Morin SN, Goltzman D, Prior JC. Sedentary behavior does not predict low BMD nor fracture-population-based Canadian Multicentre Osteoporosis Study. J Bone Miner Res 2024; 39:231-240. [PMID: 38477796 DOI: 10.1093/jbmr/zjae004] [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: 05/24/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 03/14/2024]
Abstract
Sedentary behavior (SB) or sitting is associated with multiple unfavorable health outcomes. Bone tissue responds to imposed gravitational and muscular strain with there being some evidence suggesting a causal link between SB and poor bone health. However, there are no population-based data on the longitudinal relationship between SB, bone change, and incidence of fragility fractures. This study aimed to examine the associations of sitting/SB (defined as daily sitting time), areal BMD (by DXA), and incident low trauma (fragility) osteoporotic fractures (excluding hands, feet, face, and head). We measured baseline (1995-7) and 10-yr self-reported SB, femoral neck (FN), total hip (TH), and lumbar spine (L1-L4) BMD in 5708 women and 2564 men aged 25 to 80+ yr from the population-based, nationwide, 9-center Canadian Multicentre Osteoporosis Study. Incident 10-yr fragility fracture data were obtained from 4624 participants; >80% of fractures were objectively confirmed by medical records or radiology reports. Vertebral fractures were confirmed by qualitative morphological methods. All analyses were stratified by sex. Multivariable regression models assessed SB-BMD relationships; Cox proportional models were fit for fracture risk. Models were adjusted for age, height, BMI, physical activity, and sex-specific covariates. Women in third/fourth quartiles had lower adjusted FN BMD versus women with the least SB (first quartile); women in the SB third quartile had lower adjusted TH BMD. Men in the SB third quartile had lower adjusted FN BMD than those in SB first quartile. Neither baseline nor stable 10-yr SB was related to BMD change nor to incident fragility fractures. Increased sitting (SB) in this large, population-based cohort was associated with lower baseline FN BMD. Stable SB was not associated with 10-yr BMD loss nor increased fragility fracture. In conclusion, habitual adult SB was not associated with subsequent loss of BMD nor increased risk of fracture.
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Affiliation(s)
- Sigríður Lára Guðmundsdóttir
- School of Education, Department of Health Promotion, Sport and Leisure Studies, University of Iceland, 101 Reykjavik, Iceland
| | - Claudie Berger
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, Canada
| | - Heather Macdonald
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada
- Active Aging Research Team, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | - Wilma M Hopman
- Kingston General Hospital Research Institute, Kingston Health Sciences Centre, Kingston, ON K7L 2V7, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Stephanie M Kaiser
- Department of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Christopher S Kovacs
- Discipline of Medicine/Endocrinology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL A1B 3V6, Canada
| | | | - Suzanne N Morin
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, Canada
- Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - David Goltzman
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, Canada
- Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Jerilynn C Prior
- Division of Endocrinology, Department of Medicine, Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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King EM, Swann SA, Prior JC, Berger C, Mayer U, Pick N, Campbell AR, Côté HCF, Murray MCM. Vitamin D intakes among women living with and without HIV in Canada. HIV Med 2023; 24:628-639. [PMID: 36597960 DOI: 10.1111/hiv.13454] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/06/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Patterns of vitamin D intake are relatively unexplored among women living with HIV, despite its importance for women's health. We compared vitamin D dietary and supplement intakes in women with HIV and population-based national controls and investigated barriers to intake. METHODS In this case-control study, women with HIV in the Children and Women: AntiRetrovirals and Markers of Aging (CARMA) cohort were matched with Canadian Multicentre Osteoporosis Study (CaMos) controls. Participants were queried for vitamin D in dairy consumption, supplementation/dosage, and sociodemographic variables. We assessed barriers to supplementation and factors associated with dietary intake by regression modelling. RESULTS Ninety-five women living with HIV were age-matched to 284 controls. Women with HIV had lower income and bone mineral density and were more likely to smoke, take multiple medications and be non-white. Vitamin D dietary intake was lower in women living with HIV versus controls [0.76 vs. 1.79 μg/day; adjusted odds ratio (aOR) for greater than or equal to median intake 0.29 (0.12-0.61), p = 0.002], but any supplementation was higher [62.2% vs. 44.7%; aOR = 3.44 (95% CI: 1.16-11.00), p = 0.03]. Total vitamin D intake was similar between groups. Smoking was associated with no supplementation; non-white ethnicity and low income were related to lower dietary intake. CONCLUSIONS Women living with HIV showed lower dietary vitamin D intake but higher supplementation rates, suggesting that care providers are promoting supplementation. Women living with HIV who smoke, have low incomes and are non-white may particularly benefit from targeted efforts to improve vitamin D intake.
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Affiliation(s)
- Elizabeth M King
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.,Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Shayda A Swann
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Experimental Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerilynn C Prior
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Centre for Menstrual Cycle and Ovulation Research, Endocrinology and Metabolism, University of British Columbia, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claudie Berger
- Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Ulrike Mayer
- Women's Health Research Institute, Vancouver, British Columbia, Canada
| | - Neora Pick
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Amber R Campbell
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hélène C F Côté
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melanie C M Murray
- Women's Health Research Institute, Vancouver, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
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Papaioannou A, Adachi JD, Berger C, Jiang Y, Barron R, McGinley JS, Wirth RJ, Anastassiades TP, Davison KS, Hanley DA, Ioannidis G, Kaiser SM, Kovacs CS, Leslie WD, Morin SN, Prior JC, Towheed T, Goltzman D. Testing a theoretical model of imminent fracture risk in elderly women: an observational cohort analysis of the Canadian Multicentre Osteoporosis Study. Osteoporos Int 2020; 31:1145-1153. [PMID: 32034452 DOI: 10.1007/s00198-020-05330-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
UNLABELLED We examined the underlying relationship between fracture risk factors and their imminent risk. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher imminent fracture risk. Past year falls indirectly predicted imminent risk through physical functioning and general health. INTRODUCTION This study aimed to examine direct and indirect effects of several factors on imminent (1 year) fracture risk. METHODS Data from women age 65 and older from population-based Canadian Multicentre Osteoporosis Study were used. Predictors were identified from study years 5 and 10, and imminent fracture data (1-year fracture) came from years 6 and 11 (year 5 predicts year 6, year 10 predicts year 11). A structural equation model (SEM) was used to test the theoretical construct. General health and physical functioning were measured as latent variables using items from the 36-Item Short Form Health Survey (SF-36) and bone mineral density (BMD) T-score was a latent variable based on observed site-specific BMD data (spine L1-L4, femoral neck, total hip). Observed variables were fractures and falls. Model fit was evaluated using root mean square error of approximation (RMSEA), Tucker Lewis index (TLI), and comparative fit index (CFI). RESULTS The analysis included 3298 women. Model fit tests showed that the SEM fit the data well; χ2(172) = 1122.10 < .001, RMSEA = .03, TLI = .99, CFI = .99. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher risk of fracture in the subsequent year (p < .001). Past year falls had a statistically significant but indirect effect on imminent fracture risk through physical functioning and general health (p < .001). CONCLUSIONS We found several direct and indirect pathways that predicted imminent fracture risk in elderly women. Future studies should extend this work by developing risk scoring methods and defining imminent risk thresholds.
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Affiliation(s)
| | - J D Adachi
- McMaster University, Hamilton, ON, Canada
| | - C Berger
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Y Jiang
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
| | - R Barron
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - J S McGinley
- Vector Psychometric Group, LLC, Chapel Hill, NC, USA
| | - R J Wirth
- Vector Psychometric Group, LLC, Chapel Hill, NC, USA
| | | | - K S Davison
- University of Victoria, Victoria, BC, Canada
| | - D A Hanley
- Cumming School of Medicine, University of Calgary, Calgary, AL, Canada
| | | | - S M Kaiser
- Dalhousie University, Halifax, NS, Canada
| | - C S Kovacs
- Memorial University of Newfoundland, St. John's, NL, Canada
| | - W D Leslie
- University of Manitoba, Winnipeg, MB, Canada
| | - S N Morin
- McGill University, Montreal, QC, Canada
| | - J C Prior
- University of British Columbia, Vancouver, BC, Canada
| | - T Towheed
- Queen's University, Kingston, ON, Canada
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Hopman WM, Berger C, Joseph L, Morin SN, Towheed T, Anastassiades T, Adachi JD, Hanley DA, Prior JC, Goltzman D. Longitudinal assessment of health-related quality of life in osteoporosis: data from the population-based Canadian Multicentre Osteoporosis Study. Osteoporos Int 2019; 30:1635-1644. [PMID: 31069440 DOI: 10.1007/s00198-019-05000-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/22/2019] [Indexed: 01/22/2023]
Abstract
UNLABELLED Little is known about the association between health-related quality of life (HRQOL) and osteoporosis in the absence of fracture, and how HRQOL may change over time. This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. INTRODUCTION Fragility fractures have a detrimental effect on the health-related quality of life (HRQOL) of those with osteoporosis. Less is known about the association between HRQOL and osteoporosis in the absence of fracture. METHODS Canadian Multicentre Osteoporosis Study participants completed the SF-36, a detailed health questionnaire and measures of bone mineral density (BMD) at baseline and follow-up. We report the results of participants ≥ 50 years with 10-year follow-up. Self-reported osteoporosis at baseline and BMD-based osteoporosis at follow-up were ascertained. Multivariable linear regression models were developed for baseline SF-36 domains, component summaries, and change over time, adjusting for relevant baseline information. RESULTS Baseline data were available for 5266 women and 2112 men. Women in the osteoporosis group had substantially lower SF-36 baseline scores, particularly in the physically oriented domains, than those without osteoporosis. A similar but attenuated pattern was evident for the men. After 10-year follow-up (2797 women and 1023 men), most domain scores dropped for women and men regardless of osteoporosis status, with the exception of mentally-oriented ones. In general, a fragility fracture was associated with lower SF-36 scores and larger declines over time. CONCLUSIONS This study provides evidence of substantially reduced HRQOL in women and men with self-reported and/or BMD-confirmed osteoporosis, even in the absence of fragility fracture. HRQOL should be thoroughly investigated even prior to fracture, to develop appropriate interventions for all stages of the disease.
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Affiliation(s)
- W M Hopman
- Kingston General Health Research Institute, Kingston Health Sciences Centre, Kingston, Ontario, Canada.
- Department of Public Health Sciences, Faculty of Medicine, Queen's University, Kingston, Ontario, Canada.
| | - C Berger
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - L Joseph
- Department of Epidemiology and Biostatistics, McGill University, Montreal, QC, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montréal, QC, Canada
| | - T Towheed
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - T Anastassiades
- Division of Rheumatology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - D A Hanley
- McCaig Institute for Bone & Joint Health, University of Calgary, Calgary, AB, Canada
| | - J C Prior
- Department of Medicine/Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - D Goltzman
- Department of Medicine, McGill University, Montréal, QC, Canada
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