Neil Binkley

University of Wisconsin–Madison, Madison, Wisconsin, United States

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Publications (269)875.8 Total impact

  • Osteoporosis International 09/2015; DOI:10.1007/s00198-015-3318-4 · 4.17 Impact Factor
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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.
    Calcified Tissue International 07/2015; DOI:10.1007/s00223-015-0044-z · 3.27 Impact Factor
  • Neil Binkley · Cyrus Cooper
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    ABSTRACT: In this issue of the Journal of Clinical Densitometry, articles consider sarcopenia epidemiology, current and future approaches to diagnosis, tools to assess muscle mass and/or function, the roles of vitamin D and nutrition in general in sarcopenia, and finally the care of patients with this condition. All authors have taken a clinical approach to their topic area and provide bulleted key messages as the most salient points. Copyright © 2015 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.
    Journal of Clinical Densitometry 07/2015; DOI:10.1016/j.jocd.2015.05.067 · 2.03 Impact Factor
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    ABSTRACT: Osteoporosis remains under-diagnosed. Routine abdominal CT can provide opportunistic screening, but the effect of IV contrast is largely unknown. The overall performance for predicting osteoporosis was similar between enhanced and unenhanced scans. Therefore, both non-contrast and contrast-enhanced abdominal CT scans can be employed for opportunistic osteoporosis screening. Osteoporosis is an important yet under-diagnosed public health concern. Lumbar attenuation measurement at routine abdominal CT can provide a simple opportunistic initial screen, but the effect of IV contrast has not been fully evaluated. Mean trabecular CT attenuation values (in Hounsfield units, HU) at the L1 vertebral level were measured by oval region-of-interest (ROI) on both the unenhanced and IV-contrast-enhanced CT series in 157 adults (mean age, 62.0). All patients underwent correlative central DXA within 6 months of CT. Based on DXA BMD of the lumbar spine, femoral neck, and total proximal femur: osteoporosis, osteopenia, and normal BMD was present in 33, 77, and 47, respectively. Statistical analysis included Bland-Altman plots and receiver operating characteristic (ROC) curves. Mean difference (±SD) in L1 trabecular attenuation between enhanced and unenhanced CT series was +11.2 HU (±19.2) (95 % CI, 8.16-14.22 HU), an 8 % difference. Intra-patient variation was substantial, but no overall trend in the HU difference was seen according to underlying BMD. ROC area under the curve (AUC) for unenhanced and enhanced CT for diagnosing osteoporosis were similar at 0.818 and 0.830, respectively (p = 0.632). Thresholds for maintaining 90 % specificity for osteoporosis were 90 HU for unenhanced and 102 HU for enhanced CT. Thresholds for maintaining 90 % sensitivity for osteoporosis were 139 HU for unenhanced and 144 HU for enhanced CT. Similar diagnostic performance was seen for diagnosing low BMD (osteoporosis or osteopenia) using higher HU cut-offs. Contrast-enhanced CT shows an average increase of 11 HU over the unenhanced series for L1 trabecular attenuation. The overall performance for predicting osteoporosis is similar between the enhanced and unenhanced scans, thus either can be employed for initial opportunistic screening.
    Osteoporosis International 07/2015; DOI:10.1007/s00198-015-3224-9 · 4.17 Impact Factor
  • Journal of Clinical Densitometry 07/2015; 18(3):436. DOI:10.1016/j.jocd.2015.05.039 · 2.03 Impact Factor
  • Journal of Clinical Densitometry 07/2015; 18(3):422. DOI:10.1016/j.jocd.2015.05.004 · 2.03 Impact Factor
  • 06/2015; DOI:10.1530/boneabs.4.P187
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    ABSTRACT: New densitometer installation requires cross-calibration for accurate longitudinal assessment. When replacing a unit with the same model, the International Society for Clinical Densitometry recommends cross-calibrating by scanning phantoms 10 times on each instrument and states that spine bone mineral density (BMD) should be within 1%, whereas total body lean, fat, and %fat mass should be within 2% of the prior instrument. However, there is limited validation that these recommendations provide adequate total body cross-calibration. Here, we report a total body cross-calibration experience with phantoms and humans.
    Journal of Clinical Densitometry 06/2015; DOI:10.1016/j.jocd.2015.04.003 · 2.03 Impact Factor
  • Joan M Lappe · Neil Binkley
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    ABSTRACT: Maintenance of adequate vitamin D status is a stratagem to consider for sarcopenia prevention and treatment. Vitamin D deficiency is common and involves all ages of most racial/ethnic groups and both sexes. Evidence suggests that vitamin D is important for muscle strength and function, and prospective studies are underway to further define these effects. This article summarizes the potential effects of vitamin D on skeletal muscle structure and function and provides guidance for vitamin D supplementation in prevention and treatment of sarcopenia and falls. Copyright © 2015 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.
    Journal of Clinical Densitometry 06/2015; DOI:10.1016/j.jocd.2015.04.015 · 2.03 Impact Factor
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    ABSTRACT: Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g. diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX. Copyright © 2015. Published by Elsevier Inc.
    Bone 05/2015; 78. DOI:10.1016/j.bone.2015.05.016 · 3.97 Impact Factor
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    ABSTRACT: Women with type 1 diabetes (T1DM) have an elevated fracture risk. We therefore compared the associations of health behaviors and clinical factors with bone mineral density (BMD) and bone remodeling between premenopausal women with and without T1DM to inform potential interventions. Participants included women with T1DM (n = 89) from the Wisconsin Diabetes Registry Study and age- and race-matched controls without diabetes (n = 76). Peripheral (heel, forearm) and central (hip, spine) BMD, markers of bone resorption and formation, bone cell signaling, glycemic control, and kidney function were assessed. Health behaviors and medical history were self-reported. In controls, but not in women with T1DM, older age was associated with lower bone resorption (p < 0.006) and formation (p = 0.0007). Body mass index (BMI) was positively associated with heel and forearm BMD in both controls and T1DM women (all p < 0.0001), but with hip and spine BMD only in controls (p < 0.005). Worse glycemic control during the previous 10 years, greater alcohol intake, history of smoking, and lack of physical activity were associated with poorer bone outcomes only in women with T1DM (all p < 0.002); whereas use of hormonal contraceptives was related to low bone formation in both women with and without T1DM (all p < 0.006). Diabetes duration, insulin dose, residual C-peptide, and kidney function were not associated with bone in T1DM. Age and BMI may not predict bone health in T1DM women. However modifiable behaviors such as optimizing glycemic control, limiting substance and hormonal contraceptive use, and increasing physical activity may improve bone health in T1DM women. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Diabetes/Metabolism Research and Reviews 05/2015; 31(4). DOI:10.1002/dmrr.2627 · 3.55 Impact Factor
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    ABSTRACT: It is unclear if vitamin D supplementation improves central blood pressure or arterial stiffness in Native American (NA) women. Healthy postmenopausal NA women were randomized to receive 400 IU or 2500 IU of vitamin D for 6 months. Central systolic blood pressure (cSBP), central pulse pressure (cPP) and aortic augmentation index (AIx) were estimated by tonometry at baseline and after 6 months. Study volunteers (n = 98) were 61 (7.3) years old. 25(OH)D was 26.4 (11.0) ng/mL. 25(OH)D was similar between the two treatment groups (p = 0.291), as were baseline cSBP, cPP, and CVD risk factors (all p > 0.1). Treatment with 2500 IU of daily vitamin D3 did not affect cSBP, cPP, or AIx (all p > 0.1) compared to 400 IU daily. Despite low serum 25(OH)D at baseline, 6 months of vitamin D supplementation did not improve central blood pressure parameters or arterial stiffness in NA women. CLINICAL TRIALS. NCT01490333. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Atherosclerosis 04/2015; 240(2):526-528. DOI:10.1016/j.atherosclerosis.2015.04.795 · 3.99 Impact Factor
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    ABSTRACT: Vitamin D metabolites are widely studied for their roles in bone health, immune functions, and other potential physiologic roles in humans. However, the optimal blood levels of vitamin D metabolites are still unclear. Various methods for measuring vitamin D metabolites have been used and recently liquid chromatography tandem mass spectroscopy (LC-MS/MS) has been adopted as the gold standard for vitamin D metabolite measurement. Here, we report the use of LC-MS/MS to measure 25-hydroxyvitamin D (25(OH)D2&3 ), and 1,25-dihydroxyvitamin D (1,25(OH)2 D2&3 ), in three laboratory nonhuman primate species: common marmoset (Callithrix jacchus), rhesus macaque (Macaca mulatta), and cynomolgus macaque (Macaca fascicularis), and compare them to humans using the same technique. The nonhuman primates showed blood levels for 25(OH)D3 and 1,25(OH)2 D3 significantly higher than human values with marmosets having the highest levels. Marmoset samples showed significantly more variability among individuals than those from macaques for both metabolites, but all three nonhuman primate species exhibited large variation within species for both 25(OH)D2&3 and 1,25(OH)2 D2&3 . Marmoset females had significantly lower values than the males for 25(OH)D3 , while rhesus males showed a significant decrease in 25(OH)D3 with age. The most striking finding is the variation within species for vitamin D levels even in laboratory primates that have a controlled diet, UV exposure, and in some cases, genetic constraints. Similar variation in 25(OH)D responses to a fixed dose of oral vitamin D supplementation has been reported in humans. We suggest that these species can provide primate models for examining the factors influencing variation in the levels of vitamin D necessary for human and nonhuman primate health. Am. J. Primatol. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    American Journal of Primatology 04/2015; 77(7). DOI:10.1002/ajp.22403 · 2.44 Impact Factor
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    ABSTRACT: The 2014 Santa Fe Bone Symposium provided a setting for the presentation and discussion of the clinical relevance of recent advances in the fields of osteoporosis and metabolic bone disease. The format included oral presentations of abstracts by endocrinology fellows, plenary lectures, panel discussions and breakout sessions, with ample opportunities for informal discussions before and after scheduled events. Topics addressed in these proceedings included a review of the important scientific publications in the past year, fracture prevention in patients with dysmobility and immobility, fracture liaison services for secondary fracture prevention, management of pre-menopausal osteoporosis, the role of bone microarchitecture in determining bone strength, measurement of microarchitecture in clinical practice and methods to improve the quality of bone density testing. This is a report of the proceedings of the 2014 Santa Fe Bone Symposium.
    Endocrine Research 03/2015; 40(2). DOI:10.3109/07435800.2015.1005746 · 1.28 Impact Factor
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    ABSTRACT: Body mass index (BMI) is commonly used to predict obesity in clinical practice because it is suggested to closely correlate with percent body fat (%BF). With aging, women lose both lean mass and height. Because of this, many clinicians question whether BMI is an accurate predictor of obesity in aging women. In evaluating the equation for BMI (weight/height), it is clear that both variables can have a dramatic effect on BMI calculation. We evaluated the relationship between BMI and %BF, as measured by dual-energy x-ray absorptiometry, in the setting of age-related changes in height loss and body composition in women. Our objective is to determine whether BMI continues to correlate with %BF as women age. Study participants were identified using data from five osteoporosis clinical trials, where healthy participants had full-body dual-energy x-ray absorptiometry scans. Deidentified data from 274 women aged between 35 and 95 years were evaluated. %BF, weight, age, tallest height, actual height, and appendicular lean mass were collected from all participants. BMI was calculated using the actual height and the tallest height of each study participant. %BF was compared with BMI and stratified for age. BMI calculated using the tallest height and BMI calculated using actual height both had strong correlations with %BF. Surprisingly, the effects of changes in height and lean body mass balance each other out in BMI calculation. There continues to be a strong correlation between BMI and %BF in adult women as they age.
    Menopause (New York, N.Y.) 02/2015; 22(7). DOI:10.1097/GME.0000000000000382 · 3.36 Impact Factor
  • Diane Krueger · Jessie Libber · Neil Binkley
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    ABSTRACT: Trabecular bone score (TBS) is related to microarchitecture and fracture risk independently of bone mineral density (BMD) and clinical risk factors. Widespread clinical TBS use requires documentation of reproducibility and ideally comparability across scanners. This study evaluated TBS reproducibility and explored differences between Lunar Prodigy and iDXA densitometers. Reproducibility was assessed from replicate scans in 210 men and women participating in various dual-energy X-ray absorptiometry (DXA) precision assessments. iDXA-to-Prodigy comparability was evaluated using 155 participants from 3 study groups. L1-L4 BMD and TBS precision was similar on iDXA and Prodigy (BMD coefficient of variation = 1.9% and 1.5% and TBS coefficient of variation = 1.4% and 1.6%, respectively). Precision did not differ between men and women; however, between-technologist differences (p < 0.05) of similar magnitude were observed for both BMD and TBS. Prodigy-to-Prodigy TBS values were highly correlated (R(2) = 0.85 with bias of -0.010 TBS units). Agreement was less robust comparing Prodigy with iDXA instruments (TBS R(2): 0.72-0.81 with biases of 0.012-0.034 TBS units). In conclusion, TBS precision is comparable to that of BMD and does not differ between men and women. Additionally, in these cohorts, slight TBS differences were observed between iDXA and Prodigy scans. These data suggest a potential difference between densitometer models perhaps due to higher iDXA image resolution. Copyright © 2015 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.
    Journal of Clinical Densitometry 02/2015; 18(2). DOI:10.1016/j.jocd.2014.11.003 · 2.03 Impact Factor
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    ABSTRACT: Summary Substantial variability exists in the serum 25(OH)D increase observed in response to vitamin D supplementation. Measurement of circulating cholecalciferol and 24,25(OH)2D, as indicators of vitamin D absorption and degradation, respectively, account for approximately half of the variation in serum 25(OH)D observed following supplementation. Introduction Vitamin D supplementation produces a variable response in serum 25(OH)D. This variability likely reflects, in part, differences in vitamin D absorption and/or degradation. Despite this variation in response, virtually all expert recommendations endorse a fixed vitamin D supplementation dose, an approach also used in most prospective studies. Such utilization of a single vitamin D dose does not assure attaining any pre-specified target 25(OH)D level, thereby compromising clinical care and prospective supplementation trials. This study begins addressing this weakness by exploring the feasibility of vitamin D metabolite measurements to predict serum 25(OH)D level attained following supplementation. Methods Ninety-one community-dwelling postmenopausal women with baseline 25(OH)D of 10–30 ng/mL received oral vitamin D3, 2300 or 2500 IU, daily for 4–6 months. Serum 25(OH)D, cholecalciferol (D3), and 24,25(OH)2D were measured before and at the end of supplementation to determine if metabolite concentrations allow prediction of the 25(OH)D level attained. Results From baseline and follow-up data, we derived a multiple linear regression model predicting posttreatment 25(OH)D as follows: final 25(OH)D = 8.3 + (1.05*initial 25(OH)D) − (7.7*initial 24,25(OH)2D) + (0.53*final D3) + (4.2*final 24,25(OH)2D). This model has an adjusted R 2 = 0.55, thus accounting for approximately half of the observed variance in the final 25(OH)D level. Conclusions The contributions of circulating cholecalciferol and 24,25(OH)2D to this predictive model can be considered as indicators of intestinal absorption and clearance, respectively. This paradigm requires further study; it may allow efficient “treat-to-25(OH)D-target” strategies useful in optimizing prospective studies and clinical practice.
    Osteoporosis International 01/2015; 26(5). DOI:10.1007/s00198-014-3010-0 · 4.17 Impact Factor
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    ABSTRACT: Summary Bone health may be negatively impacted by childhood socio-environmental circumstances. We examined the independent associations of single-parent childhood and parental death or divorce in childhood with adult bone strength indices. Longer exposure to a single-parent household in childhood was associated with lower bone strength in adulthood. Introduction Because peak bone mass is acquired during childhood, bone health may be negatively impacted by childhood socio-environmental disadvantage. The goal of this study was to determine whether being raised in a single-parent household is associated with lower bone strength in adulthood. Methods Using dual-energy X-ray absorptiometry data from 708 participants (mean age 57 years) in the Midlife in the United States Biomarker Project, we examined the independent associations of composite indices of femoral neck bone strength relative to load (in three failure modes: compression, bending, and impact) in adulthood with the experience of single-parent childhood and parental death or divorce in childhood. Results After adjustment for gender, race, menopause transition stage, age, and body mass index, each additional year of single-parent childhood was associated with 0.02 to 0.03 SD lower indices of adult femoral neck strength. In those with 9–16 years of single-parent childhood, the compression strength index was 0.41 SD lower, bending strength index was 0.31 SD lower, and impact strength index was 0.25 SD lower (all p values Conclusions Independent of parental death or divorce, growing up in a single-parent household is associated with lower femoral neck bone strength in adulthood, and this association is not entirely explained by childhood or adult socioeconomic conditions or lifestyle choices.
    Osteoporosis International 12/2014; 26(3). DOI:10.1007/s00198-014-2990-0 · 4.17 Impact Factor
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    ABSTRACT: Summary Improved approaches to assess functional change over time are needed to optimally reduce fall/fracture risk; jumping mechanography (JM) may be one such methodology. In this study, JM parameters were more reproducible than traditional functional tests. JM may be better able to demonstrate efficacy of interventions to mitigate sarcopenia. Introduction Jumping mechanography (JM), a tool using maximal countermovement jumps performed on a force plate, may more reliably assess muscle function than traditional methods. The purpose of this study was to examine JM retest reliability in older adults compared with commonly used muscle and physical function assessments. Methods Community-dwelling individuals age ≥70 years performed physical and muscle function assessments including the short physical performance battery (SPPB), grip strength, and JM on multiple occasions over 3 months. JM parameters included body weight-corrected peak power and jump height. Appendicular lean mass was measured by dual energy x-ray (DXA). Mixed effects linear regression models were used to estimate between- and within-person variability summarized as intra-class correlation coefficients (ICC). Results Ninety-seven individuals (49 females, 48 males, mean age 80.7 years) participated. All testing was well tolerated; no participant sustained injury. Jump power, height, and grip strength were greater (p SPPB score, and gait speed had lower ICCs (0.81, 0.77, and 0.76, respectively). Conclusion In older adults, JM has excellent retest reliability, is stable over time, and can be performed safely. JM retest reliability was comparable to grip strength and possibly better than SPPB and gait speed. JM is a promising tool for muscle function assessment in older adults. Comparison of this approach with traditional assessment tools in longitudinal interventional studies is needed.
    Osteoporosis International 12/2014; 26(2). DOI:10.1007/s00198-014-2983-z · 4.17 Impact Factor
  • IOF Regionals - 5h Asia-Pacific Osteoporosis Meeting; 11/2014

Publication Stats

8k Citations
875.80 Total Impact Points


  • 1994–2015
    • University of Wisconsin–Madison
      • • Department of Medicine
      • • Department of Biochemistry
      • • School of Medicine and Public Health
      • • Institute on Aging
      • • Wisconsin National Primate Research Center
      • • Department of Medical Sciences
      Madison, Wisconsin, United States
  • 2009
    • University of Wisconsin - Stout
      Menominee, Wisconsin, United States
  • 2008
    • New Mexico Clinical Research and Osteoporosis Center
      Albuquerque, New Mexico, United States
  • 2003–2006
    • University of Vermont
      Burlington, Vermont, United States
  • 1998–2000
    • Wisconsin National Primate Research Center
      Madison, Wisconsin, United States