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Abstract

Osteoporosis affects 4-6 million (13%-18%) postmenopausal white women in the United States. Most studies to date on risk factors for osteoporosis have considered body mass index (BMI) only as a possible confounder. In this study, we assess the direct relationship between BMI and osteoporosis. We conducted a cross-sectional study among women aged 50-84 years referred by their physicians for a bone mineral density (BMD) examination at Baystate Medical Center between October 1998 and September 2000. BMI was determined prior to the BMD examination in the clinic. Information on other risk factors was obtained through a mailed questionnaire. Ordinal logistic regression was used to model the association between BMI and osteoporosis, controlling for confounding factors. BMI was inversely associated with BMD status. After adjustment for age, prior hormone replacement therapy (HRT) use, and other factors, odds ratios (OR) for low, high, and obese compared with moderate BMI women were 1.8 (95% CI 1.2-2.7), 0.46 (95% CI 0.29- 0.71), and 0.22 (95% CI 0.14-0.36), respectively, with a significant linear trend (p < 0.0001) across BMI categories. Evaluating BMI as a continuous variable, the odds of bone loss decreased 12% for each unit increase in BMI (OR = 0.88, 95% CI 0.85-0.91). Women with low BMI are at increased risk of osteoporosis. The change in risk associated with a 1 unit change in BMI ( approximately 5-8 lb) is of greater magnitude than most other modifiable risk factors. To help reduce the risk of osteoporosis, patients should be advised to maintain a normal weight.

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... Postmenopausal women have been generally recognized as the population with high risk of osteoporosis, which may be mainly explained by an obvious decline in estrogen level (27). Most previous studies also proposed a high BMI to exert a protective factor for osteoporosis (28)(29)(30). One possible reason was that adipocytes are important for estrogen production sources, and a higher BMI may indirectly affect osteoblast and osteoclast activity by producing more estrogen sources (31). ...
... Our study found that higher LDL-C level is independently associated with osteoporosis in type 2 diabetic patients. Cui et al. and Li et al. both revealed that elevated serum HDL-C level has a greater probability of being osteoporosis, but no correlations between LDL-C, TC, and TG and osteoporosis (26)(27)(28)(29)(30)(31)(32)(33). In a cross-sectional study by Zhang et al., non-linear relationships were found of TC, LDL-C, HDL-C with lumbar spine BMD in postmenopausal women (34). ...
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Background Subjects with type 2 diabetes mellitus (T2DM) are susceptible to osteoporosis. This study was conducted to evaluate the association between glycemic variability evaluated by continuous glucose monitoring (CGM) and osteoporosis in type 2 diabetic patient. Methods A total of 362 type 2 diabetic subjects who underwent bone mineral density (BMD) measurement and were monitored by a CGM system from Jan 2019 to May 2020 were enrolled in this cross-sectional study. Glycemic variability was calculated with the Easy GV software, including 24-hour mean blood glucose (24-h MBG), the standard deviation of 24-h MBG (SDBG), coefficient of variation (CV), mean amplitude of glycemic excursions (MAGE), and time in range between 3.9 and 10.0 mmol/L (TIR). Other potential influence factors for osteoporosis were also examined. Results Based on the T-scores of BMD measurement, there were 190 patients with normal bone mass, 132 patients with osteopenia and 40 patients with osteoporosis. T2DM patients with osteoporosis showed a higher 24-h MBG, SDBG, CV, and MAGE, but a lower TIR (all p < 0.05). Multivariate logistic regression analysis revealed that age, female gender, body mass index (BMI), low-density lipoprotein cholesterol (LDL-C), serum uric acid (SUA) and MAGE independently contribute to osteoporosis, and corresponding odds ratio [95% confidence interval (CI)] was 1.129 (1.072-1.190), 4.215 (1.613-11.012), 0.801 (0.712-0.901), 2.743 (1.385-5.431), 0.993 (0.988-0.999), and 1.380 (1.026-1.857), respectively. Further receiver operating characteristic analysis with Youden index indicated that the area under the curve and its 95% CI were 0.673 and 0.604-0.742, with the optimal cut-off value of MAGE predicting osteoporosis being 4.31 mmol/L. Conclusion In addition to conventional influence factors including age, female gender, BMI, LDL-C and SUA, increased glycemic variability assessed by MAGE is associated with osteoporosis in type 2 diabetic patients.
... Being thin during adolescence not only impairs one's own health but also affects the next generation. For example, thin women have low bone density [4] and frequent menstrual irregularities [5]. In addition, thin women are reported to have a higher risk of giving birth to low-birth-weight infants [6] [7]. ...
... Too thin or underweight at a young age is not limited to one's own health issues, such as osteoporosis and abnormal menstrual cycle, and could have a great impact on the next generation [4] [5] [6] [7]. Especially in Japan, the relationship between thin women in their 20s and low-birth-weight infants is regarded as a problem. ...
... Prior studies have shown that lower BMIs are correlated with an increased likelihood of developing osteoporosis and maintaining abnormal BMDs. 22 Although the relationship between BMI and a reduced BMD remains inconclusive, some possible explanations are that a higher BMI / body weight imposes a greater mechanical load on the bone which leads to an increase of bone mass to Accepted Article accommodate this load. 22 It is worth noting that the estimated prevalence of osteoporosis in the general population varies between 5.1% (50 -59 years old) to 16.4% (70 -79 years old). ...
... 22 Although the relationship between BMI and a reduced BMD remains inconclusive, some possible explanations are that a higher BMI / body weight imposes a greater mechanical load on the bone which leads to an increase of bone mass to Accepted Article accommodate this load. 22 It is worth noting that the estimated prevalence of osteoporosis in the general population varies between 5.1% (50 -59 years old) to 16.4% (70 -79 years old). 23 In our population 8.8% of patients under the age of 50 and 29.7% of patients who were 50 years and older at the second DXA scan had osteoporosis. ...
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Objective A 2007 study performed at Montefiore Medical Center (Bronx, NY) identified high prevalence of reduced bone density in an urban population of patients with epilepsy and suggested that bone mineralization screenings should be regularly performed for these patients. We conducted a long‐term follow up study to determine whether bone mineral density (BMD) loss, osteoporosis, and fractures have been successfully treated or prevented. Methods In the current study, patients from the 2007 study who had two dual‐energy absorptiometry (DXA) scans performed at least five years apart were analyzed. The World Health Organization (WHO) criteria to diagnose patients with osteopenia or osteoporosis was used and each patient’s probability of developing fractures was calculated with the Fracture Risk Assessment tool (FRAX). Results The median time between the first and second DXA scans for the 81 patients analyzed was 9.4 years (range 5 ‐ 14.7). The median age at the first DXA scan was 41 years (range 22 ‐ 77). Based on WHO criteria 79.0% of patients did not have worsening of bone density, while 21.0% had new osteopenia or osteoporosis; many patients were prescribed treatment for bone loss. Older age, increased duration of anti‐epileptic drug (AED) usage, and low body mass index (BMI) were risk factors for abnormal BMDs. Based on the first DXA scan, the FRAX calculator estimated that none of the patients in this study had a ten‐year risk of more than 20% for developing major osteoporotic fracture (hip, spine, wrist or humeral fracture). However, in this population, 11 patients (13.6%) sustained a major osteoporotic fracture after their first DXA scan. Significance Despite being routinely screened and frequently treated for bone mineral density loss and fracture prevention, many patients with epilepsy suffered new major osteoporotic fractures. This observation is especially important as persons with epilepsy are at high risk for falls and traumas.
... It was observed that Ova-lacto vegetarians (20%) had lower prevalence of osteoporotic ailments and nonvegetarians (47%) had higher prevalence. Asomaning (2006) and Byberg et al (2015) have reported the similar data where subjects with only vegetarian base had lower BMD levels. It is evident that none of the subjects were vegans. ...
... It can be attributed to the higher per cent of osteoporotic subjects having higher BMI. Asomaning (2006) studied the association of osteoporosis and BMI and observed that women with low BMI are at increased risk of osteoporosis in a a cross-sectional study among women aged 50-84 years in the United States. In a recent study, Aljohara (2014) measured the prevalence and factors associated with low BMD in Saudi women in Riyadh, Saudi Arabia and found that there is a positive association of age, education and dietary products with low levels of BMD i.e. osteoporotic conditions. ...
Article
The study was undertaken to evaluate the impact of nutrition education on knowledge, attitude and practice levels of thirty volunteer osteoporotic subjects visiting orthopedic clinics of Davangere district of Karnataka state. Socioeconomic and nutritional status was assessed by standard procedures and nutrition education imparted on relevant aspects. A well-structured questionnaire of 15 statements with multiple answers was developed and used before and after one day counselling to determine knowledge, attitude and practice of the subjects. Hypertension was the common family medical history followed by diabetes mellitus and fractures. Absence of physical activities or exercises was evident. Rice was consumed on daily basis whereas ragi on weekly basis by maximum number of respondents. Grade I obesity was more prevalent among males (20%) than female (5%) whereas Grade II obesity was only observed in females (30%). Assessment of knowledge gain after nutrition education revealed that Per centage gain in knowledge was more among male subjects (54.8%) than female subjects (36.9%) and that of attitude for both the subjects was at a range of 35.6 to 36.5%. The per cent gain in practice was slightly higher among male subjects (19.3%) compared to female subjects (15.0%) The overall per centage gain of knowledge, attitude and practice for all subjects was 42.9 per cent, 37.4 per cent and 15.4 per cent respectively which was statistically significant (p<0.05) indicating the positive impact of nutrition education on KAP levels of the subjects.
... [14] Previous studies showed that women were at an increased risk of developing osteoporosis because of their faulty behavior of physical inactivity, sun-avoidance behavior, low intake of dairy products, and poor diets. [15][16][17] ...
... To help reduce the risk of osteoporosis, patients should be advised to maintain a weight within the normal range. [15,16] The risk of osteoporotic fractures increases in adults who have low BMI of less than 20 kg/m 2 . [18] On the contrary, patients who are obese (BMI >30 kg/ m 2 ) are also at a high risk of developing osteoporosis and fractures because of the risk of repeated falls and the weakness of the skeletal muscles due to loss of its mass as a result of aging. ...
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Introduction: Osteoporosis is a growing major health problem with medical, social, and economic burden. The pathogenesis of osteoporosis involves excessive bone resorption by osteoclasts and decreased new bone formation by osteoblasts. Early diagnosis is the key to minimize the impact of osteoporosis on patients. Dual-energy X-ray absorptiometry at the hip or spine is the main standard test for measuring bone mineral density, and according to the World Health Organization, the T-score value of -2.5 or less determines osteoporosis. Aim: In this work, we aimed to study the risk factors associated with osteoporosis among a population sample of osteoporotic and controls in the United Arab Emirates (UAE) and relate them to the T-score value. Material and methods: Two hundred male and female participants were recruited in the study. A questionnaire was used and data were correlated with the T-score value of the participants. Results: Results showed a positive correlation between the T-score value of the patients with osteoporosis and their calcium intake, exercise duration, and the age at menopause of female patients, whereas a negative correlation was evident between the T-score value and both caffeine and nicotine consumption. Results also revealed that patients with osteoporosis have significantly low body mass index, low calcium intake, and shorter duration of exposure to the sun than the control group. Conclusion: In conclusion, more intervention should be directed toward changing the modifiable risk factors in patients with osteoporosis and more studies should be directed toward osteoporosis in the UAE.
... This pilot study shows that among all the risk factors investigated, BMI was the strongest predictor of CT-based bone measures within a group of smokers with and without lung disease. The association between BMI and osteoporosis is well-known [57,58]. In a study of 1765 elderly men and women, Nguyen et al. [57] observed that, compared with subjects whose BMI was less than 27 kg/m 2 , those with BMI values greater than 27 kg/m 2 had higher age-adjusted BMD (8% in men and 10% in women). ...
... In a study of 1765 elderly men and women, Nguyen et al. [57] observed that, compared with subjects whose BMI was less than 27 kg/m 2 , those with BMI values greater than 27 kg/m 2 had higher age-adjusted BMD (8% in men and 10% in women). In another cross-sectional study of 505 women aged 50-84 years, Asomaning et al. [58] found that, after adjustment for age, prior hormone replacement therapy (HRT) use, and other factors, women's odds ratios of osteoporosis vs. osteopenia/normal BMD were 1.8 for underweight (< 19 kg/m 2 ), 0.46 for overweight (BMI 25 to <30 kg/m 2 ), and 0.22 for obese (≥ 30 kg/m 2 ) women when compared with women of normal BMI. ...
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ABSTRACT Osteoporosis causes fragile bone, and bone microstructural quality is a critical determinant of bone strength and fracture risk. This study pursues technical validation of novel CT‐based methods for assessment of peripheral bone microstructure together with a human pilot study examining relationships between bone microstructure and vertebral fractures in smokers. To examine the accuracy and reproducibility of the methods, repeat ultra‐high‐resolution (UHR) CT and micro‐CT scans of cadaveric ankle specimens were acquired. Thirty smokers from the University of Iowa COPDGene cohort were recruited at their 5‐year follow‐up visits. Chest CT scans, collected under the parent study, were used to assess vertebral fractures. UHR CT scans of distal tibia were acquired for this pilot study to obtain peripheral cortical and trabecular bone (Cb and Tb) measures. UHR CT‐derived Tb measures, including volumetric bone mineral density (BMD), network area, transverse trabecular density, and mean plate width, showed high correlation (r > 0.901) with their micro‐CT‐derived values over small regions of interest (ROIs). Both Cb and Tb measures showed high reproducibility—intra‐class correlation (ICC) was greater than 0.99 for all Tb measures except erosion index and greater than 0.97 for all Cb measures. Female sex was associated with lower transverse Tb density (p
... [8,14,15] It is also known that low BMI is associated with increased risk of osteoporosis. [16] In this study, only 12.72% were underweight which denoted that the number at risk for osteoporosis in the study group was less as per this modifiable risk factor. The other risk factors that were examined in this study included calorie and calcium intake and physical activity. ...
... Moreover, a lower BMI was reported in women with osteoporosis compared to patients with normal BMD (23.7 versus 28.5 kg/m 2 , P=0.001). 23 The results of a comparison between BMD and TBS are shown in table 3. As shown, about 37% of osteoporosis diagnosed patients (based on their BMD) were in the PDM-TBS group. ...
Article
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Background: Trabecular bone score (TBS) measures the underlying quality of bone texture using dual-energy X-ray absorptiometry (DXA) images. The present study aimed to investigate the correlation between lumbar spine bone mineral density (BMD) and TBS, and subsequently determine whether the association varies with the body mass index (BMI). Methods: Data from 548 patients were collected and categorized into three groups according to the relationship between BMD and age. BMD of the lumbar spine (LS) using DXA and TBS from DXA images were measured. Pearson's correlation coefficient (SPSS software, version 24.0) was used to investigate the association between LS-BMD and TBS, as well as the effect of BMI and age on these parameters. P<0.05 was considered statistically significant. Results: The total mean TBS was 1.31±0.12. LS-BMD and TBS values significantly decreased with age in both sexes. A statistically significant correlation was found between TBS and LS-BMD (r=0.601). An increase in BMI was associated with a higher LS-BMD score and a lower TBS level. The correlation coefficient between LS-BMD and TBS reduced as the BMI increased. By comparing TBS with BMD, the majority of the patients with osteopenia and osteoporosis had fully degraded and partially degraded TBS, respectively. Conclusion: TBS was positively correlated with LS-BMD and decreased with age. Moreover, the extent of the correlation varied with respect to BMI.
... Moreover, there is an interesting relationship between body size and BMD. Cross-sectional studies have suggested that BMD is proportional to the body size (Asomaning et al., 2006;Felson et al., 1993), and longitudinal studies showed that loss of BMD at most sites was positively related to the rate of loss in fat mass (Chen et al., 1997;Reid et al., 1994). Intriguingly, accumulating evidence has suggested body mass index (BMI) and BMD share some common genetic determinants (Kemp et al., 2017;Locke et al., 2015), implying shared regulatory mechanisms between body weight and bone composition. ...
Article
Background: Recent studies suggested an inverse association between exposures to perfluoroalkyl substances (PFASs) and bone mineral density (BMD). Whether exposures to PFASs are also associated with changes in BMD has not been examined. Methods: Five major PFASs (perfluorooctanesulfonic acid, PFOS; perfluorooctanoic acid, PFOA; perfluorohexanesulfonic acid, PFHxS; perfluorononanoic acid, PFNA; perfluorodecanoic acid, PFDA) and BMD (g/cm2) at six bone sites (spine, total hip, femoral neck, hip intertrochanteric area, hip trochanter, and hip Ward's triangle area) were measured at baseline among 294 participants in the POUNDS-LOST study, a weight-loss trial, of whom a total of 175 participants had BMD measured at both baseline and year 2. Linear regression was used to model the differences or changes in BMD for each SD increment of PFAS concentrations. In a secondary analysis, interactions between PFASs and baseline body mass index (BMI), as well as a BMI-related genetic risk score (GRS) derived from 97 BMI-predicting SNPs were examined in relation to changes in BMD. Results: At baseline, both PFOS and PFOA were significantly associated with lower BMD at several sites. For each SD increase of PFOS, the βs (95% CIs) for BMD were -0.020(-0.037, -0.003) for spine, -0.013(-0.026, 0.001) for total hip, -0.014(-0.028, 0.000) for femoral neck, and -0.013(-0.026, 0.000) for hip trochanter. For PFOA, the corresponding figures were -0.021(-0.038, -0.004) for spine, -0.015(-0.029, -0.001) for total hip, and -0.015(-0.029, -0.002) for femoral neck. After adjusting for baseline covariates and 2-year weight change, higher baseline plasma concentrations of PFOS, PFNA, and PFDA were associated with greater reduction in BMD in the hip; the βs (95% CIs) were -0.005(-0.009, -0.001), -0.006(-0.010, -0.001), and -0.005(-0.009, -0.001), respectively. Similar associations were found in hip intertrochanteric area for all PFASs except PFHxS, with βs ranging from -0.006 for PFOA to -0.008 for PFOS and PFNA. Participants with a higher GRS tended to have less PFAS-related BMD decline in total hip (Pinteraction = 0.005) and the hip intertrochanteric area (Pinteraction = 0.021). There were similar PFAS-related BMD changes by baseline BMI levels, although the interactions did not achieve statistical significance. Conclusions: This study demonstrated that higher plasma PFAS concentrations were not only associated with a lower BMD at baseline, but also a faster BMD loss in a weight-loss trial setting. Genetic predisposition to larger body size may somewhat attenuate the deleterious effects of PFASs on BMD. Further exploration of the possible impact of PFAS exposures on bone density is warranted.
... Accordingly, Oh et al. reported that a body weight under 55 kg was a predisposing factor for pelvic fractures in female patients undergoing radiotherapy [28]. Low body mass index and decreased bone mass has been identified as a risk factor for pelvic fractures in the general population [29]. However, how low body mass index contributes to the formation of pelvic fractures is unclear [30]. ...
Article
Purpose: Radiotherapy is a treatment method performed using ionizing radiation on cancer patients either alone or with surgery and/or chemotherapy. Although modern radiotherapy techniques provide a significant advantage in protecting healthy tissues, it is inevitable that normal tissues are also located in the areas targeted by radiations. In this study, we aimed to examine the bone mineral density changes in bone structures commonly included in the irradiated area such as, L5 vertebra, sacrum, and femur heads, in patients who have received pelvic radiotherapy; and the relationship between these changes with radiation dose. Material and methods: Patients included in the study had been previously diagnosed with rectal cancer, which were operated or not. Preoperative or postoperative pelvic radiotherapy was planned for all patients. In terms of convenience when comparing with future scans, all densitometry and CT scans were performed with the same devices. Fifteen patients were included in the study. In order to determine the dose of radiation each identified area had taken after radiotherapy, the sacrum, L5 vertebra, bilateral femoral heads, and L1 regions were contoured in the CT scans in which treatment planning was done. Sagittal cross-sectional images were taken advantage of while these regions were being contoured. Results: Bone mineral density was evaluated with CT and dual-energy X-ray absorptiometry before and after the treatment. The regions that have theoretically been exposed to irradiation, such as L5, sacrum, left to right femur were found to have significant difference in terms of bone density. According to CT evaluation, there was a significant decrease in bone intensity of L5, sacrum, left and right femurs. Dual-energy X-ray absorptiometry assessment revealed that the whole of the left femoral head, left femur neck and Ward's region were significantly affected by radiotherapy. However, there was no significant difference in the sacrum and L5 vertebra before and after radiotherapy. Conclusion: More accurate results could be achieved if the same study was conducted on a larger patient population, with a longer follow-up period. When the reduction in bone density is at maximum or a cure is likely in a long-term period, bone mineral density could be determined by measurements performed at regular intervals.
... First, the change of the life indexes with the T score shows us some ways to prevent the loss of the bone mass in our daily life. The life indexes show that the people who with high BMI [29] and tea drinking [30] will have higher bone mass, which is consistent with the previous study. BMI is not a percentage of body fat which should take age, gender, and occupation into consideration when using it to predict body fat percentage or obesity. ...
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Bone mass loss contributes to the risk of bone fracture in the elderly. Many factors including age, obesity, estrogen and diet, are associated with bone mass loss. Mice studies suggest that the intestinal microbiome might influence the bone mass by regulating the immune system, however there has been little evidence from human studies. We have recruited 361 Chinese elderly women to collect data for a metagenomic-wide association study (MWAS) to investigate the influence of the gut microbiome on bone health. Gut microbiome data were produced using BGISEQ500 sequencing, BMD was calculated using Hologic dual energy X-ray machine, BMI (Body Mass Index) and age were also provided. This therefore data allows exploration of gut microbiome diversity and links to bone mass loss, as well as microbial species and modules as markers for bone mineral density. Making these data potentially useful in studying the role the gut microbiota might play in bone mass loss and offering exploration into the bone mass loss process.
... Family history of osteoporosis and fracture, tobacco consumption, dietary habits, sedentary lifestyle, cigarette smoking, alcohol abuse and caffeine consumption are common factors closely related to the occurrence of osteoporosis. Body mass index (BMI) also affects osteoporosis (Assomaning et al., 2006). ...
Article
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Osteoporosis is the most common bone disease in humans, representing a major public health problem. Few studies have investigated osteoporosis risk factors such as calcium and vitamin D intake, quality of life and body mass index (BMI) among multi-ethnic adults in the Malaysian context. This study aimed to determine the ethnic variation in osteoporosis risk factors among students in Universiti Malaysia Terengganu (UMT). A cross-sectional study via a self-administrated questionnaire was carried out among 198 respondents aged 19 to 25 years from UMT. The data in the present study included a three -day food record and anthropometric measurements. Nutritionist ProTM analysis software version 5.3 was used to calculate dietary calcium and vitamin D intake from the diet histories, based on the Nutrient Composition of Malaysian Food Database guidance for the dietary calcium intake and the United States Department of Agriculture (USDA) for vitamin D intake. The data were analyzed using Kruskal-Wallis, Mann-Whitney and ChiSquare tests. The findings indicate the median calcium intake was 348.3 mg/day while for vitamin D intake was only 1.37 µg/day. Indian participants had a significantly lower intake level of calcium (243.5 mg/day), followed by Chinese (362.3 mg/day) and Malays (440.4 mg/day). The median vitamin D intakes of Malay, Chinese, and Indian adults were 2.15 μg/day, 1.37 μg/day and 1.14 μg/day, respectively. Furthermore, the BMI among respondents at 20.88 (6.4) kg/m2 categorized as normal weight. It was found that there was no significant difference (p> 0.05) in BMI across ethnicity. Lastly, there was a significant association (p< 0.05) between ethnicity and calcium intake (p = 0.001).
... Clinical covariates. Patients in the high risk group for osteoporosis are generally female, older, and with lower body mass indices (BMIs) 32 . There are many other patient factors, but age, gender, and BMI were selected as factors that can be easily identified by dentists. ...
Article
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Osteoporosis is becoming a global health issue due to increased life expectancy. However, it is difficult to detect in its early stages owing to a lack of discernible symptoms. Hence, screening for osteoporosis with widely used dental panoramic radiographs would be very cost-effective and useful. In this study, we investigate the use of deep learning to classify osteoporosis from dental panoramic radiographs. In addition, the effect of adding clinical covariate data to the radiographic images on the identification performance was assessed. For objective labeling, a dataset containing 778 images was collected from patients who underwent both skeletal-bone-mineral density measurement and dental panoramic radiography at a single general hospital between 2014 and 2020. Osteoporosis was assessed from the dental panoramic radiographs using convolutional neural network (CNN) models, including EfficientNet-b0, -b3, and -b7 and ResNet-18, -50, and -152. An ensemble model was also constructed with clinical covariates added to each CNN. The ensemble model exhibited improved performance on all metrics for all CNNs, especially accuracy and AUC. The results show that deep learning using CNN can accurately classify osteoporosis from dental panoramic radiographs. Furthermore, it was shown that the accuracy can be improved using an ensemble model with patient covariates.
... [ [63][64][65] Dietary deficiencies Malnutrition or dietary deficiencies frequently occur in patients with CLD (12% of OLT patients), due to altered nutritional requirements during ascites or other complications. [66,67] Alcohol consumption Ethanol affects bone directly via a toxic effect on osteoblasts and indirectly by altering PTH, vitamin D, testosterone, IGF-1, cytokines (e.g., TNF or IL-6) and cortisol levels. ...
Article
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Almost all patients with chronic liver diseases (CLD) show altered bone metabolism. Depending on the etiology, this manifests in a severe osteoporosis in up to 75% of the affected patients. Due to high prevalence, the generic term hepatic osteodystrophy (HOD) evolved, describing altered bone metabolism, decreased bone mineral density, and deterioration of bone structure in patients with CLD. Once developed, HOD is difficult to treat and increases the risk of fragility fractures. Existing fractures affect the quality of life and, more importantly, long-term prognosis of these patients, which presents with increased mortality. Thus, special care is required to support the healing process. However, for early diagnosis (reduce fracture risk) and development of adequate treatment strategies (support healing of existing fractures), it is essential to understand the underlying mechanisms that link disturbed liver function with this bone phenotype. In the present review, we summarize proposed molecular mechanisms favoring the development of HOD and compromising the healing of associated fractures, including alterations in vitamin D metabolism and action, disbalances in transforming growth factor beta (TGF-β) and bone morphogenetic protein (BMP) signaling with histone deacetylases (HDACs) as secondary regulators, as well as alterations in the receptor activator of nuclear factor kappa B ligand (RANKL)–osteoprotegerin (OPG) system mediated by sclerostin. Based on these mechanisms, we give an overview on the limitations of early diagnosis of HOD with established serum markers.
... None of our patients was under treatment with methadone. Although in our study BMI was not associated with BMD, low BMI is a risk factor for low bone mineral density in both HIV positive and HIV negative patients [23,24]. A study on 918 HIV infected patients showed that T-scores at femoral neck and lumbar spine were positively correlated with BMI (p < 0.001) and that underweight patients had a higher risk of osteopenia and osteoporosis [25]. ...
... In another study carried out by Asomaning K, et al women with low BMI are at increased risk of osteoporosis. The change in risk associated with a 1-unit change in BMI (approximately 5-8 lb.) is of greater magnitude than most other modifiable risk factors 16 . ...
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Background: Osteopenia is considered as precursor of osteoporosis. Osteoporosis is a major public health problem associated with substantial morbidity and socio-economic burden worldwide. Osteopenia occurs more frequently in most menopausal women. Early detection of the same can be beneficial to control prevalence of osteoporosis and also to reduce the fracture rates.Methods: A cross-sectional quantitative study using DEXA (Dual Energy X-ray Absorptiometry) was conducted on 80 women. A self-structured questionnaire was used to evaluate the level of awareness among the study subjects. The data was analyzed using statistical tests such as Chi-Square test for association. The level of significance was set at 5%.Results: The prevalence of osteopenia in the studied population was 63.75%. The mean age was recorded to be 40.35 years. The mean age of women with menopause in this study is 50.62 years. Out of the 51(63.75%) women diagnosed with osteopenia, 5.9% were underweight, 33.3% were normal and 49% were obese. Of the diseased, 37.3% experienced adequate amount sunlight exposure required while 62.7% did not. Out of the 80 women interviewed 43.75% were aware about osteopenia, its causes and complications; which 56.25% were unaware about the same.Conclusions: Women were screened for osteopenia with the help of DEXA scan according to the (World Health Organization) WHO, T-Score criteria-which may go undiagnosed otherwise and may experience the risk and complications of osteoporosis.
... In this study older, female athletes had lower BMI, reported higher levels of physical activity, and had a higher prevalence of low BMD, but not of fractures, than women in the general population. Both physical inactivity and a low BMI are associated with osteoporosis and an increased risk of fractures [6,[20][21][22]. Our findings indicate that the increased risk of having low BMD in long-term, old, female athletes might be due to differences in BMI. ...
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Background Physical activity (PA) is generally beneficial for bone health, but the effect of high levels of PA over many years, in older women, is unknown. Methods T-score from Dual-energy X-ray absorptiometry (DXA), and self-reported baseline characteristics were recorded for 24 female, cross-country-skiing-competitors, aged 68–76 years, from the Birkebeiner Ageing Study. Data from 647 women in the same age range from the Tromso-6 population study, with recorded DXA findings, were used for comparison. Results The athletes reported a median(range) of 9(1–34) participations in the 54 km, yearly ski-race, indicating long-term PA. They also reported more moderate and high levels of PA than women in the general population (52% vs. 12 and 30% vs. 0%, respectively). The athletes had lower body mass index (BMI) than the controls (mean BMI 21.7 vs 26.9 kg/m², p < 0.001). As many as 22/24(92%) of the athletes and 477/647(74%) of the controls had a low bone mineral density (BMD) (T-score < − 1), p 0.048, Pearson chi square test. Odds ratio (OR) of low BMD was 3.9 in athletes vs. controls (p 0.048, logistic regression), but adjusting for BMI largely diminished the effect estimate, which was no longer statistically significant (aOR 1.81, p 0.432). The proportion of self-reported fractures was the same in the two groups. Conclusions This pilot study suggests that long-term, high levels of PA are associated with low bone mineral density in older women, and the finding might be due to differences in BMI. Despite the lower bone mineral density the athletes did not report more fractures.
... We initially expected that BMI would be a significant contributor to the Chapman Bone Algorithm (CBA). Women with low BMIs are characterized as having weaker bones that are more susceptible to fractures, while the bones of women with high BMIs must be proportionately stronger in order to support a greater body mass [25]. The analysis of BMI in this data set, however, was not statistically significant (P> 0.05). ...
Article
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Osteoporosis is the most common metabolic bone disease and goes largely undiagnosed throughout the world, due to the inaccessibility of DXA machines. Multivariate analyses of serum bone turnover markers were evaluated in 226 Orange County, California, residents with the intent to determine if serum osteocalcin and serum pyridinoline cross-links could be used to detect the onset of osteoporosis as effectively as a DXA scan. Descriptive analyses of the demographic and lab characteristics of the participants were performed through frequency, means and standard deviation estimations. We implemented logistic regression modeling to find the best classification algorithm for osteoporosis. All calculations and model building steps were carried out using R statistical language. Through these analyses, a mathematical algorithm with diagnostic potential was created. This algorithm showed a sensitivity of 1.0 and a specificity of 0.83, with an area under the Receiver Operating Characteristic curve of 0.93, thus demonstrating a high predictability for osteoporosis. Our intention is for this algorithm to be used to evaluate osteoporosis in locations where access to DXA scanning is scarce.
... Pada studi 5 tahun pemakaian kontrasepsi levonorgestrel yang dilakukan oleh Brache et al., 38% memiliki level fluktuasi estradiol normal,27% memiliki level estradiol yang rendah dan sisanya 35% memiliki level estradiol tinggi. 11 14,15 WHO pernah mengeluarkan pernyataan bahwa levonorgestrel implan tidak memiliki efek buruk terhadap densitas tulang, dan tidak ada restriksi penggunaan metode kontrasepsi ini bagi wanita yang ingin menggunakannya. 16 Hasil pernyataan tersebut sama dengan hasil penelitian ini, bahwa tidak ada hubungan bermakna antara penggunaan kontrasepsi implan dengan angka kejadian densitas massa tulang tidak normal. ...
... [16] Asomaning K et al. stated "the change in risk associated with one unit change in BMI (approximately 5-8 pounds) is of greater magnitude than most of the other modifiable risk factors". [17] In this study mean body weight and mean BMI decreased but the mean BMD increased. This could be because of the antiosteoporotic treatment provided to them. ...
Article
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Background: Osteoporosis is “a systemic metabolic bone disease characterized by low bone mass and micro architectural deterioration with a consequent increase in bone fragility with susceptibility to fracture. Multiple drug therapy with Alendronate, Calcium & plain vitamin D or alfacalcidol has been established to treat osteoporosis. In any patient with healthy liver and kidneys, plain vitamin D is expected to be as good as more active form of vitamin D. This study was conducted to compare the efficacy, safety and cost effectiveness between alfacalcidol and plain vitamin D in addition to Calcium and Alendronate in the management of osteoporosis. Methods: The Randomized Controlled Trial was conducted in B.P. Koirala Institute of Health Sciences, a tertiary care hospital in Eastern Nepal, over a period of twelve months from January 2013 to December 2014. Patient in group A were given Alfacalcidol, and group B were given plain Vitamin D. Results: Most of the patients were from the age group 60-69 yrs of age; mean age 65.54 ± 7.49. The BMD and T score were recorded at baseline and after treatment. The BMD measured 0.62853±.060241 at baseline and 0.67910 ± 0.059040 after treatment and T score measured -3.204 ±0.5455 at baseline and -2.698 ± 0.5772 after treatment. There is no statistical significance between the parameters (BMD and T score) of the two groups. Conclusion: For the first time in Nepal we have shown that the therapy with alfacalcidol and plain vitamin D when used with alendronate and calcium, have similar efficacy and safety, though the cost of the treatment with alfacalcidol was much higher than that of the plain vitamin D
... Uzun süre yüksek doz steroid kullanımı, hiperparatiroidizm, sigara kullanımı, Paget hastalığı gibi artmış kemik yıkımı ile seyreden durumlarda, diabetes mellitus, romatoid artrit gibi sistemik hastalıklarda ve düşük vücut kitle indeksine (VKİ) sahip insanlarda PYK insidansı daha yüksektir. Genel popülasyonda VKİ'nin osteoporoz ve kemik fraktür riskini arttırdığı belirtilmiştir (1). Japonya'da yapılan bir çalışmada serviks kanseri nedeniyle RT uygulanan kadınlarda 49 kg altında olmanın sakral yetmezlik fraktürü ile ilişkili olduğu, benzer olarak Kore'de yapılan bir çalışmada da 55 kg altında olmanın yetmezlik fraktürü için belirgin bir predispozan faktör olduğu belirtilmiştir (2,3). ...
... Earlier studies [8,9] identified that the migration of black South Africans into urban areas significantly affects their health status with an increase in the incidence of obesity and non-communicable diseases related to urbanisation, the nutrition transition, and decreased physical activity. A high body mass index (BMI) has been suggested to protect against low BMD by some [10,11], while others have found excessive fat mass to be associated with low BMD and not protecting against osteoporosis [12,13]. Similarly, lean mass and not fat mass strongly correlated with bone health in black South African women [14]. ...
Article
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This prospective study investigated the association between nutrient intake, dietary patterns, and changes in bone turnover and bone mineral density (BMD) in postmenopausal urban black South African women over two years. These women (n = 144) underwent BMD measurements at the distal radius, lumbar spine, femoral neck (FN), as well as a biochemical analysis which included the parathyroid hormone (PTH), 25-hydroxyvitamin D, C-Telopeptide of type I collagen (CTX-1) in 2010 and 2012. Their dietary intake was assessed in 2010 using a food frequency questionnaire, and sociodemographic and health information was collected. Four dietary patterns explained 54.4% of the variance of dietary intake, namely staple foods and processed meats, home cooking, snacking, and high sugar. Dietary magnesium negatively correlated with CTx-1 in 2012 (r = −0.21, p = 0.02), calcium correlated with distal radius BMD in 2010 (r = 0.22, p = 0.01) and 2012 (r = 0.24, p = 0.005), and the snacking dietary pattern score correlated with FN BMD in 2010 (r = 0.18, p = 0.03) and 2012 (r = 0.21, p = 0.02). The baseline CTx-1 and dietary magnesium intake predicted 22% of the variance in percentage change of CTx-1 over two years (p < 0.001).The magnesium intake predicted short-term bone resorption over two years.
... 12 Kofi Asomaning concluded in their study that women with low BMI are at an increased risk of osteoporosis and the odds of bone loss decreased by 12% with each unit increase in BMI. 13 Jain V et al concluded that after adjusting for age, chance of getting low BMD was 94% less in obese females when compared to females with normal BMI in Indian population. 14 Significant positive correlation was observed between BMI and BMD in postmenopausal Pakistani females by Tariq S et al. 15 Some authors have also reported no significant association between BMI and BMD. ...
Article
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Background: Osteoporosis is a common health problem that affects postmenopausal females, leading to increased susceptibility to fractures. Body mass index (BMI) has been shown to be an important predictor of bone mineral density (BMD) with increased body weight correlating with positive influence on bone metabolism. Low BMI predisposes postmenopausal females to rapid bone loss and low bone mass, crucial in the pathogenesis of osteoporosis. However, a specific BMI value chart to accurately predict osteoporosis remains to be fully established. The present study aimed to investigate the relationship of BMI and BMD in postmenopausal Indian females.Methods: 90 healthy postmenopausal females with 1-5 years of menopause were enrolled in the study. Subjects were categorized according to their BMI into normal, overweight and obese. BMD was assessed using dual energy X-ray absorptiometry (DEXA) scan at L1-L4 vertebrae and femoral neck and expressed as T-scores. Quantitative variables were compared using ANOVA/Kruskal Wallis Test.Results: Bone mineral density was significantly higher in the obese group as compared to normal BMI group at both lumbar spine (p=0.001) and femoral neck (p=0.001). BMD at lumbar spine was lower than that at femoral neck across all the three groups of BMI.Conclusions: BMI and body weight are important factors affecting BMD. Postmenopausal females with low BMI are more likely to have osteopenia and osteoporosis and are thus at an increased risk of pathological fractures. Routine BMD monitoring in postmenopausal females with low BMI may be necessary to initiate early clinical interventions for osteoporosis.
... In another study, a significant relationship was found between BMI and femur neck bone mineral density, and it was stated that body weight may be effective in avoiding osteoporosis (Yanık, Atalar, Külcü, Gokmen, 2007). Studies in different countries revealed that increased BMI of postmenopausal women increases the risk of osteoporosis (Hyassat et al., 2017;Tian et al. 2017;Asomaning, Bertone-Johnson, Nasca, Hooven, Pekow, 2006;Mazocco & Chagas, 2017). Since the majority of women in our study were overweight, they were found to be at risk for osteoporosis. ...
Article
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Background: Osteoporosis may cause morbidity and mortality especially in postmenopausal women. Aim: This study has been conducted in order to assess the risk factors of menopausal women for osteoporosis. Methodology: The study which was conducted in a descriptive and cross-sectional style, was carried out with women in the postmenopausal period who made application to the gynecology clinic of a university hospital. The sample of the study was comprised of 331 post-menopausal women. Data were gathered through socio-demographic information form prepared in line with the literature and osteoporosis risk factors questionary form. During the assessment of the data, by means of the SPSS 16.0 packaged software, were calculated the percent and frequency values. Results: It was determined that the average age of the participants was 54,6±5,3; 76,4% have experienced menarch within the age range of 12-14 years; 57,1% had experienced 4 pregnancies and over; 36,6% have entered the menopause within the age range of 45-49 years and that 74,6% have experienced natural menopause. It was also specified that 26,3% of the women were preferring milk and dairy products while 64,4% were preferring liquid food products such as tea and coffee containing caffeine; 18,4% consume coffee daily (up to 3 cups), almost half of the women are over-weighted; 65,6% used medicine regularly that could create a risk for orteoporosis; 12,69% of them had used long-term corticosteroids previously; 12,7% of them were mindful of taking sunbathing for 15 minutes daily and that 54,1 of them never made sports. Conclusion: It was determined that postmenopausal women who comprised of the sample have osteoporosis risk factors such as parity, menopause period, malnutrition in terms of milk and dairy products, excessive tea and coffee consumption, being overweighted, breakage story, sedantary life, smoking, insufficient sun intake, chronic diseases and drug usage.
... A low BMI has been identified as a risk factor for the development of osteoporosis. 31 Maintaining an optimal weight while balancing risks and benefits for healthy aging certainly needs to be balanced. ...
Article
Objective: The objective of this study is to describe the association of premature ovarian insufficiency (POI) and early menopause on bone mineral density (BMD) and osteoporosis in a large cohort of women living in Canada. Methods: Cross-sectional baseline data from a deeply characterized cohort (female participants) of the Canadian Longitudinal Study on Aging was used. Additional bio-psycho-social characteristics that may influence bone health and the development of osteoporosis were explored. Results: The mean age of women at the time of baseline assessment was 65 years (N = 12,339). When comparing women with POI to those with early and normal age of menopause, there was no difference in hip BMD between groups, but women in the POI group were more likely to have a higher rate of self-reported osteoporosis (21.9% vs 16.7%) and have used osteoporosis drugs (11.39% vs 7.63%). After adjustment, POI was found to increase the odds of osteoporosis, as diagnosed using BMD. Current cigarette smoking was found to influence this association. Protective factors included obesity and current hormone therapy use, but not the duration of hormone therapy use. Women in the POI group were more likely to be obese, have decreased physical activity, and were more likely to be current smokers. Conclusion: These results confirm findings from smaller cohorts illustrating that POI is associated with osteoporosis. Increasing understanding of the sequelae associated with an earlier loss of ovarian function will aid in targeting earlier screening and intervention strategies for women in Canada and abroad.
... There was no significant gender difference in preference for yoga, aerobics and cardio exercise. Lower BMI is a risk factor for osteoporosis; [22][23][24][25][26] the change in risk associated with a single unit change in BMI (approximately 5-8 lb) is of greater magnitude than most other modifiable risk factors [27] . Load-bearing exercises are to be emphasized on because they have been shown to be more strongly associated with improvements in bone mineral density when compared to non-weight-bearing exercises [28] . ...
Research
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This cross-sectional descriptive study was conducted on of 357 educated individuals (150 females: 42.02% & 207 males: 57.98%), based in Mumbai metropolitan region, using online questionnaire. Significantly more males (Z=2.078; p=0.037) took calcium supplements and self-reported exposure to sunlight for more than one hour per day was significantly (Z=3.094; p=0.002) higher for males. As compared to males, fewer females reported consumption of tobacco (Z=5.133; p<0.0001) and alcohol (Z=4.280; p<0.0001). Significant gender differences were observed in frequency of physical exercise (Z=2.612; p=0.009) and in preference for type of physical exercise: walking (Z=2.044; p=0.041) and strength exercises (Z=6.262; p<0.0001). Significantly more female respondents reported family history of osteoporosis (Z=3.085; p=0.002) and co-morbid conditions (Z=3.228; p=0.001). The gender differences in awareness of osteoporosis were not significant. Community-based studies are necessary for creating awareness about osteoporosis and bring about early interventions, such as, calcium and vitamin D supplementation, and other lifestyle changes.
... Previously, it was believed that women with low BMI are at increased risk of developing osteoporosis, but in our study, a higher body mass index was associated with high BMD which coincides well with recent studies showing overweight and obesity as protective factors against future osteoporotic fractures. [21,22] Epidemiological studies have suggested that body fat percentage may affect bone mass status, especially in the aged group. The effect of metabolically active adipose tissue on the bone or skeleton may be regulated by both weight-bearing and nonweight-bearing effects. ...
Article
Objective: This study was conducted to assess lean body mass, body fat percentage, and handgrip strength in the prediction of bone mineral density (BMD) in postmenopausal women. Materials and methods: This cross-sectional study included 102 postmenopausal women aged between 45 and 80 years (mean age 58) who were screened for osteoporosis using a dual-energy X-ray absorptiometry scan at the lumbar spine. The lean body mass, body fat percentage, and handgrip strength were calculated. Results: The lean body mass, body fat percentage, and handgrip strength were having a positive association (correlation coefficient: 0.48, 0.29, and 0.3, respectively) with BMD. Conclusion: Lean body mass, body fat percentage, and handgrip strength can detect early loss of BMD in postmenopausal women leading to early screening for osteoporosis resulting in early interventions minimizing BMD loss over a much longer period after menopause.
... Other factors that are considered to increase the risk of osteoporosis and broken bones include: a family history of osteoporosis, parental history of hip fracture, an index of 19 or less body mass (BMI) (Asomaning, Bertone-Johnson, et al., 2006). ...
Article
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Osteoporosis is one of the non-communicable diseases that closely links to lifestyle and nutrition. This is a cross-sectional descriptive epidemiologic study, carried out on 440 Jazan university students (males& females). They are chosen by a stratified multistage cluster sampling technique to assess their knowledge, attitude, and practices (KAP) about osteoporosis risk factors. The data are collected using a validated semi structured Arabic questionnaires. The findings revealed that almost all survey participants agreed with the definition of osteoporosis, which is the decrease of bone density, with only 8.7% disagreeing. Furthermore, 80.0 percent of survey participants classified osteoporosis as a cause of bone fracture. The findings suggest that the study participants' good attitudes toward risk factor prevention of osteoporosis are linked to the daily consumption of an acceptable amount of milk. Another positive attitude toward osteoporosis prevention stemmed from a reduction in the amount of energy drinks consumed, which has been identified as an osteoporosis risk factor. The study recommends that university students of all grades participate in health education programs about osteoporosis risk factors and preventive treatment.
... positive correlation between BMI and BMD in post-menopausal women [22,23,32], and a study by Cherif et al. showed an overall high bone density in obese women [33]. ...
Article
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There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.
... Based on the aforementioned findings, we hypothesize that adequate control of disease activity (DAS28-ESR) between baseline and during the observation period (4.9 ± 1.6 and 3.2 ± 1.0, p < 0.001) in the abatacept group and higher rate of ACPA in group III could partly explain the discrepancy in the effect on BMD among the groups. It is also well known that low BMI is one of risk factors of systemic bone loss or osteoporosis (40). In current investigation, abatacept group, although had lower BMI, increased more BMD than other groups after 3 years. ...
Article
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Objective To compare changes in bone mineral density (BMD) in rheumatoid arthritis (RA) patients receiving three-year conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD), tumor necrosis factor-α inhibitors (TNFi), and abatacept. Methods Patients with RA were recruited from September 2014 to February 2021. Dual-energy X-ray absorptiometry was used to measure BMD at the femoral neck (FN), total hip (TH), and lumbar spine (L1-4) at enrollment and three years later. Changes in the BMD of each regimen group were analyzed. Multiple ordinary least squares regression was used with the dependent variables to develop a model to predict the change in BMD. Results A total of 752 participants were enrolled and 485 completed the three-year follow-up period. Of these, 375 (Group I), 84 (Group II), and 26 (Group III) participants received csDMARDs, TNFi, and abatacept therapy, respectively. Considering both type of therapy and completion of the follow-up period, participants were divided into groups A (csDMARDs, n = 104), B (TNFi, n = 52), and C (abatacept, n = 26). Compared to baseline, BMD decreased significantly at FN (p = 0.003) and L1-4 (p = 0.002) in Group A and at L1-4 (p = 0.005) in Group B, but remained stable at all sites in Group C. In terms of regression-adjusted percent change in BMD, there was a significant difference seen at all measured sites between group C compared to both groups A and B (+0.8%, -2.7%, -1.8% at FN; +0.5%, -1.1%, -1.0% at TH; +0.8%, -2.0%, -3.5% at L1-4, respectively; all p < 0.05). Anti-osteoporosis therapy had a BMD-preserving effect in RA. Conclusion Compared with csDMARDs and TNFi, abatacept may have a better BMD-preserving effect in RA. Anti-osteoporosis therapy can prevent systemic bone loss irrespective of RA therapy.
... Patients in the high-risk group of osteoporosis are generally female, older, and have a lower body mass index (BMI) [20]. Although there are many other patient variables, age, gender, and BMI were selected in this study as easily identifiable patient factors. ...
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Background and Objectives: A few deep learning studies have reported that combining image features with patient variables enhanced identification accuracy compared with image-only models. However, previous studies have not statistically reported the additional effect of patient variables on the image-only models. This study aimed to statistically evaluate the osteoporosis identification ability of deep learning by combining hip radiographs with patient variables. Materials andMethods: We collected a dataset containing 1699 images from patients who underwent skeletal-bone-mineral density measurements and hip radiography at a general hospital from 2014 to 2021. Osteoporosis was assessed from hip radiographs using convolutional neural network (CNN) models (ResNet18, 34, 50, 101, and 152). We also investigated ensemble models with patient clinical variables added to each CNN. Accuracy, precision, recall, specificity, F1 score, and area under the curve (AUC) were calculated as performance metrics. Furthermore, we statistically compared the accuracy of the image-only model with that of an ensemble model that included images plus patient factors, including effect size for each performance metric. Results: All metrics were improved in the ResNet34 ensemble model compared with the image-only model. The AUC score in the ensemble model was significantly improved compared with the image-only model (difference 0.004; 95% CI 0.002–0.0007; p = 0.0004, effect size: 0.871). Conclusions: This study revealed the additional effect of patient variables in identification of osteoporosis using deep CNNs with hip radiographs. Our results provided evidence that the patient variables had additive synergistic effects on the image in osteoporosis identification.
... While assessing the relationship between BMI and osteoporosis, we found the highest percentage (63.6%) of osteoporosis in the underweight population. A study by Asomaning K et al 15 signified the increased risk of osteoporosis in women with low BMI 15 . This is in accordance with our study in which there was a gradual decrease in the percentage of osteoporosis with increasing BMI, the lowest percentage being documented in the obese women. ...
Article
Aim: Association of various demographic characteristics with osteoporosis in post menopausal women. Study design: Descriptive study. Place and duration of study: Radiology Department North West General Hospital and Research Centre, Peshawar, from 15th August 2013 to 14th August 2014. Methodology: Post menopausal women referred for osteoporosis screening were scanned for bone mineral density (BMD) of the left hip by Dual-energy X-ray absorptiometry (DEXA) technique. Patients who were using any drugs or had any known disease affecting bone metabolism and patients already diagnosed as osteoporotic were excluded. Mean±SD were calculated for numerical data using SPSS version 16. Chi-Square test was applied. Results: Among the 318 post menopausal women, the mean age was 62.51±9.15 and menopausal duration 15.19±8.27 years. Mean BMI was 29.2±6.47Kg/m2. Parity ranged from 0 to 14 children, with mean of 6±. Overall observed frequency of osteoporosis was 38.1%. Osteoporosis was significantly associated with older age groups (p<0.05). Majority of patients beyond the age of 70 years (58.3%) and with menopausal duration of ≥21 years (52.8%) had osteoporosis. Low BMI, defined as BMI<18.5Kg/m2, was associated with lower BMD (p<0.01). No significant association was established between early and late onset menopause and osteoporosis, as well as high parity and osteoporosis in our study. Conclusion: Increasing age, longer duration of menopause, low BMI, and physical inactivity were significantly associated with the presence of osteoporosis. Keywords: Osteoporosis, Menopause, Bone Mineral Density (BMD), Dual-Energy X ray Absorptiometry (DEXA)
... Low BMI triggers a myriad of health issues such as malnourishment, compromised immune systems, fatigue and anemia, leading to irregular menstruation and fertility issues for women [17]. Low BMI also elevates a risk of osteoporosis among women [18]. Evidence shows that men and women with low BMI are at higher risks for mortality compared to those with normal BMI [19]. ...
Article
Objective This study aimed to synthesize the best available evidence regarding the effectiveness of non-pharmacological interventions on body mass index (BMI), body dissatisfaction, depression and anxiety among individuals with anorexia nervosa (AN). Methods Published studies in English were searched using seven databases (such as PubMed). Grey literature was searched using ProQuest and Scopus. Studies were screened, appraised and extracted by two independent reviewers. Meta-analysis was performed and standardized mean difference was used as an effect measure. Heterogeneity was determined by I² statistics and Cochran χ² test. Publication bias was appraised using funnel plots. Sensitivity and subgroup analyses were also conducted. Results Nineteen RCTs from eight different countries were included in this review. Behavioral family system therapy (BFST) was found to enhance BMI while conjoint family therapy (CFT) was more effective in ameliorating depression. Studies implementing combined family and individual therapy and those with longer therapeutic durations produced larger effect sizes. Conclusion This review provided evidence to support BSFT, CFT and combined family and individual therapy for adolescents with AN. Practical implications Healthcare professionals may offer the two interventions to adolescents with AN in clinical settings. Future research may further investigate the effectiveness of BSFT and CFT on BMI and depression.
... Interestingly enough, some studies reported that obese older adults have less fall risk because they move less -thus, the fall risk is decreasing. Hence overweight and obese older adults seem to adopt a more tentative gait pattern, slower pace when walking, and increased base support due to their difficulties 19 . On the other hand, low BMI values could set a fertile ground for the manifestation of other comorbidities, such as osteoporosis, leading to an increased fall risk. ...
Article
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Objectives: To investigate the impact of the body mass index (BMI) change on risk of falling in postmenopausal women with osteopenia or osteoporosis. Also, we aimed to evaluate and associate the individuals' functionality, mobility and balance with the risk of falling. Methods: This one-year prospective observational study assessed 498 postmenopausal Greek women over the 50th year of age suffering from either osteoporosis or osteopenia. Parameters such as the height, weight and BMI were documented. Furthermore, the subjects were asked whether they experienced a fall the preceding year. Balance was evaluated using the Berg Balance Scale, the Timed-Up-And-Go test, and the 30 Seconds Sit-to-Stand test. Hand-grip strength was assessed with the Jamar Hydraulic Hand Dynamometer. Results: The observed one-year BMI change was associated with falls in postmenopausal osteopenic and osteoporotic women over the age of 70. Additionally, there were statistically significant changes in the BBS, TUG, 30CST and the hand-grip strength on both hands at the one-year follow-up but there were not associated with an increased fall risk. Conclusion: The one-year change in BMI was associated with the risk of falling in postmenopausal osteopenic and osteoporotic women over the 70th year of age. Whereas, the one-year change in balance, mobility and grip strength were not linked to an increased risk of falling.
... However, after controlling for confounders (including BMI, steroids, smoking, fracture history, vitamin D and calcium use), there was no association of MC to LBD. Increasing the validity of our results, we did find that BMI and steroid use were independent predictors of LBD, consistent with prior literature [22,23]. This is the largest study evaluating LBD in MC patients and has several strengths including spanning academic and community practice, diagnoses verified by review of pathology, and inclusion of matched cohort to attempt to control for confounders. ...
Article
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Background Microscopic colitis (MC) is a subtype of inflammatory bowel disease (IBD) with overlapping risk factors for low bone density (LBD). While LBD is a known complication of IBD, its association with MC is not well-established. Aims Assess the prevalence of LBD in MC compared to control populations, and evaluate if MC predicts LBD when controlling for confounders. Methods Retrospective, observational case control study of adult patients with pathologically confirmed MC from 2005 to 2015. Bone density measurements were abstracted from dual-energy X-ray absorptiometry (DEXA) reports, and bone density was classified using T-score: normal (T ≥ − 1.0), osteopenia (− 1.0 > T > -2.5) or osteoporosis (T ≤ − 2.5). Demographics, disease, medication history and LBD risk factors were obtained from chart review. Prevalence of LBD was compared to national and local controls. A matched control cohort to MC patients without prior diagnosis of LBD was analyzed with logistic regression to assess the relationship of MC to LBD. Results One hundred and eighteen patients with MC were identified. Osteopenia in women with MC was more prevalent compared to national controls (67% vs. 49%, p = 0.0004), and LBD was more prevalent in MC patients compared to local controls (82% vs. 55%, p < 0.0001). In MC patients without prior diagnosis of LBD matched to controls, there was a higher prevalence of osteopenia (53.2% vs. 36.7%, p = 0.04). However, after controlling for confounders, MC was not associated with LBD (OR 0.83, 95% CI 0.22, 3.16, p = 0.8). Conclusions While LBD was more prevalent in MC patients compared to control populations, with adjustment for key confounders (including BMI, steroids, smoking, vitamin D and calcium use), MC was not an independent predictor of LBD.
... Previous observational studies have identified various physiological and pathological factors correlated with BMD value [6]. For instance, body mass index (BMI) [7], age [8], gender [9], smoking history [10] and sex hormone-binding globulin (SHBG) [11] have been suggested as risk factors of osteoporosis. SHBG is a glycoprotein that has high affinity to sex steroids [12], which has been reported to regulate the bioavailability and concentration of free estradiol and testosterone [13,14]. ...
Article
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Previous observational studies have identified various risk factors associated with the development of osteoporosis, including sex hormone-binding globulin (SHBG). The aim of this study was to determine the potential causal effects of circulating SHBG concentrations on bone mineral density (BMD). Two-sample Mendelian randomization (MR) approach was applied in analyses. From summary-level data of genome-wide association studies (GWAS), we selected 11 single-nucleotide polymorphisms (SNPs) associated with SHBG levels as instrumental variable, and used summary statistics for BMD at forearm (FA) (n = 8143), femoral neck (FN) (n = 32,735), lumbar spine (LS) (n = 28,498) and heel (HL) (n = 394,929), and total-body BMD of different age-stages (15 or less, 15–30, 30–45, 45–60, 60 or more years old) (n = 67,358). Inverse causal associations was observed between SHBG levels and FA BMD (Effect = − 0.26; 95% CI − 0.49 to − 0.04; P = 0.022), HL eBMD (Effect = − 0.09; 95% CI − 0.12 to − 0.06; P = 3.19 × 10–9), and total-body BMD in people aged 45–60 years (Effect = − 0.16; 95% CI − 0.31 to − 2.4 × 10–3; P = 0.047) and over 60 years (Effect = − 0.19; 95% CI − 0.33 to − 0.05; P = 0.006). Our study demonstrates that circulating SHBG concentrations are inversely associated with FA and HL eBMD, and total-body BMD in people aged over 45 years, suggesting that the role of SHBG in the development of osteoporosis might be affected by chronological age of patients and skeletal sites.
... More specifically, our RA patients with osteoporosis had significantly lower BMI, while RA patients without osteoporosis had more than 3 times the prevalence of obesity among RA patients with osteoporosis. It is known that low BMI represents an independent and significant risk factor for osteoporosis (31,32), therefore one can suppose a protective effect of body fat on BMD. This hypothesis was proven: for example, Mazocco et al. (33) reported, as we observed, that the prevalence of osteoporosis among obese subjects is significantly lower than that of normal-weight and overweight subjects, while Barrera et al. (34), studying femoral neck BMD, reported that obesity incurs a three-fold reduction in the risk for osteoporosis compared to persons with normal weight. ...
Article
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Objective. The objective of this initial phase of the study is to retrospectively screen rheumatoid arthritis (RA) phenotype characteristics associated with osteoporosis. Methods. The study included all RA patients who randomly came to the university rheumatology department between January and July 2018. Demographic data, anthropometric data, RA-specific variables, osteoporosis data and comorbidities were collected retrospectively and cross-sectionally from the first (and most frequently the only) observation sheet of each patient within the study timeframe. Correlations and comparison were analyzed using appropriate non-parametric tests, all of the reported being significant (p
... For BMI, we identified its positive association with knee osteoarthritis and sleep duration, which is consistent with what have been reported in (65,66), respectively. We also confirmed a protective effect of BMI on osteoporosis as suggested previously by (67,68). Moreover, increased BMI is also considered to be one of the contributing factors for PVD in both our study and other related work (69). ...
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The proliferation of genome-wide association studies (GWAS) has prompted the use of two-sample Mendelian randomization (MR) with genetic variants as instrumental variables (IVs) for drawing reliable causal relationships between health risk factors and disease outcomes. However, the unique features of GWAS demand that MR methods account for both linkage disequilibrium (LD) and ubiquitously existing horizontal pleiotropy among complex traits, which is the phenomenon wherein a variant affects the outcome through mechanisms other than exclusively through the exposure. Therefore, statistical methods that fail to consider LD and horizontal pleiotropy can lead to biased estimates and false-positive causal relationships. To overcome these limitations, we proposed a probabilistic model for MR analysis in identifying the causal effects between risk factors and disease outcomes using GWAS summary statistics in the presence of LD and to properly account for horizontal pleiotropy among genetic variants (MR-LDP) and develop a computationally efficient algorithm to make the causal inference. We then conducted comprehensive simulation studies to demonstrate the advantages of MR-LDP over the existing methods. Moreover, we used two real exposure–outcome pairs to validate the results from MR-LDP compared with alternative methods, showing that our method is more efficient in using all-instrumental variants in LD. By further applying MR-LDP to lipid traits and body mass index (BMI) as risk factors for complex diseases, we identified multiple pairs of significant causal relationships, including a protective effect of high-density lipoprotein cholesterol on peripheral vascular disease and a positive causal effect of BMI on hemorrhoids.
... In the United States, more than 14 million postmenopausal white women have osteopenia [4], which leads to fractures and fractures lead to extensive health problems if not diagnosed and treated early [5]. Statistical data have shown that 4-6 million (13%-18%) postmenopausal women in the United States have osteoporosis [6], whereas osteoporosis occurs in more than one-third of the women over 65 years old in western societies [7]. High levels of osteopenia and osteoporosis have been detected in screening programs in Dubai as of May 24 2007 [8]. ...
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The primary objectives of this research are to explore and evaluate the correlation between the Body Mass Index (BMI) and Bone Mineral Density (BMD), to gauge the correlation between age and BMD and to investigate the effect of gender on BMD. Methods: BMD was determined in the femoral neck and lumbar (L2-L4) regions for 210 men and women with an average age of (57.41 ± 9.73) using dual energy X-ray absorptiometry (DEXA). Subsequently, 116 participants were determined to have osteopenia, and 94 participants had osteoporosis. We analyzed the data by multiple regression and ANOVA models. Results: We found the highest percentages of osteopenia and osteoporosis, 48.3% and 44.7%, respectively in obese patients. The statistical analysis of each independent variables (age, gender and BMI) indicated that there were no significant correlations between the BMI and BMD in osteopenia and osteoporosis (p-value = 0.2001 and p-value = 0.4622), respectively. Moreover, the correlation of the independent variables (age, gender and BMI) together and the dependent variable (BMD) was significant (p-value = 0.034, P ≤ 0.05) of osteoporosis only, but the correlation was not significant between BMD and each individual variables separately, compatible with a diagnosis of osteopenia and osteoporosis. Furthermore, the most effective variable on the BMD was the BMI (p-value= 0.02) of osteopenia, while the age (p-value = 0.011) was the most effective variable on the BMD of osteoporosis when they were tested jointly. Conclusions: The BMD was influenced significantly by all independent variables (age, gender and BMI) together in the osteoporosis not in osteopenia, so all variables together are considered as risk factors of osteoporosis. However, this effect could not be implied in the osteopenia patients.
... The review further reports that individuals well over 60 years of age who are overweight have an increased chance of developing foot problems, arthritis, incontinence, declining physical functioning, acute health events, and stroke [16]. The exception to this pattern of disease susceptibility is osteoporosis, "because the increased load on the skeleton of high body mass index (BMI) individuals promotes higher bone mineral density" [17]. ...
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After menopause, when estrogen levels decrease, there is room for the activity of anthropogenic substances with estrogenic properties – endocrine disruptors (EDs) – that can interfere with bone remodeling and changes in calcium-phosphate metabolism. Selected unconjugated EDs of the bisphenol group – BPA, BPS, BPF, BPAF, and the paraben family – methyl-, ethyl-, propyl-, butyl-, and benzyl-parabens – were measured by high performance liquid chromatography-tandem mass spectrometry in the plasma of 24 postmenopausal women. Parameters of calcium-phosphate metabolism and bone mineral density were assessed. Osteoporosis was classified in 14 women, and 10 women were put into the control group. The impact of EDs on calcium-phosphate metabolism was evaluated by multiple linear regressions. In women with osteoporosis, concentrations of BPA ranged from the lower limit of quantification (LLOQ) – 104 pg/ml and methyl paraben (MP) from LLOQ – 1120 pg/ml. The alternative bisphenols BPS, BPF and BPAF were all under the LLOQ. Except for MP, no further parabens were detected in the majority of samples. The multiple linear regression model found a positive association of BPA (β=0.07, p<0.05) on calcium (Ca) concentrations. Furthermore, MP (β=-0.232, p<0.05) was negatively associated with C-terminal telopeptide. These preliminary results suggest that these EDs may have effects on calcium-phosphate metabolism.
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Aim: The aim of this study was to evaluate the physical activity, nutritional habits, and body composition calculated by Bioelectrical Impedance Analysis, of the individuals whose Body Mass Index were below 25 kg/m 2 and above 25 kg/m 2. Material and Methods: 131 students (70 female, 61 male) of Bulent Ecevit University Medical Faculty, Health Sciences Faculty and Vocational School of Health Sciences were voluntarily involved in the study. Body Mass Index values were measured via Bioelectric Impedance Analysis by Tanita BC 418 and body composition values were saved. Students divided into two groups according to Body
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Introduction Low backache (LBA) is highly prevalent in osteoporotic patients and affects their quality of life. Overall, osteoporosis incidence is greater in females than in males, and osteoporotic fractures typically occur with only modest or moderate trauma. Aims and Objectives To evaluate osteoporosis as a cause of LBA in patients attending a neurosurgical outpatient department and to study various risk factors associated with it. Materials and Methods The study entitled “Osteoporosis presenting as LBA: An entity not uncommon to be missed” was a 2-year hospital-based study conducted from August 2014 to July 2016 in a prospective manner and included 100 patients of osteoporosis with LBA. Analysis of records included their chief complaints, signs and symptoms, diagnostic investigations performed, treatment modalities they underwent, and further recommended management carried on them. Results Out of total 100 patients evaluated, 33 (33%) were male and 67 (67%) were female; the age of patients was in the range of 35–70 years (mean 56.54 ± 91). The number of patients with a significant medical or surgical history was 31 (31%). The history of drug intake such as thyroxine, steroids, and antiepileptics was present in a total of 11 patients out of which 10 were female and one was male. Regarding lifestyle characteristics of studied patients, a total number of 72 (72%) were having sedentary habits with 15 (45.5%) males and 57 (85.1) females, the total number of moderate workers was 19 (27.3) males and 10 (14.9%) females, and heavy workers were 9 (9%) with 9 (27.3) males and 0 (0%) female. Conclusion LBA is highly prevalent in osteoporotic patients especially in women. The incidence of osteoporosis and LBA increased with low body mass index, increasing age, and duration of menopause. The various risk factors for osteoporosis include smoking, history of medical diseases such as diabetes mellitus, history of hysterectomy, and history of antiepileptic, thyroxine, and steroid intake.
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Background: Advances in radiotherapy (RT) have led to improved oncologic outcomes for women with gynecologic cancers; however, the long-term effects and survivorship implications need further evaluation. The purpose of this study was to determine the incidence of pelvic fractures and changes in bone mineral density (BMD) after pelvic RT. Methods: Two hundred thirty-nine women who had pelvic RT for cervical, endometrial, or vaginal cancer between 2008 and 2015 were prospectively studied. BMD scans and biomarkers of bone turnover were obtained at the baseline and 3 months, 1 year, and 2 years after RT. Imaging studies were assessed for pelvic fractures for up to 5 years. Patients with osteopenia, osteoporosis, or pelvic fractures at any point were referred to the endocrinology service for evaluation and treatment. Results: The median age at diagnosis was 51 years; 132 patients (56%) were menopausal. The primary diagnoses were cervical (63.6%), endometrial (30.5%), and vaginal cancer (5.9%). Sixteen patients (7.8%; 95% confidence interval, 4.5%-12.4%) had pelvic fractures with actuarial rates of 3.6%, 12.7%, and 15.7% at 1, 2, and 3 years, respectively. Fractures were associated with baseline osteoporosis (P < .001), higher baseline bone-specific alkaline phosphatase (P < .001), and older age (P = .007). The proportion of patients with osteopenia/osteoporosis increased from 50% at the baseline to 58%, 59%, and 70% at 3 months, 1 year, and 2 years, respectively. Conclusions: A high proportion of women had significant decreases in BMD after pelvic RT, with 7.8% diagnosed with a pelvic fracture. BMD screening and pharmacologic intervention should be strongly considered for these high-risk women.
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The association of bone loss with age, sex, and several prevalent and modifiable potential risk factors for osteoporosis was studied in 1,856 men and 2,452 women aged 55 years and over from the Rotterdam Study, a population-based cohort study in the Netherlands. The rate of change in femoral neck bone mineral density was estimated longitudinally between 1990 and 1995, after 2 years of follow-up on average. These rates, adjusted for age and body mass index, were -0.0025 (95% confidence interval -0.0038 to -0.0012) in men and -0.0045 (95% confidence interval -0.0056 to -0.0034) g/cm/2year in women (p = 0.03). Bone loss accelerated with age, as seen more clearly in men than in women. Lower body mass index and cigarette smoking were associated with increased bone loss in both men and women. In men, higher calcium intake was associated with lower rates, and disability was associated with borderline significantly higher rates of bone loss (p = 0.07). In women, a nonsignificant relation was observed with disability, but not with dietary calcium intake. Alcohol intake was not consistently related to the rate of bone loss in either sex. It is concluded that in elderly people the rate of bone loss is higher in women, progresses with age, and is further determined by several modifiable risk factors, particularly in men. Am J Epidemiol 1998;147:871-9.
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Patients with low bone mineral density (BMD) have a high risk of future fractures, and should be actively considered for treatment to reduce their risk. However, BMD measurements are not widely available in some communities, because of cost and lack of equipment. Simple questionnaires have been designed to help target high-risk women for BMD measurements, thereby avoiding the cost of measuring women at low risk. However, such tools have previously focused on evaluation of non-Asian women. We collected information about numerous risk factors from postmenopausal Asian women in eight countries in Asia using questionnaires, and evaluated the ability of these risk factors to identify women with osteoporosis as defined by femoral neck BMD T-scores < or =-2.5. Multiple variable regression analysis and item reduction yielded a final tool based on only age and body weight. This risk index had a sensitivity of 91% and specificity of 45%, with an area under the curve of 0.79. Previously published risk indices based on larger numbers of variables performed similarly well in this Asian population. Large differences in risk were identified using our index to create three categories: 61% of the high-risk women had osteoporosis, compared with only 15% and 3% of the intermediate- and low-risk women, respectively. The low-risk group represented 40% of all women, for whom BMD measurements are probably not needed unless important risk factors, such as prior nonviolent fracture or corticosteroid use, are present. An existing population-based sample of postmenopausal Japanese women was used to validate our index. In this sample of Japanese women the sensitivity was 98% and specificity was 29%; the low-risk category, for whom BMD is probably unnecessary, represented 25% of all women. We conclude that our index performed well for classifying the risk of osteoporosis among postmenopausal Asian women and applying it would result in more prudent use of BMD technology.
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Large segments of the population at risk for osteoporosis and fracture have not been evaluated, and the usefulness of peripheral measurements for short-term prediction of fracture risk is uncertain. To describe the occurrence of low bone mineral density (BMD) in postmenopausal women, its risk factors, and fracture incidence during short-term follow-up. The National Osteoporosis Risk Assessment, a longitudinal observational study initiated September 1997 to March 1999, with approximately 12 months of subsequent follow-up. A total of 200 160 ambulatory postmenopausal women aged 50 years or older with no previous osteoporosis diagnosis, derived from 4236 primary care practices in 34 states. Baseline BMD T scores, obtained from peripheral bone densitometry performed at the heel, finger, or forearm; risk factors for low BMD, derived from questionnaire responses; and clinical fracture rates at 12-month follow-up. Using World Health Organization criteria, 39.6% had osteopenia (T score of -1 to -2.49) and 7.2% had osteoporosis (T score </=-2.5). Age, personal or family history of fracture, Asian or Hispanic heritage, smoking, and cortisone use were associated with significantly increased likelihood of osteoporosis; higher body mass index, African American heritage, estrogen or diuretic use, exercise, and alcohol consumption significantly decreased the likelihood. Among the 163 979 participants with follow-up information, osteoporosis was associated with a fracture rate approximately 4 times that of normal BMD (rate ratio, 4.03; 95% confidence interval [CI], 3.59-4.53) and osteopenia was associated with a 1.8-fold higher rate (95% CI, 1.49-2.18). Almost half of this population had previously undetected low BMD, including 7% with osteoporosis. Peripheral BMD results were highly predictive of fracture risk. Given the economic and social costs of osteoporotic fractures, strategies to identify and manage osteoporosis in the primary care setting need to be established and implemented.
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Objectives To clarify the factors associated with prevention, diagnosis, and treatment of osteoporosis, and to present the most recent information available in these areas. Participants From March 27-29, 2000, a nonfederal, nonadvocate, 13-member panel was convened, representing the fields of internal medicine, family and community medicine, endocrinology, epidemiology, orthopedic surgery, gerontology, rheumatology, obstetrics and gynecology, preventive medicine, and cell biology. Thirty-two experts from these fields presented data to the panel and an audience of 699. Primary sponsors were the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institutes of Health Office of Medical Applications of Research. Evidence MEDLINE was searched for January 1995 through December 1999, and a bibliography of 2449 references provided to the panel. Experts prepared abstracts for presentations with relevant literature citations. Scientific evidence was given precedence over anecdotal experience. Consensus Process The panel, answering predefined questions, developed conclusions based on evidence presented in open forum and the literature. The panel composed a draft statement, which was read and circulated to the experts and the audience for public discussion. The panel resolved conflicts and released a revised statement at the end of the conference. The draft statement was posted on the Web on March 30, 2000, and updated with the panel's final revisions within a few weeks. Conclusions Though prevalent in white postmenopausal women, osteoporosis occurs in all populations and at all ages and has significant physical, psychosocial, and financial consequences. Risks for osteoporosis (reflected by low bone mineral density [BMD]) and for fracture overlap but are not identical. More attention should be paid to skeletal health in persons with conditions associated with secondary osteoporosis. Clinical risk factors have an important but poorly validated role in determining who should have BMD measurement, in assessing fracture risk, and in determining who should be treated. Adequate calcium and vitamin D intake is crucial to develop optimal peak bone mass and to preserve bone mass throughout life. Supplementation with these 2 nutrients may be necessary in persons not achieving recommended dietary intake. Gonadal steroids are important determinants of peak and lifetime bone mass in men, women, and children. Regular exercise, especially resistance and high-impact activities, contributes to development of high peak bone mass and may reduce risk of falls in older persons. Assessment of bone mass, identification of fracture risk, and determination of who should be treated are the optimal goals when evaluating patients for osteoporosis. Fracture prevention is the primary treatment goal for patients with osteoporosis. Several treatments have been shown to reduce the risk of osteoporotic fractures, including those that enhance bone mass and reduce the risk or consequences of falls. Adults with vertebral, rib, hip, or distal forearm fractures should be evaluated for osteoporosis and given appropriate therapy.
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PURPOSE: To determine the relationship between measures of body size and the risk of hip fracture in elderly women.PARTICIPANTS AND METHODS: The association between measures of body size and hip fracture risk was assessed in 8,011 ambulatory, nonblack women 65 years of age or older enrolled in the Study of Osteoporotic Fractures with measurements of total body weight, percent weight change since age 25, hip girth, lean mass, fat mass, percent body fat, body mass index, modified body mass index, and femoral neck bone mineral density (BMD) at the second examination. These 8,011 women were followed prospectively for incident hip fractures occurring after the second examination, which were confirmed by review of x-ray films.RESULTS: During an average of 5.2 years after the second examination, 236 (2.9%) women experienced hip fractures. Similar associations were observed between hip fracture risk and all measures of body size including total body weight, percent weight change since age 25, hip girth, lean mass, fat mass, percent body fat, body mass index, and modified body mass index. Women with smaller body size had a higher risk of subsequent hip fracture compared with those with larger body size, while women with average and larger body sizes shared similarly lower risks of subsequent hip fracture. For example, the incidence rate of hip fracture was 9.35 per 1000 woman-years in women in the lowest quartile of total weight compared with 4.63 per 1000 woman-years in women in the highest quartile of total weight (age-adjusted relative risk 1.93, 95% confidence interval (CI) 1.34 to 2.80), while rates of hip fracture among women in the second and third quartiles of total weight (5.22 and 4.32 per 1000 woman-years, respectively) were not significantly different from the rate among women in the highest quartile (P > 0.64). The increased risk of hip fracture among women of smaller body size remained after further adjustment for additional potential confounding factors including height at age 25, smoking status, physical activity, health status, estrogen use, and diuretic use. After further adjustment for femoral neck BMD, women with smaller body size were no longer at significantly increased risk of hip fracture compared with those with larger body size. For example, after adjustment for height at age 25, smoking status, physical activity, health status, estrogen use, and diuretic use, thin women had a 2.5-fold increase in the risk of hip fracture (multivariate relative risk 2.51, 95% CI 1.69 to 3.73) compared with the referent group composed of the heaviest women. After further adjustment for femoral neck BMD, the multivariate relative risk of hip fracture among thin women compared to heaviest women was 0.98 (95% CI, 0.64 to 1.50).CONCLUSION: Older women with smaller body size are at increased risk of hip fracture. This effect is because of lower hip BMD in women with smaller body size. Assessment of body size for prediction of hip fracture risk can be accomplished by measuring total body weight.
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Body mass index (BMI) is widely accepted as the ‘gold standard’ for determining whether a patient is underweight or overweight. However, its use and accuracy is dependent on obtaining accurate measures of height and weight. Physiological changes, equipment variability and observer error leads to height being a measure fraught with inaccuracy. This has led to the development of other measures to calculate height, including demi-span and knee height. But how much more accurate are these alternatives? The aim of this pilot study was to compare three anthropometric methods for measuring height in older people standing height, demi-span and knee height.
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In 1994 the WHO proposed guidelines for the diagnosis of osteoporosis based on measurement of bone mineral density. They have been widely used for epidemiological studies, clinical research and for treatment strategies. Despite the widespread acceptance of the diagnostic criteria, several problems remain with their use. Uncertainties concern the optimal site for assessment, thresholds for men and diagnostic inaccuracies at different sites. In addition, the development of many new technologies to assess the amount or quality of bone poses problems in placing these new tools within a diagnostic and assessment setting. This review considers the recent literature that has highlighted the strengths and weaknesses of diagnostic thresholds and their use in the assessment of fracture risk, and makes recommendations for actions to resolve these difficulties.
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In this case-control study of the epidemiology of hip fracture in postmenopausal women aged 45–74 years, cases of hip fracture and two control groups were selected from admissions to four general hospitals in Connecticut between September 1977 and May 1979. Fewer cases of hip fracture than controls had been exposed to estrogen replacement therapy, and among those who had been exposed, exposure time was shorter than that for controls. The cases had breastfed their children for shorter durations, and they more often had had both ovaries removed. Also, the cases were found to weigh less than the controls. The negative associations of hip fracture with estrogen replacement therapy, intact ovaries, and weight are consistent with the hypothesis that estrogens protect against hip fracture.
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We conducted an in vitro investigation of the loads and energies needed to fracture the proximal part of the femur in twelve fresh cadavera under loading conditions simulating one particular type of fall. The fracture loads ranged from 778 to 4,040 newtons and the work to fracture, from five to fifty-one joules. We also investigated the relationship between the fracture loads and several potential indices of bone strength, which were measured non-invasively at the subcapital, basic-cervical, and intertrochanteric regions with quantitative computed tomography. A very high positive correlation with the fracture load resulted from use of an intertrochanteric index--the product of the average trabecular computed-tomography number and the total cross-sectional area of the bone (R2 = 0.93, standard error of estimate = 295 newtons, and p less than 0.00001). We expect the use of this parameter to result in improved assessments of the degree of osteoporosis and of the component of risk of fracture of the hip that is associated with bone strength. However, the measured work to fracture for the isolated femur was an order of magnitude smaller than estimates of the energy available during a typical fall (about 450 joules), suggesting that energy absorbed during falling and impact, rather than bone strength, may be the dominant factors in the biomechanics of fracture of the hip.
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Neither age-related osteoporosis nor the increasing incidence of falls with age sufficiently explain the exponential increase in the incidence of hip fracture with aging. We propose that four conditions must be satisfied in order for a fall to cause a hip fracture: (a) the fatter must be oriented to impact near the hip; (b) protective responses must fail; (c) local soft tissues must absorb less energy than necessary to prevent fracture, and (d) the residual energy of the fall applied to the proximal femur must exceed its strength. All of these events become more likely with aging and lead to an exponential rise in the risk of hip fracture with advancing age. This model also suggests that a combination of measurements of neuromuscular function and of bone strength may be the most accurate approach to assessing the risk of hip fracture.
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In this case-control study of the epidemiology of hip fracture in post-menopausal women aged 45-74 years, cases of hip fracture and two control groups were selected from admissions to four general hospitals in Connecticut between September 1977 and May 1979. Fewer cases of hip fracture than controls had been exposed to estrogen replacement therapy, and among those who had been exposed, exposure time was shorter than that for controls. The cases had breastfed their children for shorter durations, and they more often had had both ovaries removed. Also, the cases were found to weigh less than the controls. The negative associations of hip fracture with estrogen replacement therapy, intact ovaries, and weight are consistent with the hypothesis that estrogens protect against hip fracture.
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During a 15-month period, 47 elderly female patients admitted to hospital with a fractured neck of femur were studied immediately prior to discharge, in comparison with 34 elderly female control patients undergoing elective surgery who had been admitted over the same period to the same orthopaedic wards. The principal differences between the two populations were that the fracture patients had a lower forearm trabecular bone density, with lower bodyweight (both lower muscle mass and lower fat content), increased body sway, worse eyesight and reduced mental acuity. The serum biochemistry of the two groups was almost indistinguishable except that the fracture patients tended to have slightly lower concentrations of proteins. There was no evidence to implicate dietary vitamin D deficiency, osteomalacia, oestrogen deficiency or alcoholism in the aetiology of the fracture, nor was there evidence to suggest alterations in endocrine function with respect to cacitonin or parathyroid hormone.
Article
Objective: To determine the causes of hip or wrist fractures.Design: Case-control analysis nested in a prospective cohort study.Setting: Four clinical centers in Baltimore, Maryland, Minneapolis Minnesota, Portland, Oregon, and Monessen, Pennsylvania.Participants: Non-black women age 65 and older living in the community.Measurements: We measured bone density, arm strength, and anthropometric characteristics at a baseline examination. Those who subsequently suffered hip (n = 130) or wrist (n = 294) fractures as a result of a fall and a consecutive sample of those who fell without a fracture (n = 467) were interviewed about their falls.Results: In multivariate analyses, those who suffered hip fractures were more likely to have fallen sideways or straight down (odds ratio 3.3; 95% confidence interval 2.0 to 5.6) and to have landed on or near the hip (32.5; 9.9, 107.1) than women who fell without a fracture. Among women who fell on the hip, those with hip fractures were taller (1.5; 1.2, 2.2 per SD increase), less likely to have landed on a hand (0.3; 0.1 to 0.6) or to break the fall by grabbing or hitting an object (0.4; 0.2, 0.9), had weaker triceps (1.7; 1.2, 2.5 per SD decrease), and were more likely to land on a hard surface (2.8; 1.4, 5.5) than those without fractures. Women with wrist fractures were more likely to have fallen backward (2.2; 1.3, 3.8) and to have landed on a hand (20.4; 11.5, 36.0) than those who fell without a fracture. Among women who fell on the hand, those with wrist fractures were taller (1.4; 1.1, 1.8 per SD increase) and less likely to break the fall by grabbing or hitting an object (0.4; 0.2, 0.7). Among women who fell on their hip or hand, the risk of fracturing that site more than doubled for each standard deviation decrease in bone density at the site of fracture.Conclusions: The nature of the fall determines the type of fracture, while bone density and factors that increase or attenuate the force of impact of the fall determine whether a fracture will occur when a faller lands on a particular bone. These findings have important implications for prevention of fractures in older women.
Article
To determine the factors associated with appendicular bone mass in older women. Cross-sectional analysis of baseline data collected for a multicenter, prospective study of osteoporotic fractures. Four clinical centers in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela valley, Pennsylvania. A total of 9704 ambulatory, nonblack women, ages 65 years or older, recruited from population-based listings. Demographic and historical information and anthropometric measurements were obtained from a baseline questionnaire, interview, and examination. Single-photon absorptiometry scans were obtained at three sites: the distal radius, midradius, and calcaneus. Multivariate associations with bone mass were first examined in a randomly selected half of the cohort (training group) and were then tested on the other half of the cohort (validation group). In order of decreasing strength of association, estrogen use, non-insulin-dependent diabetes, thiazide use, increased weight, greater muscle strength, later age at menopause, and greater height were independently associated with higher bone mass. Gastric surgery, age, history of maternal fracture, smoking, and caffeine intake were associated with lower bone mass (all P < 0.05). For example, we found that 2 or more years of estrogen use was associated with a 7.2% increase in distal radius bone mass, whereas gastrectomy was associated with an 8.2% decrease in bone mass. The associations between bone mass and dietary calcium intake and rheumatoid arthritis were inconsistent. Alcohol use, physical activity, use of calcium supplements, pregnancy, breast-feeding, parental nationality, and hair color were among the many variables not associated with bone mass. Multivariate models accounted for 20% to 35% of the total variance of bone mass. A large number of factors influence the bone mass of elderly women; however, age, weight, muscle strength, and estrogen use are the most important factors.
Article
More than half of all women and about one third of men will experience osteoporotic fractures during their lives. Although no symptoms occur prior to fracture, bone mineral density and other risk factors can be used to identify high-risk patients, and because effective interventions exist, many of these fractures are now preventable. The proportion of people who are affected, the mortality and morbidity resulting from osteoporotic fractures, and the major known risk factors are discussed. Greater attention should be given to measuring bone mineral density and identifying other risk factors to quantitate the degree of fracture risk among patients (with or without a history of previous fractures), because the consequences of fractures often are severe, and no symptoms other than fractures are associated with disease progression.
Article
Physical and lifestyle data were collected from 62 postmenopausal women who had declined hormone replacement therapy. Potential predictor variables were examined for their associations with bone mineral density (BMD) of the lumbar spine and femoral neck as assessed by dual x-ray absorptiometry. Body weight demonstrated the strongest association with lumbar BMD; lean body mass demonstrated the strongest association with femoral BMD. Together with the natural logarithm of the number of years since menopause (ln YSM) these anthropometric variables explained 36 and 34% of the variability of femoral and lumbar BMD, respectively. Serum estradiol levels demonstrated a weak positive association with BMD, which lost statistical significance after adjustment for body mass. Similarly, cardiovascular fitness was positively associated with femoral BMD prior to but not following adjustment for body mass. Controlling for years since menopause and body mass, the product of dietary calcium and calcium absorption demonstrated a weak positive correlation with femoral BMD (partial r = 0.30). The intake of tea was positively and significantly associated with both bone density measurements. In multiple regression analysis, femoral BMD was best explained by the lean body mass, ln YSM, and the daily intake of tea (r2 = 0.50). Similarly, lumbar BMD was best explained by body weight, ln YSM, and intake of tea (r2 = 0.44). Body mass is a major predictor of postmenopausal bone density at the hip and spine. A positive association between dietary calcium and BMD was detected only by taking into account the intestinal absorptive efficiency.
Article
To determine the relationship between measures of body size and the risk of hip fracture in elderly women. The association between measures of body size and hip fracture risk was assessed in 8,011 ambulatory, nonblack women 65 years of age or older enrolled in the Study of Osteoporotic Fractures with measurements of total body weight, percent weight change since age 25, hip girth, lean mass, fat mass, percent body fat, body mass index, modified body mass index, and femoral neck bone mineral density (BMD) at the second examination. These 8,011 women were followed prospectively for incident hip fractures occurring after the second examination, which were confirmed by review of x-ray films. During an average of 5.2 years after the second examination, 236 (2.9%) women experienced hip fractures. Similar associations were observed between hip fracture risk and all measures of body size including total body weight, percent weight change since age 25, hip girth, lean mass, fat mass, percent body fat, body mass index, and modified body mass index. Women with smaller body size had a higher risk of subsequent hip fracture compared with those with larger body size, while women with average and larger body sizes shared similarly lower risks of subsequent hip fracture. For example, the incidence rate of hip fracture was 9.35 per 1000 woman-years in women in the lowest quartile of total weight compared with 4.63 per 1000 woman-years in women in the highest quartile of total weight (age-adjusted relative risk 1.93, 95% confidence interval (CI) 1.34 to 2.80), while rates of hip fracture among women in the second and third quartiles of total weight (5.22 and 4.32 per 1000 woman-years, respectively) were not significantly different from the rate among women in the highest quartile (P > 0.64). The increased risk of hip fracture among women of smaller body size remained after further adjustment for additional potential confounding factors including height at age 25, smoking status, physical activity, health status, estrogen use, and diuretic use. After further adjustment for femoral neck BMD, women with smaller body size were no longer at significantly increased risk of hip fracture compared with those with larger body size. For example, after adjustment for height at age 25, smoking status, physical activity, health status, estrogen use, and diuretic use, thin women had a 2.5-fold increase in the risk of hip fracture (multivariate relative risk 2.51, 95% CI 1.69 to 3.73) compared with the referent group composed of the heaviest women. After further adjustment for femoral neck BMD, the multivariate relative risk of hip fracture among thin women compared to heaviest women was 0.98 (95% CI, 0.64 to 1.50). Older women with smaller body size are at increased risk of hip fracture. This effect is because of lower hip BMD in women with smaller body size. Assessment of body size for prediction of hip fracture risk can be accomplished by measuring total body weight.
Article
The relationship between low bone mass and risk of fracture is well documented. Although bone densitometry is the method of choice for detecting low bone mass, its use may be limited by the availability of equipment, cost, and reimbursement issues. Improved patient selection for bone densitometry might increase the cost-effectiveness of screening for osteoporosis, a goal we sought to achieve by developing and validating a questionnaire based solely on patient-derived data. Responses to the questionnaire were used to assign postmenopausal women to one of two groups: (1) those unlikely to have low bone mineral density (defined as 2 standard deviations or more below the mean bone mass at the femoral neck in young, healthy white women) and therefore probably not currently candidates for bone densitometry; and (2) those likely to have low bone mineral density and therefore probably candidates for bone densitometry. We asked community-dwelling perimenopausal and postmenopausal women attending one of 106 participating multispecialty centers (both academic and community based) to complete a self-administered questionnaire and undergo bone density measurement using dual x-ray absorptiometry. We used regression modeling to identify factors most predictive of low bone density at the femoral neck in the postmenopausal group. A simple additive scoring system was developed based on the regression model. Results were validated in a separate cohort of postmenopausal women. Data were collected from 1279 postmenopausal women in the development cohort. Using only six questions (age, weight, race, fracture history, rheumatoid arthritis history, and estrogen use), we achieved a target of 89% sensitivity and 50% specificity. The likelihood ratio was 1.78. Validation in a separate group of 207 postmenopausal women yielded 91% sensitivity and 40% specificity. Assuming population characteristics similar to those of our development cohort, use of our questionnaire could decrease the use of bone densitometry by approximately 30%. Sensitivity and specificity can be varied by changing the level for referral for densitometry to provide the most cost-effective use within a particular healthcare setting. Thus use of our questionnaire, an inexpensive prescreening tool, in conjunction with physician assessment can optimize the use of bone densitometry and may lead to substantial savings in many healthcare settings where large numbers of women require evaluation for low bone mass.
Article
Low body mass is a major risk factor for low energy hip fractures among women. The purpose of this study was to ascertain whether normal body mass also protects against low energy wrist fractures. A retrospective analysis of body mass indices of 330 women who sustained hip or wrist fractures from falls was performed. Data were grouped by race and age. The mean body mass index for white patients with wrist fractures was 26.4, compared with a mean body mass index of 22.3 in white patients with hip fractures. For black patients, those with wrist fractures had a mean body mass index of 28.5, compared with a mean body mass index of 22.9 for those with hip fractures. Using data from The National Health and Nutrition Examination Surveys, the mean body mass index of patients with wrist fractures was seen to be equal to or greater than the national mean body mass index, whereas that of patients with hip fractures was substantially below average. Accordingly, normal body mass was protective against hip fractures but not against wrist fractures. Because adipose tissue more typically is distributed about the hip than the wrist, the protective mechanism of normal body mass against osteoporotic fractures may promote better preventative interventions against this disease.
Article
Dietary calcium intake and physical activity are considered practical measures for prevention of osteoporosis. However, their associations with bone mineral density (BMD) in the elderly are not clear. The present study examined the association between osteoporosis and these two factors in relation to body mass index (BMI) in a cross-sectional, epidemiological study involving 1075 women and 690 men, aged 69 +/- 6.7 years (mean +/- SD). Dietary calcium intake (median of 580 mg/day) was inversely related to age (p = 0.01), positively related to physical activity index (PAI) (p = 0.01), femoral neck BMD (p = 0.01) in women, and higher lumbar spine (p = 0.003) and femoral neck BMD (p = 0.03) in men. Quadriceps strength was negatively associated with age (p < 0.0001) and positively related to BMI (p < 0.0001) and BMD (p < 0.0001) in both men and women. The PAI was associated with quadriceps strength (p < 0.0001) and femoral neck and lumbar spine BMD in women (p < 0.001) and with femoral neck BMD in men (p = 0.04); however, these associations were not significant after adjusting for age, BMI, quadriceps strength, and dietary calcium. Women in the top tertile of quadriceps strength (> or =23 kg) and dietary calcium intake (> or =710 mg/day) had 15% higher BMD than those in the lowest tertiles (< or =15 kg and < or =465 mg/day); the difference was comparable in men (11%). Among subjects with the lowest tertiles of BMI (< or =23 kg/m2 for women and < or =24 kg/m2 for men), quadriceps strength (< or =15 kg for women and < or =28 kg for men), and dietary calcium intake (< or =465 mg/day), 64% and 40% of women and men, respectively, were classified as having osteoporosis (based on a 2.5-SD reduction from the young-normal mean). The prevalence was only 12% in women and 1.5% in men among those in the highest tertiles of the three factors. Adequate dietary calcium intake and maintaining a physically active lifestyle in late decades of life could potentially translate into a reduction in the risk of osteoporosis and hence improve the quality and perhaps quantity of life in the elderly population.
Article
Few studies have evaluated risk factors for bone loss in elderly women and men. Thus, we examined risk factors for 4-year longitudinal change in bone mineral density (BMD) at the hip, radius, and spine in elders. Eight hundred elderly women and men from the population-based Framingham Osteoporosis Study had BMD assessed in 1988-1989 and again in 1992-1993. BMD was measured at femoral neck, trochanter, Ward's area, radial shaft, ultradistal radius, and lumbar spine using Lunar densitometers. We examined the relation of the following factors at baseline to percent BMD loss: age, weight, change in weight, height, smoking, caffeine, alcohol use, physical activity, serum 25-OH vitamin D, calcium intake, and current estrogen replacement in women. Multivariate regression analyses were conducted with simultaneous adjustment for all variables. Mean age at baseline was 74 years +/-4.5 years (range, 67-90 years). Average 4-year BMD loss for women (range, 3.4-4.8%) was greater than the loss for men (range, 0.2-3.6%) at all sites; however, BMD fell with age in both elderly women and elderly men. For women, lower baseline weight, weight loss in interim, and greater alcohol use were associated with BMD loss. Women who gained weight during the interim gained BMD or had little change in BMD. For women, current estrogen users had less bone loss than nonusers; at the femoral neck, nonusers lost up to 2.7% more BMD. For men, lower baseline weight and weight loss also were associated with BMD loss. Men who smoked cigarettes at baseline lost more BMD at the trochanter site. Surprisingly, bone loss was not affected by caffeine, physical activity, serum 25-OH vitamin D, or calcium intake. Risk factors consistently associated with bone loss in elders include female sex, thinness, and weight loss, while weight gain appears to protect against bone loss for both men and women. This population-based study suggests that current estrogen use may help to maintain bone in women, whereas current smoking was associated with bone loss in men. Even in the elderly years, potentially modifiable risk factors, such as weight, estrogen use, and cigarette smoking are important components of bone health.
Article
In 1994 the WHO proposed guidelines for the diagnosis of osteoporosis based on measurement of bone mineral density. They have been widely used for epidemiological studies, clinical research and for treatment strategies. Despite the widespread acceptance of the diagnostic criteria, several problems remain with their use. Uncertainties concern the optimal site for assessment, thresholds for men and diagnostic inaccuracies at different sites. In addition, the development of many new technologies to assess the amount or quality of bone poses problems in placing these new tools within a diagnostic and assessment setting. This review considers the recent literature that has highlighted the strengths and weaknesses of diagnostic thresholds and their use in the assessment of fracture risk, and makes recommendations for actions to resolve these difficulties.
Article
Small body size predicts hip fractures in older women. To test the hypothesis that small body size predicts the risk for other clinical fractures. Prospective cohort study. Population-based listings in four areas of the United States. 8059 ambulatory nonblack women 65 years of age or older. Weight, weight change since 25 years of age, body mass index, lean body mass and percent body fat, and nonspine fractures during 6.4 years of follow-up. Compared with women in the highest quartile of weight, women in the lowest quartile had relative risks of 2.0 (95% CI, 1.5 to 2.8) for hip fractures, 2.3 (CI, 1.1 to 4.7) for pelvis fractures, and 2.4 (CI, 1.5 to 3.9) for rib fractures. Adjustment for total-hip bone mineral density eliminated the elevated risk. Results were similar for other body size measures. Smaller body size was not a risk factor for humerus, elbow, wrist ankle, or foot fractures. Total body weight is useful in the prediction of hip, pelvis, and rib fractures when bone mineral density has not been measured.
Article
To construct a quick algorithm to detect patients with low bone mineral density (BMD) and osteoporosis and determine its applicability in daily general practice. Cross-sectional study in all 9107 postmenopausal women, aged 50-80, registered at 12 general practice centers. All healthy women (5303) and 25% of the remaining group (943/3804) were invited to participate. Of 6246 invited women, 4725 (76%) participated. The women were questioned (state of health, medical history, family history, and food questionnaire) and examined [weight, height, body mass index (BMI), and BMD of the lumbar spine]. Multivariable, stepwise backward and forward logistic regression analyses were performed, with BMD of the lumbar spine (L2-L4, cut-off points at 0.800 g/cm(2) for osteoporosis and 0.970 g/cm(2) for low BMD) as the dependent variable. An algorithm was constructed with those variables that correlated statistically significantly and clinically relevant with the presence of both osteoporosis and low BMD. The prevalence of osteoporosis was 23%, that of low BMD was 65%. Only three variables (age, BMI, and fractures) were statistically significant and clinically relevant correlated with the presence of both osteoporosis and low BMD. Age (OR 2.70 for osteoporosis and OR 1.77 for low BMD) and fractures during the past five years (OR 3.60 for osteoporosis and OR 2.85 for low BMD) were found to be the key predictors. From the algorithm the absolute risks varied from 9% to 51% for osteoporosis and from 48% to 84% for low BMD. The corresponding relative risks varied from 1.0 to 5.7 and from 1.0 to 1.8. Using an algorithm with age, BMI, and fracture history subgroups at high risk could be identified. However, in whatever combination, many women with osteoporosis could not be identified. Despite the differences in methods, we found predictors for osteoporosis which were comparable with the results of other cross-sectional studies, meaning that the first selection of patients at high risk for low BMD can be done adequately by both specialists and general practitioners.
Article
Currently, few elderly women have a measurement of bone mineral density (BMD). The aim of this study was to assess the potential value of a two-step screening process to identify the elderly women who are at greatest risk of fracture because of very low BMD: (1) use simple clinical criteria to select women who are highly likely to have a very low BMD and (2) measure the BMD of the women so selected. We used baseline data from 6958 women aged 75 years or older who were participants in the EPIDOS prospective study of risk factors for hip fracture. The outcome variable was very low BMD measured at the femoral neck by dual-energy X-ray absorptiometry and defined as a T-score < or = -3.5. The factors most predictive of very low BMD were low weight, history of fracture after the age of 50 years, slow gait, balance impairment, low grip strength, and dependence for instrumental activities of daily living. A score based on the risk function including these factors has a sensitivity of 80% at the median cut-off. Hence, by measuring the BMD of only half the population, 80% of the women with very low BMD can be identified. Weight is the strongest determinant of very low BMD and has approximately the same sensitivity as the complete score. In conclusion, a risk score for very low BMD based on simple criteria such as weight could be a useful clinical tool to select elderly women for bone densitometry.
Article
Most estimates of nutritional status rely on accurate recording of not only body weight but also height. Standing height is difficult to measure accurately in older adults due to mobility problems and kyphosis. Surrogate methods have been developed to estimate height including arm-span, demi-span and knee height. There are currently little data on the accuracy of these methods in the sick elderly population or which method is the most suitable in the clinical situation. To compare three commonly used clinical measurements that can estimate height and analyse their agreement with current height. Also to evaluate which method can be used most frequently. We used data collected as part of a larger intervention trial, in which elderly in-patients (over 65 years), were measured for demi-span, half arm-span, knee height and standing height. The results showed that demi-span and half arm-span could be measured in the largest proportions of our population, 75.6 and 72.3%, respectively. The correlation coefficients were high for all three estimates of height, r = 0.86 for demi-span, r = 0.87 for arm-span, and r = 0.89 for knee height (P < 0.0001 for all three). However, agreement analysis demonstrated very poor agreement between standing height and all the methods of estimation. The mean differences were 4.33 cm for demi-span, 7.04 cm for arm-span and -0.6 cm for knee height.
Article
To determine the prevalence and correlates of osteoporosis among middle-aged and elderly Jewish and Arab women in Israel. A cross-sectional study on a random sample of Israeli women, carried out through telephone interviews. Questions included physician-diagnosed osteoporosis, demographic and lifestyle variables, medical conditions, and present and past use of estrogen-containing medications. Body mass index (BMI) was calculated from reported height and weight. A national population-based survey conducted from March through August 1998. A national random sample of 888 women aged 45-74. The overall prevalence of self-reported osteoporosis was estimated at 13.7%. The rates increased abruptly from about 5.8% at ages 45-59 to 19.6% at ages 60-64, and reached 27.7% at ages 70-74. Between ages 45-59, the rates were higher among Arab women, whereas in the older group they were higher among Jewish women. There was a marked increase following menopause. After adjustment for potential confounders, at ages 45-59, osteoporosis was positively associated with menopause and BMI, whereas at ages 60-74, it was positively associated with age and family history of osteoporosis, and negatively associated with BMI. The prevalence of physician-diagnosed osteoporosis in Israel among women aged 45-74 is estimated to be 13.7%, which is similar to that for the United States. The association of osteoporosis with risk factors is age-dependent, and in particular, age-BMI interaction on osteoporosis requires further investigation.
Article
Patients with osteoporosis have a body mass index (BMI) that is significantly lower than patients with normal bone mineral density (BMD). This study was conducted to examine the associations among age, height, weight, and BMI in patients with discordant regional BMD. For the purpose of this study, discordant regional BMD was defined as having a BMD result that is in the osteoporotic range at one site while being normal at the other sites. Data from 7513 qualifying bone densitometry scans from a suburban Detroit osteoporosis testing center were analyzed. A patient was classified as having generalized osteoporosis if the T-score was < 2.5 at the lumbar spine, femoral neck, and distal radius and normal if the T-score was > 1 at the same three sites. Patients were determined to have discordant low BMD when the T-score was < 2.5 at one site while the T-score was > 1 at the other two sites. Patients with generalized osteoporosis were older (mean age: 72.2 vs 54.7 yr; p < 0.001), shorter (height: 153.1 vs 161.7 cm; p < 0.001) and had lower BMI (23.7 vs 28.5 kg/m(2); p < 0.001) compared with patients with normal BMD. The distal radius was the site where discordant osteoporosis was most prevalent (70 patients, 0.9%). Patients with isolated low distal radius BMD were similar in age (mean age: 70.4 vs 72.2. yr; p = NS), but were taller (height: 158.6 vs 153.1 cm; p < 0.001) and had BMI values that were significantly higher (BMI: 28.7 vs 23.7 kg/m(2); p < 0.001) than patients with generalized osteoporosis. Patients with discordant BMD at the distal radius had anthropometric characteristics that were significantly different from patients with generalized osteoporosis. These differences may represent differences in the etiology of osteoporosis and differential effects on cortical vs trabecular bone.
Osteo-porosis Self-Assessment Tool for Asians (OSTA) re-search group. A simple tool to identify Asian women at increased risk of osteoporosis
  • Koh
  • Ben Lk
  • W Sedrine
  • Torralba
  • Tp
Koh LK, Ben Sedrine W, Torralba TP, et al. Osteo-porosis Self-Assessment Tool for Asians (OSTA) re-search group. A simple tool to identify Asian women at increased risk of osteoporosis. Osteoporos Int 2001;12:699.
An epidemiologic study of hip fracture in post-meno-pausal women
  • Kelsey N Jl Kreiger
  • O Holford Tr
  • Connor
Kreiger N, Kelsey JL, Holford TR, O'Connor T. An epidemiologic study of hip fracture in post-meno-pausal women. Am J Epidemiol 1982;116:141.