No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
The Association between Body Mass Index and Osteoporosis in Patients Referred for a Bone Mineral Density Examination
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.
... Previous research has provided compelling evidence demonstrating that obesity and weight gain are positively correlated with higher BMD and less bone loss 13,14 . Conversely, thinness and weight loss are associated with lower BMD and an higher rate of bone loss, further emphasizing the critical role of body weight in skeletal health 13,14 . ...
... Two potential mechanisms have been proposed to explain how body mass affects osteoporosis. The first mechanism involves mechanical loading, where additional weight imposes higher static mechanical stress on bones 14 . This stress can then trigger adaptive responses, leading to changes in bone quality and structure 14 . ...
... The first mechanism involves mechanical loading, where additional weight imposes higher static mechanical stress on bones 14 . This stress can then trigger adaptive responses, leading to changes in bone quality and structure 14 . Heavy individuals tend to attain higher peak BMD in early adulthood, which exerts a greater load on weight-bearing joints and results in higher BMD, reducing the likelihood of osteoporosis in old age 14 . ...
This study investigates the correlation between body mass index (BMI) and osteoporosis utilizing data from the Taiwan Biobank. Initially, a comprehensive analysis of 119,009 participants enrolled from 2008 to 2019 was conducted to assess the association between BMI and osteoporosis prevalence. Subsequently, a longitudinal cohort of 24,507 participants, initially free from osteoporosis, underwent regular follow-ups every 2–4 years to analyze the risk of osteoporosis development, which was a subset of the main cohort. Participants were categorized into four BMI groups: underweight (BMI < 18.5 kg/m²), normal weight (18.5 kg/m² ≤ BMI < 24 kg/m²), overweight (24 kg/m² ≤ BMI < 27 kg/m²), and obese groups (BMI ≥ 27 kg/m²). A T-score ≤ − 2.5 standard deviations below that of a young adult was defined as osteoporosis. Overall, 556 (14.1%), 5332 (9.1%), 2600 (8.1%) and 1620 (6.7%) of the participants in the underweight, normal weight, overweight and obese groups, respectively, had osteoporosis. A higher prevalence of osteoporosis was noted in the underweight group compared with the normal weight group (odds ratio [OR], 2.20; 95% confidence interval [95% CI], 1.99 to 2.43; p value < 0.001) in multivariable binary logistic regression analysis. Furthermore, in the longitudinal cohort during a mean follow-up of 47 months, incident osteoporosis was found in 61 (9%), 881 (7.2%), 401 (5.8%) and 213 (4.6%) participants in the underweight, normal weight, overweight and obese groups, respectively. Multivariable Cox proportional hazards analysis revealed that the risk of incident osteoporosis was higher in the underweight group than in the normal weight group (hazard ratio [HR], 1.63; 95% CI 1.26 to 2.12; p value < 0.001). Our results suggest that BMI is associated with both the prevalence and the incidence of osteoporosis. In addition, underweight is an independent risk factor for developing osteoporosis. These findings highlight the importance of maintaining normal weight for optimal bone health.
... While body mass index (BMI) has traditionally been the most widely utilized metric owing to its simplicity and convenience, recent scientific attention has shifted towards considering the role of fat distribution as a more precise and informative measure of adiposity and its associated health risks [4]. Consequently, dual-energy X-ray absorptiometry (DXA) emerges as a valuable tool for precise body composition analysis, including adiposity, lean mass, and bone mineral density (BMD) measurements [5,6]. 2 of 13 Obesity, a multifaceted condition with far-reaching effects on physiological systems and organs, raises questions regarding its impact on bone health [7]. BMD, a crucial measure of bone "quantity", exerts a significant influence on the progression of skeletal disorders like osteoporosis and osteopenia, which significantly heighten the risk of fractures and related morbidities [8]. ...
... Previously, it was widely believed that individuals with lower BMI were at a heightened risk of developing osteoporosis and fractures [9]. Multiple studies have also reported higher BMD values in individuals with obesity or higher BMI, seemingly supporting this perspective [1,7,8]. This finding can be attributed to the mechanical loading caused by increased body weight, which stimulates bone remodeling processes and ultimately leads to improved bone density as an adaptive response [10]. ...
... Although the association between obesity and BMD has garnered significant interest, its impact remains controversial. Many studies have proposed that obesity may confer protective effects on bone health, whereas lower BMI has been associated with decreased BMD and an elevated risk of osteoporosis [1,7,9]. Salamat et al. conducted an analysis involving 5892 participants, examining their BMI as well as hip and spine BMD. ...
Adiposity and bone mineral density (BMD) are closely associated. The aim of this research was to investigate the association between BMD and adiposity measures in adults, including gynoid percent fat (GPF), android percent fat (APF), total percent fat (TPF), visceral adipose tissue percent (VAT%), and total lean mass percent (TLM%). Participants (n = 11,615) aged 18 years and older were analyzed using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. Associations between BMD and adiposity measures were investigated, and potential differences based on gender and age were explored. Significant negative associations were observed among TPF, APF, GPF, VAT%, and BMD in the fully adjusted models, while TLM% and BMD were positively associated. Stratifying by age and sex, TPF, GPF, and VAT% consistently demonstrated a negative correlation with BMD. In the young adult group, a TPF of 38.2% eliminated the negative correlation between BMD and TPF. Male BMD exhibited an inverted U-shaped relationship with APF, peaking at 35.6%, while a similar pattern was observed for the middle-aged group BMD and APF, with a peak at 31.7%. This large-sample research found a significant negative association between adiposity measures and BMD, providing valuable revelations regarding the intricate connection between adiposity and bone health.
... Low BMI ≤ 20 kg/m 2 is recognized as 1 risk factor for osteoporosis with the probability of increasing the incidence of osteoporosis-related fractures including OVFs. [4,5] Several studies report a positive correlation between BMI and BMD, with an 8% to 12% decrease in the risk of osteoporosis with a BMI increase of 1 kg/m 2 . [5][6][7][8] Reportedly, BMI is also inversely correlated with postmenopausal bone loss. ...
... [4,5] Several studies report a positive correlation between BMI and BMD, with an 8% to 12% decrease in the risk of osteoporosis with a BMI increase of 1 kg/m 2 . [5][6][7][8] Reportedly, BMI is also inversely correlated with postmenopausal bone loss. [9] In contrast, higher estrogen levels in moderately obese women have protected them against bone loss compared with woman of normal weight, despite obesity increasing the risk of adverse health outcomes including hypertension, dyslipidemia, coronary heart disease, stroke, type 2 diabetes mellitus, gallbladder disease, sleep apnea, osteoarthritis, cancer, mental illness, and mortality. ...
... A lower BMD was associated with not only a lower BMI, but also older age. [4,5,12] In this study, the age of patients in the normal BMI group was significantly older than it was in the high BMI group (75.3 ± 7.9 vs 71.6 ± 7.9), but no significant difference was noted in the low BMI group compared with the normal and the high BMI groups. A relatively younger age in the low BMI group might contribute to the lack of significant difference in BMD compared with the other BMI groups. ...
A retrospective multicenter study. Body mass index (BMI) is recognized as an important determinant of osteoporosis and spinal postoperative outcomes; however, the specific impact of BMI on surgery for osteoporotic vertebral fractures (OVFs) remains inconclusive. This retrospective multicenter study investigated the impact of BMI on clinical outcomes following fusion surgery for OVFs. 237 OVF patients (mean age, 74.3 years; 48 men and 189 women) with neurological symptoms who underwent spinal fusion were included in this study. Patients were grouped by World Health Organization BMI categories: low BMI (<18.5 kg/m2), normal BMI (≥18.5 and <25 kg/m2), and high BMI (≥25 kg/m2). Patients’ backgrounds, surgical method, radiological findings, pain measurements, activities of daily living (ADL), and postoperative complications were compared after a mean follow-up period of 4 years. As results, the proportion of patients able to walk independently was significantly smaller in the low BMI group (75.0%) compared with the normal BMI group (89.9%; P = .01) and the high BMI group (94.3%; P = .04). Improvement in the visual analogue scale for leg pain was significantly less in the low BMI group than the high BMI group (26.7 vs 42.8 mm; P = .046). Radiological evaluation, the Frankel classification, and postoperative complications were not significantly different among all 3 groups. Improvement of pain intensity and ADL in the high BMI group was equivalent or non-significantly better for some outcome measures compared with the normal BMI group. Leg pain and independent walking ability after fusion surgery for patients with OVFs improved less in the low versus the high BMI group. Surgeons may want to carefully evaluate at risk low BMI patients before fusion surgery for OVF because poor clinical results may occur.
... In the past, it was assumed that individuals most at risk of fractures were non-obese women. A lower BMI has been suggested to elevate the risk of osteoporosis [113,114]. This initial belief was mainly supported by a positive relationship between BMI and BMD [113,115]. ...
... A lower BMI has been suggested to elevate the risk of osteoporosis [113,114]. This initial belief was mainly supported by a positive relationship between BMI and BMD [113,115]. Cherif et al. [116] pointed to an overall high BMD in postmenopausal obese women. Hammoud et al. [117] found that the severity of obesity did not affect BMD values in premenopausal obese women. ...
Obesity, type 2 diabetes mellitus (T2DM) and osteoporosis are serious diseases with an ever-increasing incidence that quite often coexist, especially in the elderly. Individuals with obesity and T2DM have impaired bone quality and an elevated risk of fragility fractures, despite higher and/or unchanged bone mineral density (BMD). The effect of obesity on fracture risk is site-specific, with reduced risk for several fractures (e.g., hip, pelvis, and wrist) and increased risk for others (e.g., humerus, ankle, upper leg, elbow, vertebrae, and rib). Patients with T2DM have a greater risk of hip, upper leg, foot, humerus, and total fractures. A chronic pro-inflammatory state, increased risk of falls, secondary complications, and pharmacotherapy can contribute to the pathophysiology of aforementioned fractures. Bisphosphonates and denosumab significantly reduced the risk of vertebral fractures in patients with both obesity and T2DM. Teriparatide significantly lowered non-vertebral fracture risk in T2DM subjects. It is important to recognize elevated fracture risk and osteoporosis in obese and T2DM patients, as they are currently considered low risk and tend to be underdiagnosed and undertreated. The implementation of better diagnostic tools, including trabecular bone score, lumbar spine BMD/body mass index (BMI) ratio, and microRNAs to predict bone fragility, could improve fracture prevention in this patient group.
... Nonmodifiable factors, such as sex, age, and hormone levels, and menopausal status play a significant role. [5] Additionally, several modifiable risk factors can contribute to poor bone health, including low body mass index (BMI), [6] smoking, [7] excessive alcohol consumption, [8] and physical inactivity. [9] It is worth noting that metabolic syndromes like diabetes mellitus (DM) [10] and dyslipidemia [11] can also lead to a decrease in bone mineral density (BMD) due to the presence of oxidative stress. ...
... Covariates used in this study were chosen based on current Japanese osteoporosis guidelines [23] and the relevant literature. The covariates were age (continuous), sex (men or women), BMI (continuous), [6] fracture history (yes or no), early menopause (early or not early), [24] physical activity (active or not), [9] smoking (current, ex-smoker, or never), [7] alcohol intake (excessive drinker or not), [8] causative diseases that induce oxidative stress such as DM [10] (yes or no) and DL [11] (yes or no), use of sleep medication (yes or no), use of osteoporosis medication (yes or no), and working pattern (daytime worker, shift worker, or night-shift worker). ...
This study aimed to investigate the association between daily sleep duration of <7 hours and lower bone mineral density (BMD) using data from annual health check‐ups conducted in Japan between 2020 and 2022. Multivariate regression models were used, where BMD was the objective variable and daily sleep duration (<5 hours, 5 to <7 hours, 7 to <9 hours [reference], ≥9 hours) was the exposure variable adjusted for age, body mass index, physical activity, smoking status, and alcohol intake for men and women and further adjusted for menopausal status for women. The association between insomnia and BMD was also investigated. BMD was determined using calcaneal quantitative ultrasound and expressed as a percentage of the young adult mean (%YAM). In total, 896 men and 821 women were included. Median age was 54 years (interquartile range [IQR]: 46 to 64) for men and 55 years (IQR: 46 to 64) for women). Median BMD for men and women was 79%YAM (IQR: 71 to 89) and 75%YAM (IQR: 68 to 84), respectively. Approximately 80% of men and women slept <7 hours daily. Multivariate regression showed no association between sleep duration and BMD in men. However, women who slept 5 to <7 hours daily had significantly higher BMD by 3.9% compared with those who slept 7 to<9 hours ( p = 0.004). No association between insomnia and BMD was found. Overall, a daily sleep duration of <7 hours was not independently associated with lower BMD compared to those who slept 7 to <9 hours in men and women. However, as there is evidence of both shorter and longer sleep durations being associated with an increased risk of adverse events, including cardiovascular events, our result needs to be interpreted with caution. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
... 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). ...
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.
... Otros factores que se consideran pueden influir en el padecimiento de osteoporosis son el sobrepeso y la obesidad, que es consecuencia del aumento de la grasa corporal por la contribución de la inactividad física, la dieta y la genética. Aunque, en la literatura se ha mostrado que tener sobrepeso y obesidad puede beneficiar la densidad ósea (Albala et al., 1996;Asomaning, Bertone-Johnson, Nasca, Hooven, y Pekow, 2006;Beck et al., 2009;Greco et al., 2010;Lin et al., 2010;Looker et al., 1998;Núñez et al., 2007;Ravn et al., 1999;Siris et al., 2001;Zhao et al., 2007), hay otros estudios que muestran que personas con una elevado Índice de Masa Corporal (IMC) suelen tener mayor probabilidad de desarrollar osteoporosis (Greco et al., 2010;Lin et al., 2010). Caso contrario del sobrepeso y obesidad, son las personas con un IMC bajo, como es la desnutrición, en el cual suelen tener baja cantidad de masa grasa como reserva, esto podría traer como consecuencia la desmineralización ósea por los bajos niveles de estrógenos (Heaney, 1990;Kreiger, Kelsey, Holford, y O'Connor, 1982;Wootton et al., 1982). ...
... Otro factor que pueden incidir en el riesgo de osteopenia y osteoporosis es la edad avanzada, estudios como el de Asomaning et al. (2006), Looker, Melton, Borrud, y Shepherd (2012), y Borrud et al. (2001 muestran que las mujeres con edades de 70 a 80 años arrojaron mayor porcentaje de riesgo de osteopenia y osteoporosis, que las mujeres de 60 a 70 años. ...
... 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. ...
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.
... Osteoporosis, a debilitating skeletal disorder characterized by decreased bone density and increased fracture risk, remains a major public health concern [1][2][3][4][5]. Gelatin methacrylate (GelMA) hydrogels and bioactive glass (BG) composites have garnered significant attention in the fields of tissue engineering, particularly in bone repair for osteoporosis, primarily because of their biocompatibility, tunable mechanical properties, and ability to support cell growth [6][7][8][9][10][11]. ...
Osteoporosis poses a significant public health challenge, necessitating advanced bone regeneration solutions. While gelatin methacrylate (GelMA) hydrogels show promise, conventional fabrication methods using aqueous two-phase systems (ATPS) often result in inconsistent mechanical properties and structural irregularities. This study presents an approach synthesizing new methods and parameters for bR-GelMA, utilizing stop-flow lithography (SFL) to fabricate highly elastic micro-particles incorporating bioactive glass particles. SFL, in contrast to ATPS, offers precise control over micro-particle formation, enabling the production of uniform and stable structures ideal for biomedical applications. The resulting elastic micro-particles demonstrate rapid degradation, enhanced cell proliferation, and improved mechanical strength without compromising flexibility. This innovative approach using SFL to fabricate GelMA-based micro-particles holds significant promise for bone regeneration and other critical therapeutic applications.
... The ketogenic diet often causes weight loss (27), however, weight loss always results in bone loss and increased fracture risk ( Figure 1) (51)(52)(53). According to the theory of mechanical homeostasis, weight loss leads to the mechanical unloading of bones, resulting in a decrease in bone mass (54). ...
Diet has been proven to have significant impacts on the pathogenesis and treatment of osteoporosis. This review attempts to elucidate the current progress and controversy surrounding the ketogenic diet (KD) and β-hydroxybutyrate (BHB) in osteoporosis and offers a novel perspective on the prevention and treatment of osteoporosis. The ketogenic diet has been broadly used in the treatment of epilepsy, diabetes, obesity, and certain neoplasms by triggering ketone bodies, mainly BHB. However, in most osteoporosis-related clinical and preclinical studies, the ketogenic diet has demonstrated the detrimental effects of inhibiting bone accumulation and damaging bone microarchitecture. In contrast, BHB is thought to ameliorate osteoporosis by promoting osteoblastogenesis and inhibiting osteoclastogenesis. The main purpose of this review is to summarize the current research progress and hope that more basic and clinical experiments will focus on the similarities and differences between ketogenic diet (KD) and BHB in osteoporosis.
... However, the relationship between central obesity and BMD remains controversial. Traditionally, it was believed that obesity might protect against bone mass loss owing to increased mechanical loading, which enhances bone formation [5]. Nevertheless, increasing evidence suggests that obesity may contribute to higher risks of bone mass loss [6]. ...
Introduction: This study aimed to investigate the association and causality between central obesity and bone mineral density (BMD). Methods We utilized linkage disequilibrium score regression (LDSC) and Mendelian randomization (MR) to assess genetic correlations and causal relationships between waist circumference adjusted for BMI (WCadjBMI) and total body less head BMD (TB-BMD). Additionally, a cross-sectional analysis of 7,452 participants evaluated the relationship between A body shape index (ABSI) and TB-BMD using weighted multivariable linear regression and smooth curve fitting. Results LDSC and MR analysis confirmed a negative relationship between WCadjBMI and TB-BMD (β=-0.16; 95% CI: -0.26, -0.07). The cross-sectional study indicated that an increase of 0.01 ABSI corresponded to a decrease of 0.035 TB-BMD (g/cm ² ), with this negative effect being particularly pronounced in males and older adults. An inflection point was identified at ABSI = 0.076: below this threshold, ABSI positively correlated with pelvis BMD, whereas above it, the association became negative. Conclusions Central obesity is significantly negatively related to BMD. Maintaining ABSI within 0.058–0.078 is crucial for individuals in bone mass accrual (20–30 years) and stabilization (30–45 years) periods. In contrast, managing central obesity in people experiencing early bone loss (45–60 years) presents greater complexity and warrants further investigation.
... Several studies have shown an association between BMI and osteoporosis. Generally, as BMI increases, the risk of osteoporosis tends to decrease [25,26]. However, in our study, the BMI was similar between the two groups (osteoporotic and non-osteoporotic) despite the osteoporotic group having lower muscle mass (as indicated by the low SI), which can be explained by the fact that BMI is a measure based on both weight and height, but it does not differentiate between the components of body weight (e.g., fat, muscle, and bone mass). ...
Objectives: This study aimed to investigate the relationship between the sarcopenia index (SI), which is derived from serum creatinine and cystatin C levels, and osteoporosis in chronic kidney disease (CKD). Methods: This study initially included patients who underwent dual-energy X-ray absorptiometry (DXA) and serum creatinine and cystatin C testing between 2005 and 2022. Subsequently, patients diagnosed with CKD were selected for the final analysis, totaling 102 patients. Both traditional and new SI were calculated, with each participant categorized into one of two groups (non-osteoporosis and osteoporosis) according to bone mineral density. To enhance statistical validity, the patients were further divided into low- and high-index groups based on the median value of both indices for comparative analysis. The association between SI and the risk of osteoporosis was estimated using multivariable logistic regression analysis. Results: Participants with lower SI values had lower bone mineral density and a higher diabetes mellitus prevalence. The non-osteoporotic group exhibited significantly higher mean values for both traditional and new SI. Multivariable logistic regression analysis identified three statistically significant variables: both indices, sex, and diabetes mellitus. Both traditional and new SI yielded individual odds ratios of 0.906 with estimated areas under the curve of 0.847 for traditional SI and 0.833 for new SI. Conclusions: This study confirmed that both traditional and new SI are associated with osteoporosis in patients with CKD. Therefore, clinicians can raise the suspicion of osteoporosis based on traditional and new SI in patients with CKD, even when DXA results are unavailable.
... TyG-BMI was found to be positively associated with BMD in three studies, while TyG-WtHR and TyG-WC were positively associated with BMD in one study. The potential positive correlation between TyG-BMI and higher BMD could be explained by incorporating BMI into the TyG formula, as increased body weight increases mechanical load and activates osteoblasts, and each unit increase in BMI is associated with a 0.0082 g/cm2 increase in BMD (68)(69)(70). Two studies found a positive connection between VAI and BMD, while one found a favorable association between METS-IR and BMD. Although there is limited evidence of an association between BMD, METS-IR, and VAI, this can be explained by the fact that both indices include an integrated BMI component (the VAI formula contains HDL, WC, triglyceride, and BMI, and the METS-IR formula contains fasting glucose, fasting triglyceride, HDL-c, and BMI). ...
Background
The relationship of insulin resistance with bone mineral density (BMD) remains unclear, offering an opportunity for novel indices to shed light on the matter. The aim of this review was to evaluate the association between surrogate indices of insulin resistance and BMD.
Methods
A systematic review was conducted to evaluate observational studies that examined the relationship between insulin resistance surrogate indices and BMD in adults. Databases including PubMed, Web of Science, Scopus, and Embase were searched. Quality assessment was performed using Joanna Briggs Institute (JBI) critical appraisal tools.
Results
This systematic review included 27 cohorts and cross-sectional studies with 71,525 participants to assess the potential link between insulin resistance surrogate indices like HOMA-IR, HOMA-β, TyG, TyG-BMI, TyG-WtHR, and TyG-WC, along with METS-IR, and VAI, and BMD at various sites. There seems to be no link between BMD and the HOMA index, despite being extensively studied in various studies (adjusted β ranging from -0.49 to 0.103). Most literature suggests that a higher TyG index is associated with decreased BMD levels (adjusted β ranging from -0.085 to 0.0124). Despite limited evidence, other insulin resistance indices such as VAI (adjusted β ranging from 0.007 to 0.016), TyG-BMI (adjusted β ranging from 0.002 to 0.415), METS-IR (adjusted β ranging from 0.005 to 0.060), TyG-WtHR (β = 0.012) and TyG-WC (β = 0.0001) have shown a positive association with BMD in a few studies.
Conclusion
This systematic review emphasizes the intricate connection between insulin resistance and BMD. The lack of ability to perform a meta-analysis and the dependence on cross-sectional studies hinder the robustness of the findings, hence necessitating well-designed longitudinal studies.
Systematic review registration
https://www.crd.york.ac.uk/prospero/, identifier CRD42024512770.
... By modifying body burden and hormonal and metabolic metabolism, among other processes, MetS exerts a complicated influence on bone (3). Previous studies have shown that obesity is a protective factor for bone mineral density (BMD) (4,5), but research in recent years has indicated that obesity is a critical risk factor for bone loss and osteoporosis in patients. It has further been suggested that MetS is associated with reduced BMD and increased risk of osteopenia or osteoporosis. ...
Background
Metabolic syndrome (MetS) has complex effects on bone health, and dual-energy spectral computed tomography (CT) has become increasingly valuable for bone quantification. However, the relationship between bone base material pairs (BMPs) and abdominal fat volume in patients with MetS remains underexplored. This study thus aimed to analyze the relationship between abdominal fat volume and various bone BMPs using dual-energy spectral CT in young and middle-aged patients with MetS.
Methods
Patients with MetS who underwent sleeve gastrectomy at the Center of Obesity and Metabolic Diseases, Beijing Shijitan Hospital, Capital Medical University, from June to November 2021 were retrospectively collected. The abdominal fat measurements and BMPs were acquired using dual-energy spectral CT imaging. These included the volumes of total abdominal fat (TAF), abdominal visceral fat (AVF), and abdominal subcutaneous fat (ASF), as well as bone densities based on hydroxyapatite (water), i.e., HAP (water), and calcium (water), i.e., Ca (water), BMPs. After grouping the patients by sex, we analyzed the differences in clinical and imaging features. The correlation between the clinical and imaging parameters of patients with MetS was evaluated with Pearson correlation coefficients. Age- and sex-adjusted partial correlation analysis between fat volume and bone BMPs was conducted for patients of different sexes. Additionally, multiple linear regression analyses were performed with age, sex, and TAF volume as the independent variables and with Ca (water) and HAP (water) as dependent variables.
Results
A total of 112 young and middle-aged patients with MetS were included in this study, including 85 females and 27 males. Compared to male patients with MetS, the females with MetS exhibited higher lumbar Ca (water) and HAP (water) BMPs, with lower volumes of TAF and AVF and a smaller abdominal circumference (P<0.01). The volumes of TAF, AVF, and ASF were negatively correlated with the average Ca (water) and HAP (water) BMPs in the first to third lumbar vertebrae (L1–L3) (P<0.05). Ca (water) and HAP (water) BMPs decreased with age and increasing TAF volume (P<0.001). The fitted equations for the relationship between bone BMPs with age, sex, and TAF volume were as follows: (I) bone Ca (water) BMP = 76.469 − 0.500 age + 6.762 sex − 0.002 TAF volume; (II) bone HAP (water) BMP =171.704 − 1.138 age + 11.825 sex − 0.004 TAF volume.
Conclusions
In young and middle-aged patients with MetS, the abdominal fat volume was negatively correlated with lumbar bone Ca (water) and HAP (water) BMPs, implying that increased abdominal fat volume may play a crucial role in the pathogenesis of osteopenia among those with MetS. The reduction of bone Ca (water) and HAP (water) with high abdominal fat volume may hold clinical significance for fracture risk in individuals with MetS.
... Obesity can have significant consequences on various organs and systems, with its effects on bone being particularly controversial (34). Lower BMI has been associated with an increased risk of osteoporosis, and higher body weight is believed to provide protection against fractures (35). However, obesity and its comorbidities such as dyslipidemia, type 2 diabetes, and metabolic syndrome, may contribute to affect bone health (36). ...
Background
The arteriosclerosis index, defined as the ratio of non-high density lipoprotein cholesterol to high density lipoprotein cholesterol (NHHR), has emerged as a novel biomarker for various diseases. The relationship between NHHR and lumbar bone mineral density (BMD) has not been previously examined.
Methods
This cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2011–2018. NHHR was calculated as (total cholesterol—high-density lipoprotein cholesterol)/high-density lipoprotein cholesterol. Lumbar BMD was calculated to Z scores. Weighted multivariate linear regression, subgroup analysis, interaction analysis, generalized additive model, and two-piecewise linear regression were used.
Results
A total of 8,602 participants were included. The negative association between NHHR and lumbar BMD was consistent and significant (Model 1: β = −0.039, 95% CI: −0.055, −0.023, p < 0.001; Model 2: β = −0.045, 95% CI: −0.062, −0.027, p < 0.001; Model 3: β = −0.042, 95% CI: −0.061, −0.023, p < 0.001). The linear relationship between NHHR and lumbar BMD was significantly influenced by body mass index (p for interaction = 0.012) and hypertension (p for interaction = 0.047). Non-linear associations between NHHR and lumbar BMD Z scores were observed in specific populations, including U-shaped, reverse U-shaped, L-shaped, reverse L-shaped, and U-shaped relationships among menopausal females, underweight participants, those with impaired glucose tolerance, those with diabetes mellitus and those taking anti-hyperlipidemic drugs, respectively.
Conclusions
NHHR exhibited a negative association with lumbar BMD, but varying across specific populations. These findings suggest that NHHR should be tailored to individual levels to mitigate bone loss through a personalized approach. Individuals at heightened risk of cardiovascular disease should focus on their bone health.
... The relationship between obesity and BMD remains controversial. Some research indicates that obesity might have a protective impact on bone health, while a lower BMI is linked to reduced BMD and a higher risk of OP (18,19). For example, Evans et al.'s study on individuals aged 55-75 found that obese participants had higher BMD compared to those with a normal BMI. ...
Background
Osteoporosis (OP), affecting millions around the globe, is a prevalent degenerative condition of the bones characterized by a decrease in bone mineral density (BMD) and an increase in bone fragility. A novel anthropometric measure, the Body Roundness Index (BRI), provides a more accurate assessment of body fat distribution compared to traditional metrics. Using data from the National Health and Nutrition Examination Survey (NHANES), this study aims to explore the relationship between BRI and total BMD in U.S. adults aged 20 and above.
Methods
Data from NHANES (2011–2018) were examined, encompassing 9,295 participants following exclusions. Dual-energy X-ray absorptiometry (DXA) was employed to measure BMD. BRI was calculated using waist circumference (WC) and height. The study accounted for variables such as demographic traits, physical exam results, lab test findings, and survey responses. Weighted multivariable linear regression models and smooth curve fitting methods were utilized to assess the relationship between BRI and total BMD.
Results
The research found a notable inverse relationship between BRI and total BMD. In the model with full adjustments, an increase of one unit in BRI was linked to a 0.0313 g/cm² reduction in total BMD (P < 0.0001). Moreover, an inflection point was identified at BRI = 9.5229, where each one-unit rise in BRI beyond this threshold corresponded to a more substantial decrease in total BMD (0.0363 g/cm²). Analysis by subgroups revealed that this negative association was consistent across most demographic and health-related categories.
Conclusions
The results demonstrate a notable inverse relationship between BRI and total BMD, indicating that a higher BRI could be associated with lower BMD and a potentially greater risk of developing OP. This underscores the significance of accounting for body fat distribution in preventing OP and advocates for the use of BRI as a valuable marker for early intervention approaches.
... Literatürde bu ilişkiyi ele alan ancak çelişkili sonuçlar bildiren kısıtlı miktarda kontrollü çalışma bulunmaktadır(9,10). VKİ'deki her 1 birimlik değişilikliğin KMY'yi, fiziksel aktivite, fonksiyonel kapasite, kalsiyum alımı, sigara ve alkol alışkanlığı gibi değiştirilebilir diğer risk faktörlerinden daha fazla etkilediğini Asomaning ve ark.(22) tarafından yapılan bir çalışmada vurgulamışlardır. Çalışmamızın retrospektif olması ve hasta sayısının az olması çalışmanın zayıf yönleri olarak sayılabilir. ...
... This emphasizes the importance of considering the VAI as a significant Traditional adiposity indicators in our study including WC, HC, and BMI, significantly reduced the risk of osteoporosis in the multiple logistic regression models for both sexes. This is consistent with previous studies that reported similar outcomes for WC [14] and BMI [49][50][51]. Furthermore, these findings support the hypothesis that mechanical loading aids bone formation and hinders bone resorption [52]. In our GAM analysis of women, we noted a concave nonlinear relationship between bone destruction and WC and BMI indices. ...
Purpose
Previous research shows conflicting views on the relationship between obesity and osteoporosis, partly due to variations in obesity classification and the nonlinear nature of these relationships. This study investigated the association between adiposity indices and osteoporosis, diagnosed using dual-energy X-ray absorptiometry (DXA), employing nonlinear models and offering optimal thresholds to prevent further bone mineral density decline.
Methods
In 2019, a prospective study enrolled males over 50 years and postmenopausal women. Anthropometric measurements, blood biochemistry, and osteoporosis measured by DXA were collected. Associations between adiposity indices and osteoporosis were analyzed using a generalized additive model and segmented regression model.
Results
The study included 872 women and 1321 men. Indices such as abdominal volume index (AVI), visceral adiposity index (VAI), waist circumference (WC), hip circumference, body mass index (BMI), waist-to-hip ratio, and waist-to-height ratio (WHtR) were inversely associated with osteoporosis. In women, the relationship between the risk of osteoporosis and the adiposity indices was U-shaped, with thresholds of WC = 94 cm, AVI = 17.67 cm ² , BMI = 25.74 kg/m ² , VAI = 4.29, and WHtR = 0.61, considering changes in bone mineral density. Conversely, men exhibited a linear patterns for the inverse association.
Conclusion
The impact of obesity and adiposity on osteoporosis varies significantly between women and men. In postmenopausal women, the relationship is nonlinear (U-shaped), with both very low and very high adiposity linked to higher osteoporosis risk. In men over 50, the relationship is linear, with higher adiposity associated with lower osteoporosis risk. The study suggests that maintaining specific levels of adiposity could help prevent osteoporosis in postmenopausal women.
... Previous research has shown that osteoporosis is associated with aging, low Body Mass Index (BMI) [7], low vitamin D levels [8],increased pro-in ammatory factors [9], and poor nutritional status [10]. Additionally, past research suggests that anemia is linked to a higher risk of osteoporosis and fractures [15], with studies in the aging population revealing a notable correlation between Hemoglobin (Hb) levels and bone density [14] [29][36]. ...
Background
The Hemoglobin-to-Red Cell Distribution Width Ratio (HRR), a key element of blood cell counts, emerges as a novel biomarker linked to various diseases and adverse health outcomes. However, its correlation with Bone Mineral Density (BMD) and osteoporosis in the elderly remains under-researched.
Methods
This study used NHANES data to examine the link between HRR and Bone Mineral Density (BMD), and osteoporosis in U.S. seniors. It involved 9,128 participants aged 50+, assessing their BMD and blood cell counts. A weighted linear model was used to assess HRR's influence on BMD, while weighted logistic regression examined its connection to osteoporosis, supported by an extensive subgroup analysis.
Results
The study utilized weighted linear regression to reveal a significant positive correlation between higher HRR levels and increased BMD. Additionally, weighted logistic regression indicated an inverse relationship between HRR levels and osteoporosis risk, consistently observed across subgroups and independent of confounders.
Conclusion
HRR may be an important marker for bone density and osteoporosis risk in the elderly, offering new insights for potential preventive and treatment strategies. However, these findings necessitate further validation and research due to study limitations.
... Low-TBS indicates a fracture-susceptible microarchitecture. There is evidence that TBS can distinguish between two three-dimensional (3D) microstructure with the same bone density, however it is appropriate for to differentiate trabecular characteristics (16). TBS is generally obtained by re-analyzing of lumbar spine anteroposterior view on dual-energy X-ray absorptiometry images. ...
Introduction: Increasing and maintaining bone density can play a role in preventing osteoporosis, as changes in the trabecular bone score (TBS) and bone mineral density (BMD) affect bone density, especially in the spine. Objectives: The present study aimed to determine the level of agreement between TBS and BMD in patients with osteoporosis and also to investigate the relationship between these two indices with body mass index (BMI). Patients and Methods: Data were collected from 843 patients, referred to the densitometry department of Resalat hospital. BMD and TBS were measured in the subjects to determine the risk of osteoporosis. The results of BMD were measured based on T-score level. The patients’ individual and clinical characteristics were also recorded and factors influencing the prognosis of density changes were evaluated. Moreover, the effect of BMI was investigated in this study. Results: The mean age of patients was 55.5 years. The kappa coefficient and Spearman’s correlation coefficient of BMD and TBS were 0.004 and -0.015, respectively. There was a significant correlation between BMI and BMD in men. The kappa coefficient gradually increased from normal bone density to osteoporosis. There was a significant negative correlation between BMI and BMD, while a significant positive correlation between height and BMD in women was existed. On the other hand, a significant negative correlation between weight and BMD was detected accordingly. Conclusion: According to the results of our study, there is no agreement between BMD and TBS.
... Tỉ lệ LX trong nhóm có và không THKG của tác giả W. Elwakil thấp hơn trong nghiên cứu này, có thể lý giải là do trong nghiên cứu của W. Elwakil với độ tuổi của những bệnh nhân tham gia nghiên cứu thấp hơn, hơn nữa do THKG và LX là hai bệnh lý liên quan đến tuổi và tỉ lệ mắc tăng dần theo tuổi. Bên cạnh đó, BMI thấp hơn là một yếu tố ảnh hưởng đến khả năng có hay không của LX [2], [12]. BMI cao trong nghiên cứu của W. Elwakil trong nhóm có THKG và không THKG lần lượt là 36,03 ± 5,9 kg/m2 và 33,7 ± 4,9 kg/m 2 , trong khi BMI trong nghiên cứu của nghiên cứu này ở nhóm THKG là 24,11 kg/m 2 và trong nhóm không THKG là 22,21 kg/m 2 . ...
Mục tiêu: Khảo sát mối liên quan giữa loãng xương và thoái hóa khớp gối ở phụ nữ cao tuổi. Đối tượng và phương pháp nghiên cứu: Nghiên cứu cắt ngang mô tả 200 bệnh nhân (BN) nữ cao tuổi (từ 60 tuổi trở lên). Chẩn đoán thoái hóa khớp gối (THKG) theo tiêu chuẩn Hội thấp khớp học Hoa Kỳ 1986, X-quang khớp gối được phân độ theo Kellgren Lawrence [1], [11]. Chẩn đoán loãng xương (LX) theo tiêu chuẩn của Tổ chức Y tế Thế giới 1994 dựa trên đo mật độ xương (MĐX) bằng phương pháp đo độ hấp thụ tia X năng lượng kép [5]. Kết quả: Tỉ lệ loãng xương trong nhóm có THKG thấp hơn so với nhóm không THKG (40,3% so với 55,26%), sự khác biệt có ý nghĩa thống kê (p = 0,04). Về tổng thể, bệnh nhân LX sẽ giảm 58% nguy cơ THKG (OR = 0,42, KTC 95% [0,2 – 0,83], p = 0,013). Tuy nhiên, khi phân tích theo phân nhóm Kellgren Lawrence của X-quang khớp gối ghi nhận tỉ lệ LX trong phân nhóm Kellgren Lawrence 3 – 4 (THKG vừa và nặng) là 56,5% cao hơn so với tỉ lệ LX trong phân nhóm Kellgren Lawrence 1 – 2 (THKG nhẹ) với tỉ lệ LX là 39% (p = 0,037). Kết luận: Bệnh nhân nữ cao tuổi thoái hóa khớp gối nhẹ có tỉ lệ loãng xương thấp hơn. Tuy nhiên tỉ lệ LX lại tăng lên khi thoái hóa khớp gối nặng.
... The existing evidence suggests that the relationship between BMI and bone density in women is more U-shaped than linear [31,32]. It seems that given that weight is one of the modifiable risk factors in reducing osteoporosis, it is necessary to advise patients to maintain their normal weight [33]. ...
Background
Osteoporosis is one of the most important risk factors for failure of the spine instrumentation. Management of patients with osteoporosis who requires spinal surgery because of the difficulty in instrument placement and the potential complications is still a challenge. This study was designed to evaluate the clinical outcome of lumbar spinal canal stenosis after instrumentation in patients with and without osteoporosis.
Methods
This prospective cohort study was performed from June 2018 to December 2020, in Be'sat Hospital, Hamadan, Iran. The sample consisted of patients over 50 years old referred to Be'sat Hospital with a diagnosis of lumbar spinal canal stenosis who underwent instrumental surgery (n = 107). Based on bone densitometry, the sample was divided into two groups with osteoporosis (n = 34) and without osteoporosis (n = 73). To collect data, we used a three-part researcher-made questionnaire (demographic information, medical records information, and paraclinical parameters). Statistical analyzes were performed by the Fisher Exact, chi-square, independent t-test, Multiple ANCOVA, Mann–Whitney and the Rank Wilcoxson tests using Stata version 17 software.
Results
The mean age (SD) of patients in the two groups with and without osteoporosis was 67.9 (7.0) and 59.1 (5.1) years, respectively (p = 0.001). The results indicated that a significant difference was observed between the two groups in sex (p = 0.032), educational status (p = 0.001), marital status (p = 0.023), employment status (p = 0.004), menopausal status (p = 0.018), taking corticosteroids (p = 0.028), and body mass index (p = 0.015). Also, there was a significant difference between two groups in the loosening of instrument (p = 0.039), the postoperative pain intensity (p = 0.007), fusion (p = 0.047), and neurogenic claudication (p = 0.003). Based on multiple ANCOVA test, there was not a significant difference between two groups in the clinical and paraclinical charatecristics (p > 0.05). The mean (SD) of T-Score in the osteoporosis group was 3.06 (0.37).
Conclusion
This study provides evidence that there is no significant difference in the clinical outcomes of lumbar spine instrumentation due to spinal canal stenosis in patients with and without osteoporosis. Because of the high cost of specific instrumentation developed for patients with osteoporosis and their unavailability, it seems that the use of conventional instrumentation along with complete treatment of osteoporosis can help improve the clinical outcome of surgery in these patients.
... This confirmed, in essence, the statistical correlation between body weight and bone mass, highlighted in a series of studies. In fact, one element that has been recently added to the already known correlation between low body weight and osteoporosis, is the opposite: the correlation between obesity and osteoporosis, as shown by a series of recent scientific publications [48][49][50][51][52][53] . (2) The statistically proved association of HRQOL with aging. ...
Objectives:
The present study aimed to investigate whether impairment of health-related quality of life (HRQOL) and possibly, the quality of sleep (Sleep Quality - SQ), of osteoporotic women, may occur, even before the onset of an osteoporotic fracture.
Methods:
The study included 109 women, divided (DXA) into two groups (age-matched): the Control Group (n=68; normal and osteopenic) and the Patient Group (n=41; osteoporotic). Review of medical history of the participants, was followed by evaluation of HRQOL and SQ with the EQ-5D-3L and the PSQI questionnaires, respectively.
Results:
There was no significant difference between the two groups (Control vs. Patient) in terms of average HRQOL and SQ, as measured by the EQ-5D-3L Questionnaire (0.73 vs. 0.70, p>0.05) and the PSQI Index value (5.56 vs. 6.29, p>0.05), respectively. A high percentage of patients was estimated as having a poor SQ (52.9% of the Control Group and 46.3% of the Patient Group, p>0.05). Increasing age, with or without the presence of osteoporosis, seemed to lead to worst QoL (OR<1.00, p<0.05).
Conclusions:
Our study documented homogeneity in HRQOL and SQ, between the two study groups. The strongest predictor for the HRQOL was age (for each year of age increase, the probability of excellent HRQOL significantly decreased).
... Protein malnutrition lowers bone mass whereas deficiency of fat-soluble vitamins contributes to defects in mineralization and thus causes osteoporosis and resultant stress fracture [49,50]. CP is also characterized by low skeletal muscle, weight loss, and low mobility, all of which negatively impacts bone mass [51][52][53]. ...
Background:
Bone disease is an under-recognized cause of morbidity in chronic pancreatitis (CP). Over the past decade, publications of original studies on bone disease in CP has warranted synthesis of the evidence to ascertain the true burden of the problem.
Aim:
To quantify the prevalence of osteopenia, osteoporosis, and fragility fractures in CP patients and investigate the associated clinical features and outcomes.
Methods:
A systematic search identified studies investigating bone disease in CP patients from Cochrane Library, Embase, Google Scholar, Ovid Medline, PubMed, Scopus, and Web of Science, from inception until October 2022. The outcomes included prevalence of osteopenia, osteoporosis, and fragility fractures, which were meta-analyzed using a random-effects model and underwent metaregression to delineate association with baseline clinical features.
Results:
Twenty-one studies were included for systematic review and 18 studies were included for meta-analysis. The pooled prevalence of osteopenia and osteoporosis in CP patients was 41.2% (95%CI: 35.2%-47.3%) and 20.9% (95%CI: 14.9%-27.6%), respectively. The pooled prevalence of fragility fractures described among CP was 5.9% (95%CI: 3.9%-8.4%). Meta-regression revealed significant association of pancreatic enzyme replacement therapy (PERT) use with prevalence of osteoporosis [coefficient: 1.7 (95%CI: 0.6-2.8); P < 0.0001]. We observed no associations with mean age, sex distribution, body mass index, alcohol or smoking exposure, diabetes with prevalence of osteopenia, osteoporosis or fragility fractures. Paucity of data on systemic inflammation, CP severity, and bone mineralization parameters precluded a formal meta-analysis.
Conclusion:
This meta-analysis confirms significant bone disease in patients with CP. Other than PERT use, we observed no patient or study-specific factor to be significantly associated with CP-related bone disease. Further studies are needed to identify confounders, at-risk population, and to understand the mechanisms of CP-related bone disease and the implications of treatment response.
... Optimal body weight as well as proper body composition in childhood are very important for bone health [26,27]. This is evidenced by highly significant direct correlations between body mass index, fat mass and lean mass and their associations with bone mineral content and bone mineral density. ...
Optimal body weight and body composition for age are relevant to child development and healthy life. Changes in lean mass and fat mass as well as its distribution are associated with alterations in the secretion of myokines and adipokines by muscle and adipose tissues. These factors are very important for bone health. The aim of the study was to assess serum leptin, adiponectin, resistin, visfatin and omentin as adipokines and myostatin and irisin as myokines with regard to their associations with bone parameters in healthy normal weight and thin children. We studied 81 healthy prepubertal children (aged 5 to 9 years) divided into three groups: group A—35 children with a BMI z-score between +1 and −1 SD; group B—36 children with a BMI z-score between −1 and −2 SD; and group C—10 thin children with a BMI z-score of <−2 SD. We observed significantly (p < 0.001) lower fat mass, fat/lean mass ratio and bone mineral density (BMD) across weight status with the lowest values in the group of thin children. We noticed significantly (p < 0.05) lower concentrations of 25-hydroxyvitamin D, resistin and high-molecular-weight (HMW) adiponectin but higher levels of myostatin as the BMI z-score deceased. We found that BMI and leptin levels were directly correlated with fat mass, lean mass, bone mineral content (BMC) and BMD. Resistin levels were negatively associated with lean mass, while visfatin concentrations were positively related to total BMD. In healthy prepubertal children there were differences in body composition and in bone mineral density across decreasing BMI status. We suggest that changes in serum myostatin and 25-hydroxyvitamin D levels may play a role in bone status of thin children. Moreover, significant relations between adipokines and bone parameters may confirm crosstalk between fat tissue and bone in these children.
... A number of large-scale epidemiological studies showing a positive relationship between BMI (or bodyweight) and bone density haves been documented. [24,25] A cross-sectional study conducted by Asomaning et al. [26] aimed to investigate the relationship between BMI and osteoporosis in elderly patients. They found that women with a lower BMI have a greater risk of osteoporosis than women of normal weight. ...
Introduction:
An increase in BMI in the elderly may reduce life expectancy and increase the risk of death, cardiovascular disease, and metabolic syndrome. Frailty index, body weight, and pain levels all seem to be linked. Excessively low or high body weight may cause muscle weakness and decrease physical activity, placing the elderly at risk for frailty.
Methodology:
This was a cross-sectional study to investigate BMI among the elderly and neurological and musculoskeletal diseases in the Aseer region, Saudi Arabia conducted during the period from 5 January, 2020 to 26 February, 2020. The data were collected using a self-administered pre-designed questionnaire, and 503 full forms of eligible subjects were included.
Results:
A total of 503 participants were included in this study, 61.2% of them were female, with a mean age of 67 ± 9. The mean BMI was 31.1 ± 7.5. Parkinsonism and hemiplegia were significantly associated with BMI (P = 0.003) and (P = 0.027), respectively. Osteoporosis and participants with no musculoskeletal problems were significantly associated with BMI (P = 0.001) and (P = 0.003), respectively.
Conclusion:
We found a significant association between Parkinsonism and hemiplegia and BMI as these conditions were more common among overweight patients. Moreover, osteoporosis was also significantly associated with BMI, and most of the patients with osteoporosis were underweight.
... 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. ...
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.
... 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] . ...
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. ...
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). ...
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]. ...
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. ...
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.
Ankle fractures, ranking as one of the very common osteoporotic fractures, pose a substantial socioeconomic burden. We aimed to investigate the incidence of elderly ankle fractures, refracture risks, and mortality rates in South Korea.
Utilizing the Korean National Health Insurance Service (NHIS) registry from January 2006 to December 2022, individuals over 50 years with ankle fractures were identified. Osteoporotic ankle fractures were defined using admission diagnoses, procedural codes, and cast-related codes. Incidence rates, refracture rates, and one-year mortality rates were analyzed with standardization adjusted for gender and age distribution.
From 2006 to 2022, annual ankle fracture incidence rose from 193.90 to 278.83 per 100,000 person-years. Women exhibited 1.93 times higher incidence than men, with a notable increase in women. Most common in ages 60 to 69, ankle fracture rates increased until 2019 and after 2020 but decreased between 2019 and 2020. The one-year ankle refracture rates and osteoporotic refracture rates increased from 3.55% and 4.56% in 2007 to 9.32% and 10.37% in 2021, respectively. The one-year mortality rate after ankle fractures decreased from 2.10% in 2007 to 1.49% in 2021.
This study offers insights into the epidemiology of osteoporotic ankle fractures in South Korea, revealing increasing incidence, gender differences, age-related patterns, and trends in refracture and mortality rates over the study period.
This study examines the incidence, refracture risk, and mortality of osteoporotic ankle fractures in South Korea using a nationwide dataset (2006-2022). The incidence of ankle fractures increased significantly, especially in women, and refracture rates also rose, highlighting an unmet need for better osteoporosis management.
Background
The muscle weakness in patients with nemaline myopathy (NM) and related disorders (NMR) often affects the muscles used for eating and dining, and some scientific evidence of poorer nutritional status of patients with myopathy exists. However, comprehensive research on the nutritional status of persons with NM or NMR has not been done.
Objectives
Our aim was to conduct a comprehensive cross-sectional pilot study among adult Finnish patients with NM or NMR to investigate their food consumption, nutrient intakes, selected nutrient-related laboratory parameters in blood, and self-assessed functioning of dining and eating and of the gastrointestinal tract. We also aimed to test the suitability of the methods selected.
Methods
The methods included a questionnaire to investigate eating-related functioning, a food frequency questionnaire, food records, and laboratory analyses from blood samples.
Results
Of 32 invited patients, 20 returned the survey and food frequency questionnaire. Food records were returned by 17, and blood samples were obtained from 16. Food consumption as well as nutrient and energy intake were highly variable between the individuals. Low energy intakes, low consumption of healthy foods, such as fruits, vegetables, and whole grains as well as low intakes of vitamin D, calcium, dietary fiber, vitamin C, folate, and iron were observed. Low nutrient intakes were seen especially in non-ambulatory participants, who also reported challenges in eating and dining related functioning. The laboratory parameters did not indicate severe undernourishment in any of the participants.
Conclusions
Evaluation of food consumption and nutrient intakes were needed to find patients with risk of undernourishment. The results underline the importance of monitoring adequate intake of calcium and vitamin D in this group of patients, especially because of the immobility-induced risk of osteoporosis. Non-ambulatory patients reported more challenges in eating and dining. This, however, did not determine the nutritional status of the patient.
Background
Both diabetes and osteoporosis have developed into major global public health problems due to the increasing aging population. It is crucial to screen populations at higher risk of developing osteoporosis for disease prevention and management in postmenopausal women with type 2 diabetes (T2D). This study aims to quantitatively investigate the association between risk factors and bone mineral density (BMD) and develop a self-assessment tool for early osteoporosis screening in postmenopausal women with T2D.
Methods
We retrospectively enrolled 1,309 postmenopausal women with T2D. Linear regression methods were used to assess the association between risk factors and BMD. Additionally, a multivariate logistic regression analysis was performed to identify independent risk factors associated with osteoporosis. Utilizing the logistic regression machine learning algorithm, we developed an osteoporosis screening tool that categorizes the population into three risk regions based on age and body mass index (BMI), indicating low, moderate, and high prevalence of osteoporosis in the age-BMI plane.
Results
Older age and lower BMI were independently associated with decreased BMD. The BMD at the total hip, femur neck, and lumbar spine differed by 12.9, 10.9, and 15.5 mg/cm ² for each 1 unit increase in BMI, respectively. Both age and BMI were identified as independent predictors of osteoporosis. The osteoporosis screening tool was developed by using two straight lines with equations of BMI = 0.56 * age−4.12 and BMI = 0.56 * age−10.88; there were no significant differences in the prevalence of osteoporosis among the training, internal test, and external test datasets in the low-, moderate-, and high-risk regions.
Conclusion
We have successfully developed and validated a self-assessment tool for early osteoporosis screening in postmenopausal women with T2D for the first time. BMI was identified as a significant modifiable risk factor. Our study may improve awareness of osteoporosis and is valuable for disease prevention and management for postmenopausal women with T2D.
Hodgkin’s lymphoma is a malignant neoplasm of lymphoid tissue that develops mainly between the ages of 15 and 45 years. Thanks to the successes in the development of modern oncohematology, today the proportion of complete remissions among patients reaches 90%. However, excellent survival rates also come with a high risk of long-term complications, one of which is decreased bone mineral density, including osteoporosis. Dynamic processes of modeling and remodeling continuously occur inside the bone, which depend on many internal and external factors acting in different directions. In patients with an established diagnosis of Hodgkin’s lymphoma, there are risk factors specific to this category of patients: the effect on the body of the tumor process and highly toxic chemotherapy drugs as part of pathogenetic treatment; and nonspecific, widespread throughout the population. Among the nonspecific factors, this review identified and examined gender, weight-to-height ratio, smoking and alcohol abuse, physical inactivity, as well as the presence of osteoporosis and fractures in the family history. The development of osteoporosis in patients with Hodgkin’s lymphoma as a subject of discussion is still only gaining interest among researchers. Differentiation of risk factors for decreased bone mineral density in this category of patients is a very pressing problem in the current reality of the lack of official clinical recommendations for the diagnosis and prevention of osteoporosis in young patients with Hodgkin lymphoma, and also due to the small amount of published material on this topic.
Background
Osteoporosis is a multifactorial disorder where genetic and environmental factors contribute to changes in bone mineral density. Several genetic polymorphisms are associated with low bone mineral density and osteoporosis risk, including estrogen receptor-α rs2234693 and rs9340799 single nucleotide polymorphisms.
Objective
To determine the allele frequencies of these polymorphisms among postmenopausal Jordanian women and to assess their association with low bone mineral density and osteoporosis among studied subjects.
Methods
This cross-sectional study enrolled 450 postmenopausal Jordanian women having dual-energy X-ray absorptiometry scans at the National Center for Diabetes, Endocrinology, and Genetics. The study protocol was approved by this center "Institutional Review Board." The estrogen receptor-α gene sequence containing rs2234693 and rs9340799 polymorphisms was identified by polymerase chain reaction, followed by restriction fragment length polymorphism.
Results
The wild-type allele frequencies of rs2234693 (T) and rs9340799 (A) were 54% and 59%, respectively. The rs9340799 GG genotype was significantly associated with lower femoral neck T-scores in women who were postmenopausal for more than 10 years (p = 0.023) and was significantly associated with lower lumbar spine (p = 0.033) and femoral neck (p = 0.002) T-scores in women older than 60 years of age. However, there was no association between rs2234693, rs9340799, or their haplotypes with osteoporosis or bone mineral density T-score values. The two polymorphisms were in Heidy-Weinberg equilibrium and exhibited strong but incomplete linkage disequilibrium.
Conclusion
The data suggest that rs9340799 polymorphism may render some women more susceptible to osteoporosis than others.
Obesity is a huge problem worldwide, and the number of obese people in society continues to increase at an alarming rate. Trauma is a constant issue and affects most people at some time in their lives. Obese patients have a higher risk of morbidity and mortality following trauma than non-obese patients. Obese patients have a different spectrum of injury than non-obese patients and have a higher risk of complications following injury and treatment. Due to the emergent nature of trauma, preoperative weight loss is not appropriate after the injury has occurred. The focus for the trauma surgeon (and anaesthetist) must be on anticipating potential preoperative, perioperative, and postoperative complications. These potential complications are well documented in the scientific literature, and their management should be anticipated and managed appropriately.
As the medical comorbidities, inherent obesity in trauma patients cannot be fully addressed after the traumatic injury has occurred, it seems logical that these issues be addressed prior to the injury occurring. This should be in the form of education for the general public about the problems associated with traumatic injuries in obese individuals, and a focused approach to preventing further increases in the obese population, reducing the BMI of those already affected by obesity.
Objective
To investigate the prevalence and risk factors of osteosarcopenia in patients with acute stroke.
Design
Overall, 224 patients within 2 weeks of having a stroke were enrolled. Demographic characteristics, National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), modified Barthel Index (MBI), Functional Ambulation Category (FAC), Berg Balance Scale (BBS), and handgrip strength were recorded. Body composition was evaluated using dual-energy X-ray absorptiometry. Patients who met the diagnostic criteria for osteoporosis and sarcopenia were defined as having osteosarcopenia.
Results
The overall prevalence of osteoporosis and sarcopenia was 46.9% and 50.9%, respectively. The prevalence of osteoporosis without sarcopenia, sarcopenia without osteoporosis, and osteosarcopenia was 18.3%, 22.3%, and 28.6%, respectively. The proportion of female sex (71.9%), median age, and NIHSS score were significantly higher, and mRS, BBS, MBI, FAC, and grip strength were significantly lower in patients with osteosarcopenia. Older age (≥65-years) (OR, 15.4), female sex (OR, 6.23), and lower BMI (<25 kg/m ² ) (OR, 43.13) were independently associated with the likelihood of osteosarcopenia.
Conclusion
Osteosarcopenia may occur in acute stroke survivors. Patients with osteosarcopenia have a significantly higher stroke severity and disability. A comprehensive diagnostic approach is imperative for osteosarcopenia, thereby facilitating implementation of optimal rehabilitative strategies.
Unlabelled:
Weight change was an influencing factor of osteoporosis and fracture in a controversial way. Based on a nationally representative data, we found that weight change from obesity in midlife to non-obesity in late adulthood was associated with a reduction in the risk of osteoporosis and wrist fracture in male, but not in female.
Introduction:
Obesity is usually recognized as a protective factor to osteoporosis and osteoporotic fracture. However, it is still unclear whether historical weight status was associated with the risk of osteoporosis and fracture. The aim of this study was to investigate the relationship between weight change patterns across adulthood and the prevalence of osteoporosis and fracture.
Methods:
Data from the National Health and Nutrition Examination Survey (NHANES) with 8725 US adults aged ≥ 40 years were analyzed in this study. Weight change patterns were categorized as "stable non-obese," "obese with earlier weight gain," "obese with recent weight gain," and "revert to non-obese" based on the body mass index (BMI) at 25 years old, 10 years prior to baseline and at baseline. Body mineral density (BMD) was measured using dual x-ray absorptiometry (DXA), and osteoporosis was diagnosed based on the World Health Organization criteria. Self-reported occurrence of osteoporotic fractures were determined by questionnaires.
Results:
Compared with subjects in "stable non-obese" group, obese with earlier weight gain were positively related to the increase of BMD in both genders, while elevated BMD was only observed in female of "obese with recent weight gain" group and in male of "revert to non-obese" group after multiple adjustment. Moreover, changing from the obesity to non-obesity in the 10 years period before baseline was associated with a 81.6% lower risk of osteoporosis (odds ratio (OR) 0.184, 95% confidence interval (CI) 0.037-0.914 (P = 0.039)) and a 69.8% lower risk of wrist fracture (OR 0.302, 95%CI 0.120-0.757 (P = 0.012)) in male, but not in female.
Conclusion:
Weight change from obesity in midlife to non-obesity in late adulthood was associated with a reduction in the risk of osteoporosis and wrist fracture in male. Our findings support the importance of investigating the mechanism of weight change in different life period.
Evaluate magnetic resonance imaging factors associated with osteoporotic vertebral compression fractures.
We retrospectively reviewed 457 patients’ records. Age, sex, and body mass index were recorded. Two blinded readers measured psoas major and paraspinal muscle areas at the L3 vertebral body level on transverse T2-weighted magnetic resonance images and the mean apparent diffusion coefficient values of the non-fractured vertebrae from Th12 to L5. Inter-reader reliability for continuous variables was assessed by intraclass correlation coefficients.
We evaluated 210 patients (103 [49.0%] men). The osteoporotic vertebral compression fractures group was older and had lower BMI and smaller psoas major and paraspinal muscle areas than the group without vertebral compression fractures (p < 0.001). The mean apparent diffusion coefficient was weakly correlated with paraspinal muscle area in the osteoporotic vertebral compression fractures group. The intraclass correlation coefficient value was 0.83, and the intraclass correlation coefficients of the psoas major and paraspinal muscles were 0.94 and 0.97, respectively. Multivariate analysis revealed that decreased psoas major and paraspinal muscle areas and increased mean apparent diffusion coefficient values were significantly associated with the presence of osteoporotic vertebral compression fractures (all p < 0.05). Psoas major and paraspinal muscle areas showed relatively high predictive accuracy (57%, 61%).
Psoas major and paraspinal muscle areas at the L3 level and the mean apparent diffusion coefficient value of non-fractured vertebrae from the Th12 to L5 level were associated with osteoporotic vertebral compression fractures. This may contribute to detecting the potential risk of healthy individuals developing osteoporotic vertebral compression fractures.
Objectives:
Despite the high prevalence of tuberculosis (TB) and the disease burden of osteoporosis and osteoporotic fractures, there is still a lack of well-designed, large-scale studies demonstrating associations among them. We aimed to investigate the effect of TB on the incidence of osteoporosis and osteoporotic fractures.
Study design:
This was a nationwide population-based cohort study.
Methods:
This study was conducted using the National Health Insurance Service Database of South Korea. We included patients with newly diagnosed TB aged >40 years from January 2006 to December 2017. An uninfected control for each TB patient was randomly extracted by frequency matching for sex, age, income level, residence, and registration date at a 2:1 ratio. The primary outcome was the incidence of osteoporosis and osteoporotic fractures between the two groups, adjusted for sex, age, income level, residence, comorbidities, body mass index, blood pressure, laboratory tests, alcohol drinking, and smoking. The risk factors associated with osteoporosis or osteoporotic fractures were also investigated.
Results:
A total of 164,389 patients with TB and 328,778 matched controls were included (71.9% males). The mean duration of follow-up was 7.00 ± 3.49 years. The incidence of osteoporosis in patients with TB was 6.1 cases per 1000 person-years, which was significantly higher than that in matched controls (adjusted hazard ratio [aHR] 1.349, 95% confidence interval [CI] 1.302-1.398, P < 0.001). The incidence of osteoporotic fractures was also higher in patients with TB than in controls (aHR 1.392, 95% CI 1.357-1.428, P < 0.001). Among fractures, the risk of hip fracture was the highest (aHR 1.703, 95% CI 1.612-1.798, P < 0.001).
Conclusions:
TB independently contributes to the incidence of osteoporosis and osteoporotic fractures, particularly hip fractures.
Background: The purpose of this study was to investigate the association between coffee, green tea, and soda drink intake and the risk of osteoporosis using data from the Korean Genome and Epidemiology Study (KoGES).
Methodology: Data for patients with osteoporosis (n=11,484) and controls (n=156,320) were extracted using a national cohort study with KoGES Health Examiner (HEXA) data of participants over 40 years of age. We then analyzed the history of coffee/green tea/soda drink intake frequency at baseline from 2004 to 2013 and follow-up data from 2012 to 2016.
Results: Regardless of the frequency of coffee intake, coffee intake showed lower odds ratios (ORs) for osteoporosis compared to the non-intake group, but not green tea and soda drink intake did not. According to the subgroup analysis by age and sex, coffee intake showed a lower ORs for osteoporosis in the both group of women age < 53 years of age and ≥ 53 years of age regardless of the frequency of coffee intake.
Conclusion: The conclusion of this study was that coffee intake was associated with lower incidence of osteoporosis in Korean women over 40 years of age, regardless of age.
Background
Polyunsaturated fatty acids (PUFAs) are closely related to osteoporosis. To test their causal relationship, we conducted a Mendelian randomization (MR) analysis.
Methods
We analyzed the causal relationship between four PUFAs measures, n-3 PUFAs (n-3), n-6 PUFAs (n-6), the ratio of n-3 PUFAs to total fatty acids (n-3 pct), and the ratio of n-6 PUFAs to n-3 PUFAs (n-6 to n-3), and five measures of osteoporosis, including estimated bone mineral density (eBMD), forearm (FA) BMD, femoral neck (FN) BMD, lumbar spine (LS) BMD, and fracture, using two-sample MR analysis. In order to verify the direct effect between PUFAs and BMD, we chose interleukin-6 (IL-6), tumor necrosis factor-β (TNF-β), and bone morphogenetic proteins 7 (BMP-7), three markers or cytokines strongly related to BMD, as possible confounding factors, and analyzed the possible causal relationships between them and PUFAs or BMD by MR. Inverse variance weighting (IVW), MR-Egger, weighted and weighted median were conducted. MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) and MR-Egger regression methods were used to evaluate the potential pleiotropy of instrumental variables (IVs) and outliers were identified by MR-PRESSO. Cochran’s Q statistic was used to detect the heterogeneity among IVs. Leave-one-out sensitivity analysis was used to find SNPs that have a significant impact on the results. All results were corrected by the Bonferroni correction.
Results
The IVW results showed that n-3 PUFAs (OR = 1.030, 95% CI: 1.013, 1.047, P = 0.001) and n-6 PUFAs (OR = 1.053, 95% CI: 1.034, 1.072, P < 0.001) were positively correlated with eBMD, while n-6 to n-3 (OR = 0.947, 95% CI: 0.924, 0.970, P < 0.001) were negatively correlated with eBMD. These casual relationships still existed after Bonferroni correction. There were positive effects of n-3 PUFAs on FA BMD (OR = 1.090, 95% CI: 1.011, 1.176, P = 0.025) and LS BMD (OR = 1.056, 95% CI: 1.011, 1.104, P = 0.014), n-3 pct on eBMD (OR = 1.028, 95% CI: 1.002, 1.055, P = 0.035) and FA BMD (OR = 1.090, 95% CI: 1.011, 1.174, P = 0.025), n-6 to n-3 on LS BMD (OR = 1.071, 95% CI: 1.021, 1.124, P = 0.005); negative effects of n-3 pct on fracture (OR = 0.953, 95% CI: 0.918, 0.988, P = 0.009) and n-6 to n-3 on FA BMD (OR = 0.910, 95% CI: 0.837, 0.988, P = 0.025). However, these causal effects all disappeared after Bonferroni correction (all P > 0.0025). None of IL-6, TNF-β, and BMP-7 had a causal effect on PUFA and BMD simultaneously (all P > 0.05).
Conclusion
Evidence from this MR study supports the genetically predicted causal effects of n-3, n-6, n-3 pct, and n-6 to n-3 on eBMD. In addition, n-3 not only associate with FA BMD and LS BMD through its own level and n-6 to n-3, but also link to fracture through n-3 pct.
Objectives
: To determine the fractal dimension (FD) and radiomorphometric indices (RMI) in the mandible from orthopantomographs (OPG) in patients with oral lesions associated with smokeless (SLT) /smoking (ST) tobacco and areca nut habits in a North Indian cohort.
Study Design
: A prospective, cross-sectional, observational pilot study was conducted of 120 subjects, including controls and 3 groups of 30 patients each with oral submucous fibrosis (OSMF), tobacco pouch keratosis (TPK), and oral leukoplakia (OL). Two observers calculated FD and the RMIs of mandibular cortical thickness (MCT), panoramic mandibular index (PMI), and mandibular cortical index (MCI).
Results
: Mean FD was significantly reduced compared to controls with all oral lesions (p<0.05) and with all habits in 3 of 4 regions of interest (p≤0.05). MCT was significantly reduced with OL (p<0.005) and in ST users (p<0.05). PMI did not differ regarding lesion status or habits. Compared to the controls, MCI C2 type was significantly more common in all oral lesions (p≤0.005) and all types of habit (p<0.005). Inter- and intraobserver agreement was strong to excellent.
Conclusions
: FD and RMI values are significantly altered compared to controls in oral lesions associated with tobacco and areca nut habits and in the dominant type of habit.
Fracture is a major complication of osteoporosis, however screening is not routinely carried out. CT-scan provides an opportunistic opportunity for screening, therefore this study aims to analyze the correlation the bone density on CT-scan and the risk of osteoporotic fracture. This was a cross-sectional study on patients who underwent abdominal-pelvic CT scan. Bone density was assessed with Hounsfield Unit (HU) CT-scan of the proximal femur and 3rd lumbar spine. Proximal femoral HU values were measured at the trabecular and cortical bones of the head-neck junction (HNt, HNc), femoral neck (FNt, FNc), and inter-trochanteric (ITt, ITc). The proximal femoral HU values were measured at the superior endplate, mid vertebral body, and inferior endplate. The risk of osteoporotic fracture was assessed by FRAX. Negative correlations were found between the risk of major osteoporotic fractures and HU in HNt, HNc, mid vertebral body, inferior endplate and mean proximal femoral HU. Negative correlations were also found between the risk of hip fracture and HU in HNt, HNc, FNc, ITt, ITc, superior endplate, mid vertebral body, inferior endplate and mean proximal femoral HU. The correlation shown supports the use of HU assessment of the proximal femur and lumbar spine as an opportunistic screening tool.
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.
Tall persons suffer more hip fractures than shorter persons, and high body mass index is associated with fewer hip and forearm fractures. We have studied the association between body height, body mass index and all non-vertebral fractures in a large, prospective, population-based study. The middle-aged population of Tromsø, Norway, was invited to surveys in 1979/80, 1986/87 and 1994/95 (The Tromsø Study). Of 16,676 invited to the first two surveys, 12,270 attended both times (74%). Height and weight were measured without shoes at the surveys, and all non-vertebral fractures in the period 1988-1995 were registered (922 persons with fractures) and verified by radiography. The risk of a low-energy fracture was found to be positively associated with increasing body height and with decreasing body mass index. Furthermore, men who had gained weight had a lower risk of hip fractures, and women who had gained weight had a lower risk of fractures in the lower extremities. High body height is thus a risk factor for fractures, and 1 in 4 low-energy fractures among women today might be ascribed to the increase in average stature since the turn of the century. Low body mass index is associated with a higher risk of fractures, but the association is probably too weak to have any clinical relevance in this age category.
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.
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.
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.
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.
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.
Seventeen subjects from a residential home in Leeds were chosen for the study, based on their ability to comply with the study protocol. Each subject was measured using a portable stadiometer for standing height, which was then adjusted for knee height, and a tape measure for demi‐span. All measurements were taken by the same researcher (TH). Measurements for demi‐span and knee height were converted using standard reference equations (for demi‐span: Bassey, 1986 ; for knee height: Chumlea, 1985 ). Data were analysed using SPSS. The Bland–Altman (1986) method for assessing agreement between two methods of measurements was carried out on the data.
Data were obtained on 15 of the 17 subjects, as two subjects were unable to be weighed. Statistical analysis revealed that the lines of agreement between the three methods varied by up to 10 cm from the average or expected figure. In other words, there was up to 10 cm difference in height when calculated by the three different methods. In over half of the 17 subjects, an accurate measurement of standing height was difficult to obtain, because of difficulties encountered by the subjects in standing fully upright through frailty or spinal deformity. Problems were also encountered with demi‐span and knee height measurements, as some subjects had poor movement in their arms and were unable to stretch their arms out fully and 11 of 17 subjects were unable to get themselves into the correct position for measuring knee height.
Although only conducted on a small sample of older people, the findings of this study highlight the difficulties in obtaining accurate height measurements for calculating BMI. While the literature suggests that demi‐span and knee height are reliable alternative methods for estimating stature, this was not the case in this study and may therefore also be a problem in clinical practice. Coupled with problems in the use of BMI in older people, the utility of performing such measures is debatable.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.