Association Between Weight-Adjusted Waist Index (WWI) and Bone Mineral Density in Postmenopausal Women: A Cross-Sectional Analysis of NHANES Data

Osteoporosis imposes significant burdens. Early detection of high-risk individuals through simple indicators can greatly improve prognosis. Red cell distribution width (RDW), a standard component of a complete blood count, shows promise, yet remains underexplored. This cross-sectional study aimed to investigate the association between RDW and femoral neck and spinal bone mineral density (BMD). Participants aged 20-79 years from the 2005-2010, 2013-2014, and 2017-2020 cycles of the National Health and Nutrition Examination Survey (NHANES) were included. BMD was measured using dual-energy X-ray absorptiometry (DXA). A total of 13,029 participants were included, comprising 6684 men, 3238 postmenopausal women, and 3107 premenopausal women, with the sample weighted to represent 98,712,128 people. After adjusting for covariates, RDW exhibited a negative association with femoral neck BMD in both men (β = -0.006; 95% CI: -0.010 to -0.002; p = 0.0053) and postmenopausal women (β = -0.005; 95% CI: -0.010 to -0.000; p = 0.0413). Subgroup and sensitivity analyses supported the robustness of these findings. A negative association between RDW and spinal BMD in men approached significance (β = -0.004; 95% CI: -0.008 to 0.000; p = 0.0557). Persistent trends were observed for RDW with spinal BMD in postmenopausal women and with both femoral neck and spinal BMD in premenopausal women. Our study suggests a negative association between RDW and femoral neck BMD in both men and postmenopausal women. These findings highlight the potential of RDW as a marker for identifying individuals at higher risk of osteoporosis.

Osteoclast inhibitory lectin (OCIL) is a newly recognized inhibitor of mouse and human osteoclast differentiation whose cellular expression is similar to that of receptor activator of nuclear factor kappaB (RANKL). The main objective of the present work was to elucidate whether naturally occurring single-nucleotide polymorphisms (SNPs) in this gene could be associated with bone mass in postmenopausal women. To that end, we studied the association of bone mineral density (BMD) measured by dual-energy X-ray absorptiometry with two nonsynonymous SNPs in the OCIL gene resulting in Asn19Lys and Leu23Val substitutions in a population of 500 postmenopausal Spanish women. A weak association was detected for Asn19Lys SNP with femoral neck (FN) BMD and lumbar spine (LS) BMD in the whole population. When the population was stratified by age, however, the association was strong in older women (> or =53 years). Thus, in this group of participants, women with CG/GG genotype displayed reductions of 5.6% and 6.7% in FN BMD and LS BMD adjusted by age and body mass index (BMI), respectively, compared to women with CC genotype. The Asn19Lys SNP alleles explained about 7% of BMD variance in older women but only 1.7-3.9% in the whole population in regression models including age and BMI. In conclusion, women with a lysine (GG genotype) at position 19 of the OCIL protein displayed lower BMD at femoral neck and at lumbar spine sites than women having an asparagine residue. Since the OCIL protein inhibits osteoclast differentiation, this amino acid substitution could have consequences for OCIL functionality.

BackgroundPregnancy has been considered a risk factor for the development of osteoporosis. Despite much research in this field, the relationship between parity and bone mineral density (BMD) is still controversial. Therefore, we conducted this study to investigate whether there was an association between parity and BMD of the femoral neck and lumbar spine in postmenopausal women.MethodsCross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES). Three linear regression models, Model 1 (unadjusted), Model 2 (adjusted for age and body mass index (BMI)), and Model 3 (adjusted for all covariates), were established to evaluate the relationship between parity and BMD. In addition, the p value trend of BMD in the different parity groups was mutually verified with the results of multiple regression. Multiple logistic regression models were used to assess the relationship between parity and osteoporosis.ResultsIn total, 924 postmenopausal women aged 45–65 years were eligible for this study. After adjustment for potential confounders, women with ≥ 6 parities had significantly lower lumbar spine BMD than women with 1–2 parities (β = − 0.072, 95% CI: − 0.125, − 0.018, P = 0.009). However, there was no correlation between parity and femoral neck BMD in any of the three regression models. Furthermore, ≥ 6 parities were associated with a significantly higher prevalence of lumbar spine osteoporosis compared with 1–2 parities (OR = 3.876, 95% CI: 1.637, 9.175, P = 0.002).ConclusionsAfter adjustment for BMD-related risk factors, ≥ 6 parities were associated with decreased lumbar spine BMD but not femoral neck BMD in postmenopausal women. This suggests that postmenopausal women with high parity are at increased risk of lumbar osteoporotic fractures and should pay more attention to their bone health.

We aim to explore the association between caffeine and its metabolites and bone mineral density (BMD) in postmenopausal women. Data of 4286 postmenopausal women were extracted from the National Health and Nutrition Examination Survey (NHANES) database in 2009-14 in this cross-sectional study. Weighted linear regression and stepwise regression analyses were used to screen the covariates. Weighted univariate and multivariate linear regression analyses were used to explore the associations between caffeine and its metabolites and BMD. The evaluation index was estimated value (β) with 95 % confidence intervals (CIs). We also explored these relationships in age subgroups. The median BMD level among the eligible women was 0⋅7 gm/cm2. After adjusting for covariates including age, body mass index (BMI), fat intake, Calcium (Ca) supplements, diabetes mellitus (DM), angina pectoris, parental history of osteoporosis (OP), anti-osteoporosis therapy, poverty income ratio (PIR), vitamin D (VD) supplements, coronary heart disease (CHD), and previous fracture, we found that caffeine intake was not significantly related to the BMD reduction (β = 0, P = 0⋅135). However, caffeine metabolites, including MethyluricAcid3, MethyluricAcid7, MethyluricAcid37, Methylxanthine3, and Methylxanthine37, were negatively associated with the BMD (all P < 0⋅05). In addition, MethyluricAcid37 and Methylxanthine37 were negatively associated with BMD in females aged <65 years old, while MethyluricAcid3 and Methylxanthine3 were noteworthy in those who aged ≥65 years old. The roles of caffeine and its metabolites in BMD reduction and OP in postmenopausal women needed further exploration.

BackgroundThis study aimed to investigate the association between the systemic immune-inflammation index (SII) and bone mineral density (BMD) and to determine the association between the SII and the risk of osteopenia/osteoporosis among postmenopausal women aged ≥50 years.MethodsPostmenopausal women aged ≥50 years from the National Health and Nutrition Examination Survey were included. BMD testing was performed using dual-energy X-ray absorptiometry. The SII was calculated based on lymphocyte (LC), neutrophil (NC), and platelet (PC) counts. Moreover, the associations of BMD with SII and other inflammatory markers, including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), the product of platelet count and neutrophil count (PPN), PC, NC, and LC, were assessed using a multivariable weighted linear regression model. Additionally, the associations of low BMD/osteoporosis with SII and other inflammatory markers were assessed using multivariable weighted logistic regression.ResultsFinally, a total of 893 postmenopausal women with a weighted mean age of 60.90 ± 0.26 years were included finally. This study found that SII was negatively associated with total femur BMD and femoral neck BMD, and postmenopausal women in a higher SII quarter group showed low lumbar spine BMD than the lowest SII quarter group when SII was converted from a continuous variable to a categorical variable. Moreover, increased SII was associated with an increased risk of low BMD and osteoporosis. In addition, this study observed that other inflammatory markers, especially NLR and PPN, were negatively associated with BMD and positively associated with the risk of osteoporosis. Finally, the subgroup analysis showed that the associations between BMD and inflammatory markers were pronounced in postmenopausal women aged ≥65 years or those with normal BMI (<25 kg/m2).ConclusionSII may be a valuable and convenient inflammatory marker that could be applied to predict the risk of low BMD or osteoporosis among postmenopausal women aged ≥50. Moreover, postmenopausal women with a high level of SII or other inflammatory markers, such as NLR and PPN, should be aware of the potential risk of osteoporosis. However, given the inherent limitations of the present study, additional large-scale studies are required to investigate the role of SII in osteoporosis further.

Influence of lean and fat mass on bone mineral density (BMD) in postmenopausal women with osteoporosis

IntroductionPrevious studies have shown that obesity has a positive effect on bone mineral density (BMD). However, excessive obesity is harmful to health, especially in older adults. In addition, it is unclear what body mass index (BMI) and waist circumference (WC) to maintain for the most beneficial BMD in older adults.MethodsMultivariate logistic regression models were used to investigate the association between BMI, WC, and femoral neck BMD using the most recent data from the 2017–2020 National Health and Nutrition Examination Survey (NHANES). Fitting smoothing curves and saturation effects analysis were also used to determine the association of nonlinear relationships between BMI, WC, and femoral neck BMD.ResultsThe analysis included a total of 2,903 adults. We discovered that BMD and WC were positively linked to femoral neck BMD. The favorable associations of BMI and WC with femoral neck BMD were maintained in all subgroup analyses stratified by sex and race, except among Mexican Americans. Furthermore, smoothing curve fitting revealed that the link between BMI and BMD was not only a linear connection, and that there was a saturation point. The BMI saturation value in the femoral neck BMD was 24.3 (kg/m2), according to the saturation effect analysis.ConclusionsIn persons over the age of 50, our research found a positive relationship between obesity and BMD, and we also found a saturation value between BMI and BMD. According to this study, maintaining BMI at a moderate level (about 24.3 kg/m2) would result in an optimal balance between BMI and BMD in adults over 50 years of age.

The association of insulin resistance (IR), as indicated by the homeostasis model assessment of insulin resistance, with bone metabolism is yet to be clarified. We aimed to investigate the relationship of IR with bone mass by using the triglyceride-glucose (TyG) index as an alternative marker of IR. Data of 4810 non-diabetes individuals (2552 men aged ≥ 50years and 2258 postmenopausal women) from the Korean National Health and Nutritional Examination Survey IV and V were analyzed. Bone mineral density (BMD) at the lumbar spine, femoral neck, total hip, and whole body were measured using dual-energy X-ray absorptiometry. After adjusting for confounding factors, there were inverse relationships of TyG index with femoral neck, total hip, and whole body BMD in men (β = - 0.085, P < 0.001 at femoral neck; β = - 0.046, P = 0.037 at total hip; β = - 0.098, P < 0.001 at whole body). However, in women, femoral neck and whole body BMD were negatively associated with the TyG index (β = - 0.071, P = 0.008 at femoral neck and β = - 0.065, P = 0.005 at whole body). The highest TyG index tertile exhibited reduced femoral neck BMD in both sexes (P = 0.003 in men and P = 0.013 in women) and reduced whole body BMD in men (P < 0.001) after adjusting for confounders. When the study subjects were divided into BMI (body mass index) < 23kg/m2 and ≥ 23kg/m2 groups, the TyG index was significantly associated with femoral neck BMD only in the women with BMI < 23kg/m2 (P = 0.009). We observed a significant association between the highest TyG index tertile and low bone mass at the femoral neck in women with BMI < 23kg/m2 (P = 0.003) that was not observed in women with BMI ≥ 23kg/m2 and men. In conclusion, IR evaluated using the TyG index was inversely associated with femoral neck BMD in non-diabetic men aged ≥ 50years and postmenopausal women. The negative influence of IR on femoral neck BMD was robust in the women with BMI < 23kg/m2. This indicates a differential effect of IR on BMD according to skeletal site, sex, and BMI.

All obesity measures were positively associated with femoral neck bone mineral density (BMD), but not with lumbar spine BMD. Hip circumference was the most important obesity measure in relation to BMD. Multiple measures are used to quantify obesity; different obesity measures have diverse relationship with BMD. Which obesity measure has the most important value in relation to BMD is still poorly understood. We examined the association between multiple obesity measures and BMD and determined the relative importance (RI, percentage of variation) of multiple obesity measures associated with BMD. Data from 5287 men and women aged between 8 and 69 years (mean age = 29 years) in the National Health and Nutrition Examination Survey 2005-2006 were analyzed. Body mass index (BMI), waist circumference, hip circumference, body fat mass (FM) index, total body FM, abdominal FM, and appendicular FM were considered the exposures and femoral neck and lumbar spine BMD the outcomes. In the multivariable analysis, greater BMI and hip circumference were associated with increased BMD at the lumbar spine and femoral neck (all P < 0.001). The remaining obesity variables were positively associated with increased femoral neck BMD only (all P < 0.001). RI of all obesity measures associated with femoral neck BMD was much greater than that associated with lumbar spine BMD. Moreover, hip circumference had higher RI (19.8 for femoral neck BMD; 7.0 for lumbar spine BMD) than other obesity measures (all RIs ≤14.1 for femoral neck BMD; all RIs ≤3.5 for lumbar spine BMD) in relation to BMD. All obesity measures were positively associated with femoral neck BMD, but not with lumbar spine BMD. Hip circumference was the most important obesity measure in relation to BMD.

Association between Ward's triangle bone mineral density levels and abdominal aortic calcification: Data from the national health and nutrition examination survey 2013–2014

Jaw osteonecrosis possibly associated with the administration of bisphosphonates is expected to be treated with a non-pharmacologic approach. This study aimed to determine whether noninvasive, mechanically mediated vibration would inhibit the decline in bone mineral density (BMD) that follows menopause, enhance the BMD of the lumbar and femoral neck, and reduce chronic back pain in postmenopausal women with osteoporosis. A total of 116 postmenopausal women with osteoporosis participated in this study, and they were divided into groups A (66 patients) and B (50). Group A received vibration treatment (Subjects vertically stand on the vibration platform, with a vibration frequency of 30 Hz, amplitude of 5 mm; they received the treatment five times per week, ten minutes each time and totally for six months), whereas women of group B served as controls without any treatment. L2 - 4 BMD, bilateral femoral neck BMD, and body mass index (BMI) were recorded before the treatment or at the third and sixth months of the treatment respectively. After the ending of the treatment, the change of BMD in each group was compared and analyzed. Chronic back pain was evaluated by visual analogue scale (VAS) at baseline and the third and sixth months of the treatment. Of the 116 women, 94 including 51 women from group A ((61.23 +/- 8.20) years) and 43 women from group B ((63.73 +/- 5.45) years), completed the study. There were no significant differences in baseline characteristics including age, BMI, menopausal years, lumbar BMD, femoral neck BMD, and VAS between the two groups. The lumbar BMD of the 51 women in group A increased by 1.3% (P = 0.034) after vibration treatment for 3 months and by 4.3% at the sixth month (P = 0.000). The lumbar BMD in group B was decreased at the third month, but there was not statistical significance (P > 0.05). At the sixth month, it was decreased by 1.9% (P < 0.05). The femoral neck BMD of the 51 women in group A was slightly increased after vibration treatment for 3 months, but without statistical significance (P > 0.05). At the sixth month, the BMD was increased by 3.2% (P < 0.05). In group B, the BMD was not decreased significantly (P = 0.185) at the third month, but decreased significantly at the sixth month (1.7%) (P < 0.05) compared with the baseline. Chronic back pain (VAS) reduced more significantly in group A at the third and the sixth months (P < 0.05) after vibration therapy in comparison with the baseline. The BMI was not significantly changed in the two groups during the period of follow-up. Vibration therapy appears to be useful in reducing chronic back pain and increasing the femoral neck and lumbar BMD in postmenopausal women with osteoporosis.

Murine studies reveal that sympathetic nervous system activation leads to decreased bone mass. Stimulant medications used to treat attention-deficit/hyperactivity disorder (ADHD) increase sympathetic tone and may affect bone remodeling. Because bone mass accrual is completed by young adulthood, assessing stimulant effects on bone density in growing children is of critical importance. To investigate associations between stimulant use and bone mass in children and adolescents. This cross-sectional analysis used data collected from January 1, 2005, to December 31, 2010, from the National Health and Nutrition Examination Survey (NHANES) database. NHANES is a series of cross-sectional, nationally representative health and nutrition surveys of the US population. All children, adolescents, and young adults aged 8 to 20 years with dual-energy x-ray absorptiometry (DXA), anthropometric, demographic, and prescription medication use data were eligible for participation. Of the 6489 respondents included in the multivariable linear regression analysis, 159 were stimulant users and 6330 were nonusers. Data were analyzed from October 8, 2015, to December 31, 2016. Stimulant use, determined by questionnaires administered via interview. The association between stimulant use and total femur, femoral neck, and lumbar spine bone mineral content (BMC) and bone mineral density (BMD) was assessed using DXA. Study participants included 6489 NHANES participants with a mean (SD) age of 13.6 (3.6) years. Stimulant use was associated with lower bone mass after adjustment for covariates. Mean lumbar spine BMC was significantly lower in stimulant users vs nonusers (12.76 g; 95% CI, 12.28-13.27 g vs 13.38 g; 95% CI, 13.26-13.51 g; P = .02), as was mean lumbar spine BMD (0.90 g/cm2; 95% CI, 0.87-0.94 g/cm2 vs 0.94 g/cm2; 95% CI, 0.94-0.94 g/cm2; P = .03) and mean femoral neck BMC (4.34 g; 95% CI, 4.13-4.57 g vs 4.59 g; 95% CI, 4.56-4.62 g; P = .03). Mean BMD of the femoral neck (0.88 g/cm2; 95% CI, 0.84-0.91 g/cm2 vs 0.91 g/cm2; 95% CI, 0.90-0.91 g/cm2; P = .08) and total femur (0.94 g/cm2; 95% CI, 0.90-0.99 g/cm2 vs 0.99 g/cm2; 95% CI, 0.98-0.99 g/cm2; P = .05) were also lower in stimulant users vs nonusers. Participants treated with stimulants for 3 months or longer had significantly lower lumbar spine BMD (0.89 g/cm2; 95% CI, 0.85-0.93 g/cm2 vs 0.94 g/cm2; 95% CI, 0.94-0.94 g/cm2; P = .02) and BMC (12.71 g; 95% CI, 12.14-13.32 g vs 13.38 g; 95% CI, 13.25-13.51 g; P = .03) and femoral neck BMD (0.87 g/cm2; 95% CI, 0.74-0.83 g/cm2 vs 0.91 g/cm2; 95% CI, 0.83-0.84 g/cm2; P = .048) than nonusers. Children and adolescents reporting stimulant use had lower DXA measurements of the lumbar spine and femur compared with nonusers. These findings support the need for future prospective studies to examine the effects of stimulant use on bone mass in children.

Risk factors for low bone mineral density in premenopausal women with endometriosis in the national health and nutrition examination survey (NHANES)

The aim of this study was to examine the association between endogenous hormones and bone mineral density (BMD) in postmenopausal women. This was a cross-sectional study of 798 postmenopausal women aged 47-85 years. Data were collected on age, age at menopause, years since menopause, smoking status, body mass index, adiposity, BMD, physical activity, and Vitamin D supplementation. Measured hormonal parameters were: follicle-stimulating hormone (FSH), estradiol, testosterone, dehydroepiandrosterone sulfate, ∆4-androstenedione, cortisol, insulin-like growth factor-1, 25-hydroxyvitamin D, and parathormone (PTH) levels. BMD was measured at the lumbar spine, femoral neck, and total hip using dual-energy X-ray absorptiometry. A directed acyclic graph was used to select potential confounding variables. Multivariable analysis showed significant associations between cortisol and femoral neck BMD (β: -0.02, 95% confidence interval [CI]: -0.03--0.00), and PTH with femoral neck BMD (β: -0.01, 95% CI: -0.02--0.01) and total hip BMD (β: -0.01, 95% CI: -0.01--0.00). Hormonal factors more likely associated with a higher risk of low BMD (osteopenia or osteoporosis) were FSH (odds ratio [OR]: 1.02, 95% CI: 1.01-1.03) and PTH (OR: 1.02, 95% CI: 1.01-1.04). Higher cortisol and PTH levels were inversely associated with BMD. Postmenopausal women with higher FSH or PTH levels were likely to have low BMD.

Little is known regarding the exact relationship between osteoporosis and cardiovascular disease. Moreover, previous research on the relationships between components of metabolic syndrome (MetS) and bone mineral density (BMD) has primarily focused on women and older men; there have been few studies in younger men. We performed a cross-sectional study to assess whether MetS is associated with BMD in the femoral neck or lumbar spine in Korean adults. We further attempted to identify the MetS component, which is the most important factor in BMD. We performed a multiple regression analysis to analyze data on 2,989 subjects from the Fourth Korea National Health and Nutrition Examination Survey. We examined the association between MetS and individuals MetS components and BMD. After adjustment for age, height, weight, smoking status, alcohol consumption and exercise, waist circumference (WC) and diastolic blood pressure (DBP) showed independent negative associations with femoral neck and spine BMD in men in all age groups. Triglyceride concentration was also negatively associated with femoral neck BMD in younger men (<45years). In premenopausal women, WC, DBP, and high-density lipoprotein cholesterol were negatively associated with spine BMD. In postmenopausal women, WC was negatively associated with femoral neck BMD. These results suggest that WC in men in all age groups may be the most important factor in bone mineral density.