Sarcopenic obesity negatively affects composite indices of femoral neck strength in premenopausal women.

Influence of Physical Activity Level on Composite Indices of Femoral Neck Strength in a Group of Young Overweight Men

With the increased incidence of hip fractures worldwide, numerous studies have reported that composite indices of femoral neck strength can improve hip fracture risk assessment. This study aimed to assess the association between composite indices of femoral neck strength and the odds of hip fracture in Chinese adults. This retrospective cross-sectional study conducted at Changzhou Second People's Hospital included 937 Chinese adults (248 with hip fractures). After overnight fasting for ≥ 8h, blood samples were collected from all participants within 24h of admission. Composite indices of femoral neck strength were derived by combining bone mineral density, weight, and height with femoral axis length and width, which were measured by dual-energy X-ray absorptiometry. In total, 937 participants (293 men and 644 women) were enrolled. The mean age was 68.3years (SD 10.5). After adjusting for confounders, higher values of CSI and ISI were associated with a lower odd of hip fracture. Increase in CSI (per 1g/m·kg) was associated with a 46% decrease in the odd of hip fracture (OR = 0.54; 95% CI, 0.39-0.74), and increase in ISI (per 0.1g/m·kg) was associated with an 82% decrease (OR, 0.18; 95% CI, 0.11-0.30). Effect sizes of CSI and ISI on the odds of hip fracture remained robust and reliable in subgroup analyses. Increased CSI and ISI were associated with a lower odd of hip fracture, especially in women, suggesting that composite indices of femoral neck strength may provide useful information for improving hip fracture risk assessment.

PurposesThe purpose of this study was to investigate the predictive effect exerted by composite indices of femoral neck strength (compressive strength index (CSI), bending strength index (BSI) and impact strength index (ISI) on the femoral head collapse in steroid-associated ONFH patients.MethodsNonoperative steroid-associated osteonecrosis of the femoral head (ONFH) patients from 2017 to 2019 were selected. The patients fell into the collapsed group and the non-collapsed group according to whether the femoral head collapsed. CSI, BSI and ISI were calculated. Moreover, bone turnover markers were measured. The statistical analysis was conducted on the predictive effects of composite indices of femoral neck strength and bone turnover index on ONFH collapse.ResultsA total of 62 patients were included. The mean CSI, BSI and ISI were significantly lower in the collapsed group than those in the non-collapsed group (P < 0.05). CSI, ISI,t-P1NP and β-CTx were suggested as the protective risk factors for the femoral head collapse in ONFH patients. The ISI area under the curve values was 0. 878.The mean survival time of the hips of patients with ISI greater than 0.435 was greater (P < 0.05) than that of patients with ISI less than 0.435.ConclusionThe composite indices of femoral neck strength can predict steroid-associated ONFH femoral head collapse more effectively than the bone turnover markers. The ISI value of 0.435 is a potential cut-off value, lower than this value can predict the early collapse of steroid-associated ONFH.

2019 Examining the relationship between habitual physical activity (PA) and bone resistance to fracture are limited by the use of self-reported PA. PURPOSE: To analyze the relationship between objectively measured intensity and duration of weight bearing PA and composite indices of femoral neck strength, a measure that integrates bone density, bone and body size variables. METHODS: PA was assessed with a uni-axial accelerometer in 143 girls and 150 boys (9.7 ± 0.3 yrs). Assessment of femoral neck bone mineral density (BMD), femoral neck width (FNW), and hip axis length (HAL) was performed with DXA. Compressive (BMD*FNW/weight) and bending strength {BMD* (FNW)2/HAL*weight} express the forces that femoral neck has to withstand in weight bearing, while impact strength {BMD*FNW*HAL/(height*weight)} expresses the energy that femoral neck has to absorb in an impact from standing height (Karlamangla et al., 2002). RESULTS: ANCOVA (adjusted for fat free mass and age) showed significant differences between boys (B) and girls (G) of about 9% for compressive (B 5.96 ± 0.07 vs. G 5.48 ± 0.07 g/kgm, p≤ 0.001), 10% for bending (B 1.95 ± 0.03 vs. G 1.77 ± 0.03 g/kgm, p≤ 0.001), and 9% for impact strength (B 0.37 ± 0.01 vs. G 0.34 ± 0.01 g/kgm, p≤ 0.001). Stepwise regression analysis using time spent at sedentary, light, moderate and vigorous intensity of PA as predictors, revealed that vigorous intensity PA explained 5–9% (p≤ 0.01) of the variance of femoral neck strength variables in both genders, except for femoral bending strength in boys. Vigorous intensity PA was then used to categorize boys and girls into quartiles. Pairwise comparison indicated that boys in the third and fourth quartile (accumulation of > 26 min/d) demonstrated higher values of compressive (11–12%, p≤ 0.01), bending (10%, p≤ 0.05) and impact strength (14%, p≤ 0.01) than boys in the first quartile. In girls, pairwise comparison revealed a significant difference between the fourth (accumulation of > 25 min/d) and the first quartile for bending strength (11%, p≤ 0.05). CONCLUSIONS: Femoral neck strength is higher in boys than girls. Vigorous intensity PA emerged as the main predictor of composite indices of femoral neck strength. Daily vigorous intensity PA for at least ∼25 min seems to be related to improved femoral neck bone health in children.

The aim of the current study was to explore the relationships between fat mass and composite indices of femoral neck strength ((compressive strength index (CSI), bending strength index (BSI) and impact strength index (ISI)) in a group of elderly Lebanese subjects. 59 elderly women and 39 elderly men whose ages range between 60 and 85 years participated in this study. Height and weight were measured, and body mass index (BMI) was calculated. Body composition and femoral neck bone mineral density were measured by DXA. Handgrip strength was measured by a hand dynamometer. In women, fat mass was negatively correlated to CSI and ISI. In men, fat mass was negatively correlated to CSI, BSI and ISI. The negative correlations between fat mass and composite indices of femoral neck strength remained significant after controlling for age. In conclusion, the current study suggests that fat mass is a negative determinant of composite indices of femoral neck strength in elderly Lebanese subjects. Implementing strategies to reduce fat mass excess seems important to prevent osteoporotic fractures in elderly subjects.

Positive correlations between physical activity level and composite indices of femoral neck strength in a group of young overweight and obese men

The purpose of this study was to investigate the relationships between vertical jump and composite indices of femoral neck strength (Compression strength index (CSI), bending strength index (BSI) and impact strength index (ISI)) in a group of young women. 206 young women (18 to 35 years) voluntarily participated in this study. Weight and height were measured, and body mass index (BMI) was calculated. Body composition, bone mineral content (BMC), bone mineral density (BMD) and trabecular bone score (TBS) were determined for each individual by Dual-energy X-ray absorptiometry (DXA). Composite indices of femoral neck strength (CSI, BSI and ISI) were calculated. Vertical jump was evaluated using a validated field test (Sargent test), and maximum power (P max, in watts) of the lower limbs was calculated accordingly. Vertical jump was positively correlated to CSI (r = 0.36; p < 0.001), BSI (r = 0.30; p < 0.001) and ISI (r = 0.33; p < 0.001). After adjusting for weight, vertical jump remained positively correlated to CSI (p = 0.026). The correlations between vertical jump and bone variables disappeared after adjusting for fat mass. The current study suggests that vertical jump is a positive determinant of composite indices of femoral neck strength in young women.

Composite Indices of Femoral Neck Strength in Middle-Aged Inactive Subjects Vs Former Football Players

Fracture risk in type 2 diabetes mellitus with insulin resistance is increased, despite relatively preserved bone mineral density (BMD). In this study, we investigated the relationship between insulin resistance and composite indices of femoral neck strength in Koreans. A population-based, cross-sectional study from the Korea National Health and Nutrition Examination Survey PARTICIPANTS: About 1243 men and 1433 women MEASUREMENTS: Insulin resistance was evaluated using the homoeostasis model assessment-estimated insulin resistance (HOMA-IR) index. Femoral neck width and axis length were measured from hip dual-energy X-ray absorptiometry scans and combined with BMD, weight and height to calculate composite indices of femoral neck strength relative to load: compression (CSI), bending (BSI) and impact strength indices (ISI). HOMA-IR showed an inverse relationship with CSI, BSI and ISI in both genders before and after adjusting for confounders (P < 0·001-0·029). CSI was more strongly associated with HOMA-IR than BSI and/or ISI in both genders (P < 0·001-0·013). When men were stratified according to HOMA-IR quartiles, all strength indices decreased as the quartile increased, after adjusting for all potential confounders (P for trend <0·001-0·001), whereas CSI and ISI did in women (P for trend = 0·012 and 0·002, respectively). Fasting insulin levels, but not glucose levels, were negatively associated with all strength indices regardless of confounders (P < 0·001-0·044). Insulin resistance is associated with low femoral neck strength, particularly against the compressive load. These findings suggest a better approach to evaluate bone health in insulin-resistant individuals.

The objective of this work was to examine the prediction of incident hip fracture risk by composite indices of femoral neck strength, constructed from dual X-ray absorptiometry (DXA) scans of the hip. These indices integrate femoral neck size and body size with bone density, and reflect the structure's ability to withstand axial compressive forces and bending forces, and the ability to absorb energy in an impact. We studied a prospective cohort of community-dwelling women, 55 years or older at baseline, average age 72 years, that was established in 1988, with follow-up until 1998. Higher baseline values of each composite strength index were associated with lower risk of incident hip fracture in this cohort. After adjusting for age and body mass index, relative risks associated with each standard deviation increment in the composite indices were 0.39 for compression strength (95% confidence interval 0.25-0.60), 0.43 for bending strength (95% confidence interval 0.27-0.70), and 0.34 for impact strength (95% confidence interval 0.20-0.58). Larger bone size relative to body size was associated with lower risk of incident hip fracture. After adjusting for age, body mass index, and bone density, each standard deviation increment in femoral neck width normalized by body weight was associated with incident hip fracture relative risk of 0.38 (95% confidence interval 0.20-0.70). Our results suggest that composite indices of femoral neck strength, constructed from DXA measurements, have the potential to improve hip fracture risk assessment. This needs further exploration in larger cohorts and in different population sub-groups.

Diabetes mellitus is associated with increased hip fracture risk, despite being associated with higher bone mineral density in the femoral neck. The objective of the study was to test the hypothesis that composite indices of femoral neck strength, which integrate dual-energy x-ray absorptiometry derived femoral neck size, femoral neck areal bone mineral density, and body size and are inversely associated with hip fracture risk, would be lower in diabetics than in nondiabetics and be inversely related to insulin resistance, the primary pathology in type 2 diabetes. This was a cross-sectional analysis. The study consisted of a multisite, multiethnic, community-dwelling sample of 1887 women in pre- or early perimenopause. Composite indices for femoral neck strength in different failure modes (axial compression, bending, and impact) were measured. Adjusted for age, race/ethnicity, menopausal stage, body mass index, smoking, physical activity, calcium and vitamin D supplementation, and study site, diabetic women had higher femoral neck areal bone mineral density [+0.25 sd, 95% confidence interval (CI) (+0.06, +0.44) sd] but lower composite strength indices [-0.20 sd, 95% CI (-0.38, -0.03) sd for compression, -0.19 sd, 95% CI (-0.38, -0.003) sd for bending, -0.19 sd, 95% CI (-0.37, -0.02) sd for impact] than nondiabetic women. There were graded inverse relationships between homeostasis model-assessed insulin resistance and all three strength indices, adjusted for the same covariates. Despite having higher bone density, diabetic women have lower indices of femoral neck strength relative to load, consistent with their documented higher fracture risk. Insulin resistance appears to play an important role in bone strength reduction in diabetes.

The aim of this study was to explore the relationship between maximal oxygen consumption (VO2 max; mL/mn/kg) and composite indices of femoral neck strength in a group of young women. 41 young women whose ages ranged from 18 to 35 years participated in the present study. Femoral neck bone mineral density was measured by DXA. Composite indices of femoral neck strength (CSI, BSI and ISI) were calculated. VO2 max (mL/mn/kg) of the participants was measured using a Cosmed Fitmate pro device (version 2.20) while exercising on a bicycle ergometer (Siemens-Elema RE 820; Rodby Elektronik AB, Enhorna, Sweden). VO2 max (mL/mn/kg) was positively correlated to CSI (r = 0.52; p < 0.001) and ISI (r = 0.45; p < 0.01). The positive associations between VO2 max (mL/mn/kg) and these two indices (CSI and ISI) remained significant after controlling for body mass index using multiple linear regression models.

Sprinting performance correlates with composite indices of femoral neck strength in middle-aged active men.

Our objective was to examine associations of physical activity in different life domains with peak femoral neck strength relative to load in adult women. Greater physical activity in each of the domains of sport, active living, home, and work was associated with higher peak femoral neck strength relative to load. Our objective was to examine the associations of physical activity in different life domains with peak femoral neck strength relative to load in adult women. Composite indices of femoral neck strength integrate body size with femoral neck size and bone mineral density to gauge bone strength relative to load during a fall, and are inversely associated with incident fracture risk. Participants were 1,919 pre- and early perimenopausal women from the Study of Women's Health Across the Nation. Composite indices of femoral neck strength relative to load in three failure modes (compression, bending, and impact) were created from hip dual-energy X-ray absorption scans and body size. Usual physical activity within the past year was assessed with the Kaiser Physical Activity Survey in four domains: sport, home, active living, and work. We used multiple linear regression to examine the associations. Greater physical activity in each of the four domains was independently associated with higher composite indices, adjusted for age, menopausal transition stage, race/ethnicity, Study of Women's Health Across the Nation study site, smoking status, smoking pack-years, alcohol consumption level, current use of supplementary calcium, current use of supplementary vitamin D, current use of bone-adverse medications, prior use of any sex steroid hormone pills or patch, prior use of depo-provera injections, history of hyperthyroidism, history of previous adult fracture, and employment status: standardized effect sizes ranged from 0.04 (p < 0.05) to 0.20 (p < 0.0001). Physical activity in each domain examined was associated with higher peak femoral neck strength relative to load in pre- and early perimenopausal women.

The purpose of this study was to describe the evolution of femoral neck strength relative to load across the menopause transition. It declined significantly over the 10 years bracketing the final menstrual period, and the rate of decline was modified by body mass index, race/ethnicity, and smoking status. Composite indices of femoral neck strength, which integrate dual energy X-ray absorptiometry (DXA)-derived bone mineral density and bone size with body size, are inversely associated with hip fracture risk. Our objective was to describe longitudinal trajectories of the strength indices across the menopausal transition. Data came from the Study of Women's Health Across the Nation; participants were pre- or early peri-menopausal, ages 42-53 at baseline, and were followed up for 9.1 ± 1.8 years. Composite indices of femoral neck strength in different failure modes (compression, bending, and impact) were created in 921 women who had three or more hip DXA scans and had definable final menstrual period (FMP) dates. We used mixed effects models to fit piecewise linear growth curves to the baseline-normalized strength indices as a function of time to/after the FMP. Compression and impact strength indices did not decline until 1 year prior to the FMP, and declined rapidly thereafter, with some slowing of decline 1 year after the FMP. Bending strength index increased slightly until 2 years prior to the FMP, then plateaued, and began to decline at the FMP. Mean decline in strength indices over 10 years was 6.9 % (compression), 2.5 % (bending), and 6.8 % (impact). Women with higher body mass index had larger declines in two of the three indices. Other major modifiers of rates of decline were race/ethnicity and smoking status. Femoral neck strength relative to load declines significantly during the menopausal transition, with declines commencing 1 to 2 years prior to the FMP.