Increased Risk Of Osteoporosis Research Articles

Distribution and diagnostic modeling of osteoporosis and comorbidities across demographic factors: A cross-sectional study of 2224 female patients

ObjectiveThis study investigates the distribution of osteoporosis (OP) and its associated comorbidities across different demographic factors. Furthermore, this study seeks to develop a statistically-based diagnostic model leveraging demographic and health indicators to provide personalized risk assessments for OP. MethodsA retrospective analysis was conducted on the demographic data, health profiles, and bone density measurements of 2224 female patients. Key variables associated with OP were identified using chi-square tests. Feature selection was refined through Lasso regression and recursive feature elimination (RFE), which guided the development of a logistic regression-based dynamic nomogram. This model was subsequently implemented on the Shiny platform for personalized online OP risk assessments. ResultsAmong 2224 female patients, 801 (36.0 %) were diagnosed with OP. Women aged 70 and older exhibited a significantly higher prevalence of OP compared to younger age groups (OR = 5.83, 95 % CI: 1.74–19.61, P = 0.004), and this remained significant in the multivariable analysis (OR = 5.18, 95 % CI: 1.19–22.52, P = 0.028). Later age at menarche was associated with increased OP risk (OR = 1.31, 95 % CI: 1.09–1.57, P = 0.004), persisting in multivariable analysis (OR = 1.25, 95 % CI: 1.03–1.52, P = 0.023). In rheumatoid arthritis (RA) patients, higher education reduced OP risk, with secondary education (OR = 0.09, P = 0.024) and college education (OR = 0.04, P = 0.009) showing protective effects. Diabetic patients who were unmarried or had non-traditional marital statuses showed increased OP risk (univariate OR = 2.73, P = 0.006; multivariate OR = 2.34, P = 0.029). Among nonalcoholic fatty liver disease (NAFLD) patients, age at menopause was significantly linked to OP risk (univariate OR = 1.04, P = 0.012). The prediction model showed strong performance (AUC = 0.720), and the dynamic nomogram on the Shiny platform provided effective personalized OP risk assessments. ConclusionAge and age at menarche are significant risk factors for OP, with later menarche increasing the risk. In RA patients, higher education levels were associated with a lower risk of OP. In contrast, unmarried or non-traditional marital statuses increased OP risk among diabetic patients. Additionally, age at menopause was found to be a significant factor for OP risk in NAFLD patients. The prediction model developed in this study, with an AUC of 0.720, provides a reliable method for personalized OP risk assessment through a dynamic nomogram. These findings highlight the crucial role of demographic factors in predicting OP risk and underscore the importance of personalized treatment strategies for effective OP prevention and management.

Evaluating the role of biological age in osteoporosis risk among middle-aged and older adults: A nationwide perspective

ObjectivesThis study aimed to investigate the association between biological age acceleration and osteoporosis (OP) risk in middle-aged and older adults using data from the National Health and Nutrition Examination Survey (NHANES). The research focused on analyzing the relationship between two biological aging metrics, Klemera-Doubal Method Age (KDMAge) and Phenotypic Age (PhenoAge), and OP risk. MethodsThe study analyzed data from NHANES, which included 6550 participants aged 50 and above from survey cycles 2005–2010 and 2017–2018. Linear and logistic regression were used to investigate the relationship between biological age acceleration (KDMAgeAccel and PhenoAgeAccel) and OP. Subgroup analysis was performed by age, gender and other factors. Multivariable Cox regression analysis yielded Hazard Ratios (HRs) relating biological age acceleration to mortality were evaluated. The study also considered the mediating roles of body mass index (BMI). ResultsKDMAgeAccel (odds ratio [OR] = 2.34, 95 % CI, 1.72–3.18) and PhenoAgeAccel (OR = 2.03, 95 % CI, 1.48–2.78) were significantly associated with increased OP risk and reduced bone mineral density (BMD). Specifically, higher KDMAgeAccel and PhenoAgeAccel were linked to higher OP prevalence and lower BMD at multiple sites. Subgroup analyses indicated that the association between accelerated biological age acceleration and OP risk was consistent across different demographics. Mediation analysis revealed that BMI partially mediated the relationship between accelerated biological age and OP, although other mechanisms are likely involved. Statistical analysis indicated that individuals with higher biological age metrics had increased mortality risk related to OP. ConclusionThe findings suggest that accelerated biological age is a robust predictor of OP risk and related mortality. KDMAgeAccel and PhenoAgeAccel could serve as valuable biomarkers for identifying individuals at high risk for OP, guiding preventive strategies.

Prevalence and risk factors of osteopenia and osteoporosis among postmenopausal women: A cross-sectional study from Jordan.

Our aim was to predict the prevalence of osteopenia and osteoporosis and their associated risk factors among postmenopausal women from Jordan. In this cross-sectional study, a total of 368 postmenopausal women were recruited from King Abdullah University Hospital (KAUH) in the North of Jordan between September 2022 and April 2023. Bone mineral density (BMD) was measured using a dual-energy X-ray absorptiometry scan. T-score was used for osteoporosis diagnosis in accordance with the International Society for Clinical Densitometry (ISCD) guidelines. Data about sociodemographic and lifestyle variables were collected using face-to-face interviews. Medical records were used to retrieve participants' BMD information. Predictors of osteoporosis were identified using logistic regression. Prevalence of osteoporosis was 40.5%, while 44.6% of participants were diagnosed with osteopenia. The lumbar spine had the highest frequency of osteoporosis (30.4%), while the left femoral neck had the highest prevalence of osteopenia (46.3%). Postmenopausal women's age (p-value=.024), and history of chronic diseases (p-value=.038) were significant factors associated with increased osteoporosis risk. Postmenopausal women from Jordan had high prevalence of osteoporosis and osteopenia. It is therefore necessary to target risk factors leading to osteoporosis and to improve patients' lifestyles through patient education. Healthcare systems should consider early screening approaches for osteoporosis at the age of menopause and thereafter. Supplements of calcium and vitamin D may be routinely considered for this age group depending on their serum levels.

Effects of Endocrine-Disrupting Chemicals on Bone Health.

This comprehensive review critically examines the detrimental impacts of endocrine-disrupting chemicals (EDCs) on bone health, with a specific focus on substances such as bisphenol A (BPA), per- and polyfluoroalkyl substances (PFASs), phthalates, and dioxins. These EDCs, by interfering with the endocrine system's normal functioning, pose a significant risk to bone metabolism, potentially leading to a heightened susceptibility to bone-related disorders and diseases. Notably, BPA has been shown to inhibit the differentiation of osteoblasts and promote the apoptosis of osteoblasts, which results in altered bone turnover status. PFASs, known for their environmental persistence and ability to bioaccumulate in the human body, have been linked to an increased osteoporosis risk. Similarly, phthalates, which are widely used in the production of plastics, have been associated with adverse bone health outcomes, showing an inverse relationship between phthalate exposure and bone mineral density. Dioxins present a more complex picture, with research findings suggesting both potential benefits and adverse effects on bone structure and density, depending on factors such as the timing and level of exposure. This review underscores the urgent need for further research to better understand the specific pathways through which EDCs affect bone health and to develop targeted strategies for mitigating their potentially harmful impacts.

PCSK9 inhibitors and osteoporosis: mendelian randomization and meta-analysis

BackgroundProprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors represent an effective strategy for reducing cardiovascular disease risk. Yet, PCSK9’s impact on osteoporosis remains unclear. Hence, we employed Mendelian randomization (MR) analysis for examining PCSK9 inhibitor effects on osteoporosis.MethodsSingle nucleotide polymorphisms (SNPs) for 3-hydroxy-3-methylglutaryl cofactor A reductase (HMGCR) and PCSK9 were gathered from available online databases for European pedigrees. Four osteoporosis-related genome-wide association studies (GWAS) data served as the main outcomes, and coronary artery disease (CAD) as a positive control for drug-targeted MR analyses. The results of MR analyses examined by sensitivity analyses were incorporated into a meta-analysis for examining causality between PCSK9 and HMGCR inhibitors and osteoporosis.ResultsThe meta-analysis involving a total of 1,263,102 subjects, showed that PCSK9 inhibitors can increase osteoporosis risk (P < 0.05, I2, 39%). However, HMGCR inhibitors are not associated with osteoporosis risk. Additionally, a replication of the analysis was conducted with another exposure-related GWAS dataset, which led to similar conclusions.ConclusionPCSK9 inhibitors increase osteoporosis risk. However, HMGCR inhibitors are unremarkably linked to osteoporosis.

Associations of sleep behaviors and genetic risk with risk of incident osteoporosis: A prospective cohort study of 293,164 participants

BackgroundUnhealthy sleep behaviors are associated with higher risks of osteoporosis (OP), while prospective evidence is limited. This study aimed to prospectively investigate this association, quantify the attributable burden of OP incidence reduction due to unhealthy sleep behaviors, and explore potential modifications by genetic risk factors. MethodsThis longitudinal cohort study was conducted utilizing data from the UK Biobank, comprising 293,164 participants initially free of OP and with requisite sleep behaviors data at baseline. We followed the participants after recruitment until November 30, 2022, to ascertain incident OP. We assessed the associations of five sleep behaviors including sleep duration, chronotype, insomnia, daytime napping, and morning wake-up difficulties, as well as sleep behavior patterns identified based on the above sleep behaviors, with the risk of OP, using Cox models adjusted for multiple confounders. The analyses were then performed separately among individuals with different OP susceptibility, indexed by standard polygenetic risk scores(PRS) for OP. Our secondary outcome was OP with pathologic fracture. Subgroup and sensitivity analyses were performed. Additionally, attributable risk percent in the exposed population (AR%) and population attributable fraction (PAF) of sleep behaviors were calculated. ResultsOver a median follow-up of 13.7 years, 8253 new-onset OP cases were documented. Unhealthy sleep behaviors, such as long or short sleep duration, insomnia, daytime napping, morning wake-up difficulties, and unhealthy sleep patterns, were associated with elevated risks of OP (HRs ranging from 1.14 to 1.46, all P-value <0.001) compared to healthy sleep behaviors. Similar associations were observed for OP with pathologic fractures. Insomnia exhibited the largest AR% of 39.98 % (95%CI: 36.46, 43.31) and PAF of 33.25 % (95%CI: 30.00, 36.34) among healthy sleep patterns and components. A statistically significant multiplicative interaction was noted between sleep behaviors and OP PRS on OP risk (all P-interaction <0.001). ConclusionsFour unhealthy sleep behaviors and sleep behavior patterns were associated to increased OP risk, with insomnia contributing the most to OP incidence, while genetic risk for OP modified this association. These findings underscore the crucial role of adhering to healthy sleep behaviors for effective OP prevention.

ASSESSING RISK FACTORS FOR OSTEOPOROSIS AND FRACTURES AT DIFFERENT SITES: LUMBAR VERTEBRAE VERSUS NECK OF FEMURS IN A LARGE COHORT. A CROSS-SECTIONAL STUDY

Osteoporosis can cause significant disability and cost to health services globally. We aim to compare risk fractures for both osteoporosis and fractures at the L1-L4 vertebrae (LV) and the neck of femurs (NOFs) in patients referred for DEXA scan in the North-West of England.Data was obtained from 31546 patients referred for DEXA scan in the North-West of England between 2004 and 2011. Demographic data was retrospectively analysed using STATA, utilising chi-squared and t-tests. Logistical models were used to report odds ratios for risk factors included in the FRAX tool looking for differences between osteoporosis and fracture risk at the LV and NOFs.In a study involving 2530 cases of LV fractures and 1363 of NOF fractures, age was significantly linked to fractures and osteoporosis at both sites, with a higher risk of osteoporosis at NOFs compared to LV. Height provided protection against fractures and osteoporosis at both sites, with a more pronounced protective effect against osteoporosis at NOFs. Weight was more protective for NOF fractures, while smoking increased osteoporosis risk with no site-specific difference. Steroids were unexpectedly protective for fractures at both sites, with no significant difference, while alcohol consumption was protective against osteoporosis at both sites and associated with increased LV fracture risk. Rheumatoid arthritis increased osteoporosis risk in NOFs and implied a higher fracture risk, though not statistically significant compared to LV. Results summarised in Table 1.Our study reveals that established osteoporosis and fracture risk factors impact distinct bony sites differently. Age and rheumatoid arthritis increase osteoporosis risk more at NOFs than LV, while height and steroids provide greater protection at NOFs. Height significantly protects LV fractures, with alcohol predicting them. Further research is needed to explore risk factors’ impact on additional bony sites and understand the observed differences’ pathophysiology.For any figures or tables, please contact the authors directly.

High Body Fat as a Predictor of Osteoporosis Risk in Postmenopausal Women: Insights From a Community-Based Cross-Sectional Study in Rural South India.

Osteoporosis poses a significant health burden, particularly among postmenopausal women. While obesity in the form of BMI has been implicated in various health conditions, the relationship between waist-hip ratio (WHR) and osteoporosis remains debated. This study aims to estimate the prevalence of osteoporosis risk and explore the association between WHR and osteoporosis risk among postmenopausal women in rural South India. A community-based cross-sectional study was conducted in the Chengalpattu district of Tamil Nadu. The study enrolled 435 postmenopausal women aged 45 years and above and the data were collected on socio-demographic characteristics, anthropometric measurements, and osteoporosis risk assessment using the Osteoporosis Self-assessment Tool for Asian Women (OSTA) scale. Logistic regression analysis was performed to identify factors associated with osteoporosis risk with 95%CI. The mean (SD) age of participants was 54.5 (8.6) years, 87% were married, 33% were illiterate with mean (SD) WHR of 0.88 (0.1). Around 80.5% of the participants were categorized as low risk, 16.1% as intermediate risk, and 3.5% as high risk based on OSTA scores. Older age, lower educational attainment, and higher waist-hip ratio were significantly associated with increased osteoporosis risk. This community-based study found a 20% osteoporosis risk among postmenopausal women using the OSTA scale, with age, lower education, and waist-hip ratio as key determinants. Early identification and interventions, particularly targeting older and obese individuals, are crucial to alleviate the burden and complications of osteoporosis.

Menarche-a journey into womanhood: age at menarche and health-related outcomes in East Asians.

Are there associations of age at menarche (AAM) with health-related outcomes in East Asians? AAM is associated with osteoporosis, Type 2 diabetes (T2D), glaucoma, and uterine fibroids, as demonstrated through observational studies, polygenic risk scores, genetic correlations, and Mendelian randomization (MR), with additional findings indicating a causal effect of BMI and T2D on earlier AAM. Puberty timing is linked to adult disease risk, but research predominantly focuses on European populations, with limited studies in other groups. We performed an AAM genome-wide association study (GWAS) with 57890 Han Taiwanese females and examined the association between AAM and 154 disease outcomes using the Taiwanese database. Additionally, we examined genetic correlations between AAM and 113 diseases and 67 phenotypes using Japanese GWAS summary statistics. We performed AAM GWAS and gene-based GWAS studies to obtain summary statistics and identify potential AAM-related genes. We applied phenotype, polygenic risk scores, and genetic correlation analyses of AAM to explore health-related outcomes, using multivariate regression and linkage disequilibrium score regression analyses. We also explored potential bidirectional causal relationships between AAM and related outcomes through univariable and multivariable MR analyses. Fifteen lead single-nucleotide polymorphisms and 24 distinct genes were associated with AAM in Taiwan. AAM was genetically associated with later menarche and menopause, greater height, increased osteoporosis risk, but lower BMI, and reduced risks of T2D, glaucoma, and uterine fibroids in East Asians. Bidirectional MR analyses indicated that higher BMI/T2D causally leads to earlier AAM. Our findings were specific to Han Taiwanese individuals, with genetic correlation analyses conducted in East Asians. Further research in other ethnic groups is necessary. Our study provides insights into the genetic architecture of AAM and its health-related outcomes in East Asians, highlighting causal links between BMI/T2D and earlier AAM, which may suggest potential prevention strategies for early puberty. The work was supported by China Medical University, Taiwan (CMU110-S-17, CMU110-S-24, CMU110-MF-49, CMU111-SR-158, CMU111-MF-105, CMU111-MF-21, CMU111-S-35, CMU112-SR-30, and CMU112-MF-101), the China Medical University Hospital, Taiwan (DMR-111-062, DMR-111-153, DMR-112-042, DMR-113-038, and DMR-113-103), and the Ministry of Science and Technology, Taiwan (MOST 111-2314-B-039-063-MY3, MOST 111-2314-B-039-064-MY3, MOST 111-2410-H-039-002-MY3, and NSTC 112-2813-C-039-036-B). The funders had no influence on the data collection, analyses, or conclusions of the study. No conflict of interests to declare. N/A.

Sharing the multidisciplinary clinical approach to peri- and postmenopausal women: A Delphi consensus among Italian gynecologists, endocrinologists, and cardiologists for an integrated and optimal approach to clinical practice.

The critical phase of perimenopausal period is marked by a reduction in estrogen levels, leading to various clinical issues (vasomotor and neurodegenerative symptoms, increased osteoporosis risk and cardiovascular risk). These complex clinical scenarios pose challenges to clinicians in providing the right support for diagnosis and treatment. A group of Italian cardiologists, endocrinologists, and gynecologists conducted a survey among expert colleagues to assess consensus on controversial issues and best practices for screening and treating peri- and postmenopausal women. The Delphi methodology was used to analyze responses from a qualitative expert panel comprising 25 cardiologists, 25 endocrinologists, and 25 gynecologists, selected nationwide. Two consecutive questionnaires were proposed between February and May 2023. Agreement among experts was assessed following the Delphi method as developed by the RAND Corporation. The results of this Delphi Consensus have been shared by the leading scientific societies: Italian Society of Cardiology, Italian Society of Endocrinology, Italian Society of Gynecology and Obstetrics, and Italian Hospital Obstetricians Gynecologists Association. The experts highlighted comorbidities and hormone deprivation as crucial clinical problems to be evaluated in perimenopausal women, requiring investigation from cardiovascular and endocrinologic perspectives to assess cardiovascular risk, involving the use of BMI, standard blood samples, endocrine-metabolic tests, and lifestyle assessment, particularly in women with higher cardiovascular and metabolic risks candidates for hormone replacement therapy (HRT). The experts also agreed on the benefits of HRT in improving lipid metabolism and reducing insulin resistance, thereby mitigating the metabolic risks associated with menopause. However, this therapy should be tailored considering individual women's comorbidities and thrombotic risk.

Osteoporotic fracture risk in women with breast cancer treated with aromatase inhibitors: a health insurance claims database study in Japan

ABSTRACT Background Hormone therapy with aromatase inhibitors (AIs) for estrogen receptor-dependent breast cancer may expose patients to an increased osteoporosis risk. This study was performed to estimate fracture risk in women with breast cancer to whom AIs were prescribed in Japan. Methods This retrospective study used data from the Japanese Medical Data Vision database. Women with breast cancer prescribed AIs over a 12-month period were identified and matched to women not prescribed AIs using a propensity score. Fracture rates were estimated by a cumulative incidence function and compared using a cause-specific Cox hazard model. The proportion of women undergoing bone density tests was retrieved. Results For all fractures sites combined, cumulative fracture incidence at 10 years was 0.19 [95%CI: 0.16–0.22] in women prescribed AIs and 0.18 [95%CI: 0.15–0.21] without AIs. AI prescription was not associated with any changes in risk (adjusted hazard ratio: 1.08 [95%CI: 0.99–1.17] p = 0.08). Women prescribed AI more frequently underwent bone density testing (31.9% [95% CI: 31.2%; 32.6%] versus 2.2% [95% CI: 2.0%; 2.4%]). Conclusions The anticipated association between AI exposure and osteoporotic fracture risk in Japanese women with breast cancer was not seen clearly.

2022 Association between severe mental illness and risk of osteoporosis and fragility fractures: analysis of UK primary care data

Abstract Introduction Severe Mental Illness (SMI), particularly schizophrenia, has been associated with reduced bone mineral density and increased risk of fractures, although some studies have shown inconsistent results. We aimed to examine the effect of SMI on recorded diagnosis of osteoporosis and fragility fracture in older people in the UK, accounting for age, sex, social deprivation and lifestyle factors (smoking, alcohol and Body Mass Index (BMI)). Methods We used de-identified data provided as part of routine primary care (IQVIA Medical Research Database). Patients with a diagnosis of SMI (schizophrenia, bipolar disorder, other psychosis) aged 50-99y between 1/1/2000-31/12/2018 were matched 1:8 to age- and sex-adjusted controls without SMI, using Exposure Density Sampling (EDS). We estimated Hazard Ratios (HR) and 95% Confidence Intervals (95%CI) based on Cox Proportional Hazards model. We stratified the analysis by sex, accounting for age, social deprivation, year (model 1), and the above plus smoking, alcohol, and BMI (model 2). We imputed missing lifestyle data using Multiple Imputation. Results In total 444,480 people aged ≥50 years were included in the analysis (SMI N=50,006; controls N=394,474). In men, prior diagnosis of SMI increased the risk of osteoporosis diagnosis by 64% (HR 1.64; 95%CI 1.44-1.88) and the risk of fragility fractures by 87% (HR 1.87; 95%CI 1.70-2.06) in model 1. SMI also increased osteoporosis risk by 49% (HR=1.49; 95%CI 1.30-1.71) and fragility fracture risk by 82% (HR=1.82; 95%CI 1.65-2.00) in model 2 in men. In contrast, prior diagnosis of SMI had no significant effect on recorded osteoporosis risk in women. Prior SMI in women increased fragility fracture risk by 53% (HR 1.53; 95%CI 1.45-1.61) in model 1 and by 51% (HR=1.51; 95%CI 1.43-1.58) in model 2. Conclusions SMI is associated with increased risk of osteoporosis in men, and fragility fractures in both men and women, with a greater effect in men.

Osteoporosis and Fracture Risk Following Benign Hysterectomy Among Female Patients in Korea

Prior research about the association between hysterectomy and osteoporosis risk had limitations. To assess osteoporosis and fracture risk among female patients who underwent hysterectomy due to benign conditions. In this retrospective cohort study, female patients aged 40 to 59 years with benign hysterectomy between 2003 and 2011 were selected from Korean National Health Insurance Data and matched by 1:1 propensity score with female patients who had health checkups and indicated that they had not had a hysterectomy. A Cox proportional hazard model was used to analyze osteoporosis and fracture risk, with participants monitored until December 31, 2020. Data analysis was performed from July 16, 2022, to January 12, 2023. Hysterectomy with or without adnexal surgical procedure. The primary outcome was the risk of osteoporosis. Secondary outcomes included the risk of vertebral fracture, hip fracture, other fractures, and total fracture. The study population included 25 910 patients; the median (IQR) age was 47 (44-50) years, and median (IQR) follow-up period was 10.9 (9.4-12.7) years. In the stratified-extended Cox proportional analysis, female patients who underwent hysterectomy without an adnexal surgical procedure were associated with a higher risk of osteoporosis within 7 years compared with female patients who did not undergo hysterectomy (hazard ratio [HR], 1.28 [95% CI, 1.19-1.37]); the analysis was divided into 7 years due to a violation of the Cox assumption, and the risk did not differ after 7 years (HR, 0.99 [95% CI, 0.93-1.06]). However, the hysterectomy group with an adnexal surgical procedure had an association with higher risk of osteoporosis compared with the nonhysterectomy group both within 7 years of study entry (HR, 1.56 [95% CI, 1.33-1.82]) and after 7 years (HR, 1.20 [95% CI, 1.04-1.40]). In the hysterectomy group without an adnexal surgical procedure, the risks of vertebral fracture, hip fracture, and total fracture were similar to those in the nonhysterectomy group. Similar trends were observed in the hysterectomy group with an adnexal surgical procedure. Hysterectomy without an adnexal surgical procedure was associated with an increased osteoporosis risk within 7 years, but not afterwards, compared with the nonhysterectomy group. Hysterectomy was not associated with vertebral and hip fractures.

The Association Between SHBG and Osteoporosis: A NHANES Cross-Sectional Study and A Bidirectional Mendelian Randomization.

This study aimed to examine the association between sex hormone-binding globulin (SHBG) and osteoporosis through a cross-sectional study and a two-sample bidirectional Mendelian randomization (MR). We used the National Health and Nutrition Examination Survey(NHANES) 2013-2014 and 2015-2016 data, with exposure as serum SHBG and outcome as osteoporosis and performed multivariate logistic regression to test the correlation between SHBG and osteoporosis. To determine the causal relationship between SHBG and osteoporosis, a two-sample bidirectional MR was employed. The genome-wide association study (GWAS) dataset for SHBG (n = 189,473) was obtained from the IEU database, and the GWAS dataset for osteoporosis (n = 212,778) was obtained from the FinnGen bioBank. The principal MR technique was inverse-variance weighting (IVW). In MR analyses, the MR-Egger intercept and Cochran Q test were used to detect multiple validity and horizontal heterogeneity. 1249 older adult participants (age ≥ 60) were involved in the cross-sectional study, including 113 osteoporosis cases. We identified a significant relationship between circulating SHBG concentration and osteoporosis risk [OR 3.963, 95% CI (2.095-7.495), P < 0.05]. Subgroup analysis indicated that SHBG was closely linked to the risk of osteoporosis in the female population [OR 1.008, 95% CI (1.002-1.013), P = 0.005] but not in males (P = 0.065). In addition, The IVW approach suggested a causal connection between SHBG and increased osteoporosis risk [OR 1.479, 95% CI (1.144-1.912), P = 0.003], and the MR-Egger intercept and the Cochran Q test validated the consistency of the MR results. Finally, the reverse MR analysis declined to identify a causal relation between SHBG and osteoporosis. Our research demonstrates a significant causal connection between circulating SHBG levels and increased osteoporosis risk. These results indicate that high SHBG may be associated with the risk of osteoporosis in postmenopausal women, but more research is needed.

Joint effects of phenol, chlorophenol pesticide, phthalate, and polycyclic aromatic hydrocarbon on bone mineral density: comparison of four statistical models.

Exposure to phenols, phthalates, pesticides, and polycyclic aromatic hydrocarbons (PAHs) can harm the skeleton. However, data about the joint effects of these chemicals' mixture on bone health are limited. The final analysis involved 6766 participants aged over 20 years recruited from the National Health and Nutrition Examination Survey. Generalized linear regression, weighted quantile sum (WQS) regression, Bayesian kernel machine regression (BKMR), and quantile g-computation (qgcomp) were performed to investigate the association of the urinary levels of chemicals (three phenols, two chlorophenol pesticides, nine phthalates, and six polycyclic aromatic hydrocarbon [PAH] metabolites) with bone mineral density (BMD) measurements and osteoporosis (OP) risk. Generalized linear regression identified that benzophenone-3, 2,4-dichlorophenol, mono-n-butyl phthalate, 1-napthol, 3-fluorene, 2-fluorene, and 1-phenanthrene were significantly associated with lower BMD and increased OP risk. The WQS index was negatively associated with total femur, femoral neck, and lumbar spine vertebra 1 (L1) BMD among all the participants, with corresponding β (95% confidence interval) values of -0.028 g/cm2 (-0.040, -0.017), -0.015 g/cm2 (-0.025, -0.004), and -0.018 g/cm2 (-0.033, -0.003). In the BKMR analysis, the overall effect of the mixture was significantly associated with femoral neck BMD among males and OP risk among females. The qgcomp model found a significant association between co-exposure and L1 BMD among all the participants and among males. Our study presents compelling epidemiological evidence that co-exposure to phenols, chlorophenol pesticides, phthalates, and PAHs is associated with reduced BMD and elevated OP risk. It provides epidemiologic evidence for the detrimental effects of these chemicals on bone health.

The Relationship Between Oxidative Stress and Osteoporosis in Chronic Dialysis Patients / Kronik Diyaliz Hastalarında Oksidatif Stres ile Osteoporoz Arasındaki İlişki

Aim: End Stage Renal Disease (ESRD) patients are subjected to enhanced oxidative stress (OS), and osteoporosis (OP) is an important cause of morbidity in patients with ESRD. Although it is controversial, in many studies made in population without renal disease, OS is related to increased OP risk. In recent study we aimed to investigate the association between OS and OP in dialysis patients. Materials and methods: Sixty two patients on maintenance dialysis programme were included into the study. Total oxidant status (TOS), lipid hydroperoxides (LOOH), and total antioxidant capacity (TAC) and bone mineral density was measured. Demographic and biochemical parameters were recorded. Patients were divided as group 1: Hemodialysis and group 2: Peritoneal Dialysis and compared. Results: Twentynine of 62 patients were on HD and 33 were on PD. In Bone mineral density BMD T–scores while there was no statistically significant difference between two groups at femur neck, according to lumbar spine among HD patients T score was better then PD patients. Mean serum concentration of LOOH was 6.07±2.91 and 5.82±2.20 µmolH2O2Eq/L, TOS was 8.89±5.89 and 7.62±3.99 µmol H2O2Eq/L, and the TAC was 1.01±0.20 and 0.93±0.16 mmolTroloxEq/L in group 1 and in group 2 respectively. Among all patients there was a positive correlation between TAC and T score in FN. There was no correlation between TOS and T-scores. Conclusion: Although enhanced OS and reduced antioxidant capacity in dialysis patients we did not find any effect of OS on OP. This result may be due to low OP rate in our patients and this novel topic needs further large scale studies in dialysis population.

Osteopenia and osteoporosis associated with hyperprolactinemic antipsychotics

IntroductionThe main role of prolactin is associated mainly with lactogenesis but additionally it participates in several endocrinological and metabolic processes. The prolactin level may be increased with some antipsychotics such as risperidone, paliperidone, and amisulpride increasing the risk of Bone Mineral Mass (BMM) decrease leading to osteopenia and osteoporosis.ObjectivesTo determine the loss of BMM associated with antipsychotic-related iatrogenic hyperprolactinemia (iHPRL) in a sample of patients suffering of chronic psychotic mental disorder and treated with antipsychotics at least for one year.MethodsA cross-sectional observational and epidemiological study in a sample of 140 patients (males 56.9%; females 43.1%; mean age 48 years), receiving antipsychotics was carried out. After giving informed consent, personal data, prolactin level, antipsychotic use and lifestyle were collected. An evaluation of BMM with a central DEXA Scan was performed. The bone mineral density considering the subject´s age and the peak bone mass in the neck of the femur, hip and in the lumbar vertebrae (L1-L4) was obtained. Inclusion criteria: presence of psychotic disorder, age between 18-65 years and treatment with an antipsychotic at least for one year. Statistical analysis was carried out using the statistical software SPSS version 26.0. A significance level α=0.05 was considered throughout the study.Results45 out of 140 patients (32,13%) had some BMM lost (osteopenia). The prevalence of osteoporosis was 5.71% (n=8). The median prolactin level in the sample was 46.1 ng/dL ± 33.1. Patients with hyperprolactinaemia showed a higher frequency of osteopenia/osteoporosis (50% with mild iHPRL and 48% with moderate/severe iHPRL) than those with normal prolactin levels (25.7%). A strong and significant relationship between the presence of osteoporosis and the treatment with risperidone was found (p=0.007).ConclusionsOsteopenia and osteoporosis are associated with hyperprolactinemic antipsychotic. Risperidone was related with a significant increased osteoporosis risk. The rutinary and systematic control of the BMM is crucial in these patients to avoid progressive bone demineralization. Managing strategies should be individualized to avoid bone demineralization and to preserve physical health.Disclosure of InterestNone Declared

Vitamin D receptor gene polymorphisms influence on clinical profile and bone mineral density at different skeletal sites in postmenopausal osteoporotic women.

Bone remodeling is marked by bone synthesis and absorption balance, and any altered dynamic in this process leads to osteoporosis (OP). The interaction of hormonal, environmental and genetic factors regulate bone metabolism. Since vitamin D displays a classic role in bone metabolism regulation, acting through vitamin D receptor (VDR), the genetic variants within VDR were the first ones associated with bone density and remodelling. Therefore, we investigated whether three single nucleotide polymorphisms (SNPs) within VDR were associated with OP differential susceptibility and clinical profile from postmenopausal versus healthy women from Northeast Brazil. Genetic association study enrolling 146 postmenopausal osteoporotic women as the patient group and 95 healthy age-matched women as the control group. We assessed three SNPs within VDR (rs11168268, rs1540339 and rs3890733), considering the clinical profile of all patients. Our results showed an association of rs11168268 G/G genotype with higher bone mineral density (BMD) mean for the total hip (A/A=0.828±0.09; A/G=0.081±0.13; G/G=0.876±0.12, p=.039), and the rs3890733 T/T genotype was associated with increased OP risk in patients below 60 years old (odds ratio [OR]=5.12, 95% confidence interval [CI]=1.13-23.27, p=.012). The rs1540339 T/T genotype was associated with protection for individuals with low melanin deposition when compared to the high melanin deposition group (OR=0.24, 95%CI=0.06-0.94, p=.029). Additionally, 61% of patients presented deficient vitamin D serum levels. The SNP rs11168268 G/G was associated with a significantly increased mean total hip BMD in patients OP, highlighting this SNP and its relationship with BMD.

Dietary inflammatory index and osteoporosis: the National Health and Nutrition Examination Survey, 2017-2018.

The dietary inflammatory index (DII) is a scoring system to quantify the inflammatory effects of nutrients and foods. Inflammation may affect bone health. The purpose of this study was to explore the relationships of DII with bone mineral density (BMD) and osteoporosis. This study involved 1023 women and 1080 men (age ≥ 50) in the US National Health and Nutrition Survey (NHANES), 2017-2018. Multivariable linear regression models were used to estimate the associations between DII and BMD. Association between DII and osteoporosis was tested with multivariable logistic regression models. In women, DII was negatively associated with total hip and femoral neck BMD after adjusting for covariates (P &lt; 0.05). In men, DII was negatively associated with lumbar spine BMD (P &lt; 0.05). DII was positively associated with osteoporosis in women (P &lt; 0.05). The odds ratios (ORs) (95% CI) for osteoporosis associated with DII quartiles 2, 3 and 4 vs. quartile 1 were 2.95 (1.08, 8.09), 5.63 (2.87, 11.04), and 6.14(2.55, 14.78), respectively. No significant association was observed in men. Higher DII scores were associated with increase osteoporosis risk in women, while no association was found in men. Greater pro-inflammatory diets might be associated with lower BMD in both women and men.

ASSESSMENT OF THE LEBANESE COMMUNITY PHARMACIST KNOWLEDGE, PRACTICE AND BARRIERS REGARDING THE PREVENTION OF OSTEOPOROSIS

Osteoporosis is a silent skeletal disease that is often recognized when fractures occur as a result of minimal trauma. Limited studies have assessed the degree of pharmacists’ involvement in osteoporosis prevention, risk-assessment/screening and physician referrals. To assess the Lebanese community pharmacists’ knowledge, practice and barriers regarding osteoporosis prevention. Secondary aim is to assess the pharmacists’ ability to identify high-risk patients who should be referred for bone mineral density (BMD) testing. A cross-sectional study was carried out in Beirut, Lebanon between September and October 2020 using self-administered questionnaire. Pharmacists completed a multi-component questionnaire that consisted of socio-demographic characteristics, practices, knowledge and barriers in relation to osteoporosis prevention and high-risk identification. Frequencies and proportions were used to describe the data. Simple and multiple linear regression analysis were used to examine the determinants of knowledge in the study population. The majority of pharmacists were rarely/never involved in counseling patients on osteoporosis risk factors (57.5%) and healthy lifestyle habits (62.5%) as well as engaging in risk-assessment (63.1%), screening using Fracture Risk Assessment Tool (FRAX) (0%) and physician referrals (sometimes-55.6%). In addition, pharmacists were also scarcely involved in reducing the risk of falls (55.1-59.4%). Pharmacists were knowledgeable about osteoporosis prevention however had important gaps in the diseases that increase osteoporosis risk as well as in FRAX tool, indications that require BMD testing and increased risk of fall medications. Significant predictors of knowledge were receiving postgraduate training on osteoporosis and earning the pharmacy degree from a university in Lebanon. Barriers to providing osteoporosis services included lack of time, staff, space, patients’ interest in prevention activities and limited inter-professional collaboration. The study findings provided important insights on the practices, knowledge and barriers of pharmacists regarding osteoporosis prevention and high-risk identification. Concerted efforts of multiple stakeholders are needed to promote the active role of community pharmacists in order to reduce the risk of morbidity, mortality and health-care costs associated with osteoporosis and related fractures.