Independent Risk Factor For Osteoporosis Research Articles

An analysis of the potential association between obstructive sleep apnea and osteoporosis from the perspective of transcriptomics and NHANES

BackgroundObstructive sleep apnea (OSA) and osteoporosis (OP) are prevalent diseases in the elderly. This study aims to reveal the clinical association between OSA and OP and explore potential crosstalk gene targets.MethodsParticipants diagnosed with OSA in the National Health and Nutrition Examination Survey (NHANES) database (2015–2020) were included, and OP was diagnosed based on bone mineral density (BMD). We explored the association between OSA and OP, and utilized multivariate logistic regression analysis and machine learning algorithms to explore the risk factors for OP in OSA patients. Overlapping genes of comorbidity were explored using differential expression analysis, Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, Least Absolute Shrinkage and Selection Operator (LASSO) regression, and Random Forest (RF) methods.ResultsIn the OSA population, the weighted prevalence of OP was 7.0%. The OP group had more females, lower body mass index (BMI), and more low/middle-income individuals compared to the non-OP group. Female gender and lower BMI were identified as independent risk factors for OP in OSA patients. Gene expression profiling revealed 8 overlapping differentially expressed genes in OP and OSA patients. KCNJ1, NPR3 and WT1-AS were identified as shared diagnostic biomarkers or OSA and OP, all of which are associated with immune cell infiltration.ConclusionThis study pinpointed female gender and lower BMI as OP risk factors in OSA patients, and uncovered three pivotal genes linked to OSA and OP comorbidity, offering fresh perspectives and research targets.

Optimal body mass index for protecting middle-aged and elderly patients with fatty liver from future fractures.

Previous studies have suggested that body mass index (BMI) should be considered when assessing the relationship between fatty liver (FL) and osteoporosis. The aim of this study was to investigate future fracture events in people with FL, focusing on the effect of BMI in both sexes. This retrospective cohort study from 2011 to 2019 enrolled 941 people, including 441 women and 500 men, aged 50 years or older who underwent liver imaging (ultrasound, computed tomography, or magnetic resonance image) and dual-energy X-ray absorptiometry (DXA, for bone mineral density measurements). The study examined predictors of osteoporosis in both sexes, and the effect of different ranges of BMI (18.5-24, 24-27, and ≥27 kg/m2 in women; 18.5-24, 24-27, 27-30 and ≥30 kg/m2 in men) on the risk of future fractures in FL patients. The average follow-up period was 5.3 years for women and 4.2 years for men. Multivariate analysis identified age and BMI as independent risk factors for osteoporosis in both sexes. Each unit increase in BMI decreased the risk of osteoporosis by ≥10%. In both women and men with FL, a BMI of 24-27 kg/m2 offered protection against future fractures, compared to those without FL and with a BMI of 18.5-24 kg/m2. The protective effect of a higher BMI against future fractures in middle-aged and elderly women and men with FL is not uniform and decreases beyond certain BMI ranges.

Moderate salt restriction in primary aldosteronism improves bone metabolism through attenuation of urinary calcium and phosphate losses.

Accumulating evidence links osteoporosis and dietary salt consumption. Primary aldosteronism (PA) is a model disease with increased dietary salt intake and constitutes an independent risk factor for osteoporosis. We, thus, assessed whether a short-term moderate reduction in salt intake in PA results in detectable osteoanabolic effects. Forty-one patients with PA on stable mineralocorticoid receptor antagonist therapy were subjected to a 12-week salt restriction. Serum and urinary electrolytes, markers of bone turnover, and a 15 steroids plasma profile were registered. After 12 weeks, urinary calcium and phosphate decreased, while plasma testosterone, serum phosphate, and bone alkaline phosphatase (BAP) all increased significantly. Longitudinal changes in BAP were independently correlated with changes in serum phosphate, parathyroid hormone, and urinary calcium in multivariate analysis. Salt restriction in PA limits urinary calcium and phosphate losses and may confer favorable osteoanabolic effects. Our findings suggest that salt restriction should be considered in patients with PA to improve bone health.

Low BMI, blood calcium and vitamin D, kyphosis time, and outdoor activity time are independent risk factors for osteoporosis in postmenopausal women.

To explore the risk factors of osteoporosis in postmenopausal women in China. This study collected all patient data from January 2014 to December 2015. Basic information and questionnaires were collected from 524 postmenopausal women in Sanya and Hainan Province. The questionnaire was administered to the enrolled participants by endocrinologists. Biochemical parameters were measured using fasting blood samples, and bone density was measured by dual energy X-ray absorptiometry at the department of radiology of Hainan hospital, PLA General Hospital. Participants with an R-value of ≤-2.5 were diagnosed with osteoporosis. After deleting missing values for each factor, 334 participants were divided into the osteoporosis (n=35) and non-osteoporosis (n=299) groups according to the R-values. The participants had a median age of 60.8 years (range: 44-94 years). Among the 334 postmenopausal women included in this study, 35 (10.5%) were diagnosed with osteoporosis. Univariate analysis showed statistically significant differences in age, BMI, type of work, alkaline phosphatase, years of smoking, blood calcium levels, kyphosis, fracture, and asthma between the two groups (P<0.05). In addition, multivariate logistic analysis showed that age (odds ratio [OR]: 1.185, 95% confidence interval [CI]: 1.085-1.293, P<0.001) and kyphosis times (OR:1.468, 95% CI: 1.076-2.001, P=0.015) were positively correlated with postmenopausal osteoporosis, whereas BMI (OR: 0.717, 95% CI: 0.617-0.832, P<0.001), blood calcium levels (OR: 0.920, 95% CI: 0.854-0.991, P=0.027), vitamin D levels (OR: 0.787, 95% CI: 0.674-0.918, P=0.002), and outdoor activity time (OR: 0.556, 95% CI: 0.338-0.915, P=0.021) were negatively correlated with postmenopausal osteoporosis. Low BMI, blood calcium and vitamin D levels, kyphosis time, and outdoor activity time are independent risk factors for osteoporosis in postmenopausal women.

Relationships among body weight, lipids and bone mass in elderly individuals with fractures: A case-control study.

The prevalence of osteoporosis and low bone mass is steadily rising each year. Low body weight is commonly linked to diminished bone mass and serves as a robust predictor of osteoporosis. Nonetheless, the connection between body mass index (BMI), bone mineral density, and lipid profiles among the elderly remains elusive. To examine the association between BMI and bone mass, explore the correlation between lipid profiles and bone mass, and delve into the interplay between lipid metabolism and bone health. The study included 520 patients aged ≥ 65 years (178 men and 342 women). Age, sex, weight, and height were recorded. Femoral neck bone mineral density and T scores were determined using a dual-energy X-ray absorptiometry scanner. Blood calcium (Ca), phosphorus (P), albumin (ALB), alkaline phosphatase (ALP), aspartate aminotransferase, alanine aminotransferase, triglyceride (TG), total cholesterol (TC), high-density lipoprotein (HDL) and low-density lipoprotein (LDL) levels were measured. Patients were classified by sex (male and female), age (65-79 years and ≥ 80 years), and T score (normal bone mineral density, osteopenia and osteoporosis). Age, sex, BMI, and ALP and TG levels were independent risk factors for osteoporosis. For the 65-79- and ≥ 80-year-old groups, females presented lower T scores than males. Ca, P, ALB, ALP, TC, HDL and LDL levels were significantly different between men and women in the 65-79-year-old group. In addition, BMI and TG levels were significantly decreased in osteoporotic patients compared with patients with normal bone mass. TC levels declined in 65- to 79-year-old male and female osteoporosis patients. In the group of women aged ≥ 80 years, osteoporotic patients showed significantly increased ALP levels. Furthermore, we found positive correlations between BMI and TG levels in the male and female patient groups. However, we found no significant differences in ALB, Ca, P, HDL and LDL levels in osteoporotic patients compared to patients with normal bone mass. Osteoporotic patients showed significantly decreased BMI and TG levels compared with those with normal bone mass. BMI showed positive correlations with TG levels in male and female patients. These results indicate correlations between BMI and bone mass and between lipid profiles and bone mass.

Prevalence and risk factors of osteoporosis detected by dual-energy X-ray absorptiometry among Chinese patients with primary biliary cholangitis.

Osteoporosis is an extrahepatic complication of primary biliary cholangitis (PBC) that increases the risk of fractures and mortality. However, Epidemiological studies of osteoporosis in patients with PBC in China and the Asia-Pacific region is lack. To assess the prevalence and clinical characteristics of osteoporosis in Chinese patients with PBC. This retrospective analysis included consecutive patients with PBC from a tertiary care center in China who underwent bone mineral density (BMD) assessment using dual-energy X-ray absorptiometry between January 2013 and December 2021. We defined subjects with T-scores ≤ -2.5 in any sites (L1 to L4, femoral neck, or total hip) as having osteoporosis. Demographic, serological, clinical, and histological data were collected. Independent risk factors for osteoporosis were identified by multivariate logistic regression analysis. A total of 268 patients with PBC [236 women (88.1%); mean age, 56.7 ± 10.6 years; 163 liver biopsies (60.8%)] were included. The overall prevalence of osteoporosis in patients with PBC was 45.5% (122/268), with the prevalence of osteoporosis in women and men being 47.0% and 34.4%, respectively. The prevalence of osteoporosis in postmenopausal women was significantly higher than that in premenopausal women (56.3% vs 21.0%, P < 0.001). Osteoporosis in patients with PBC is associated with age, fatigue, menopausal status, previous steroid therapy, body mass index (BMI), splenomegaly, gastroesophageal varices, ascites, Mayo risk score, histological stage, alanine aminotransferase, albumin, bilirubin, platelet and prothrombin activity. Multivariate regression analysis identified that older age, lower BMI, previous steroid therapy, higher Mayo risk score, and advanced histological stage as the main independent risk factors for osteoporosis in PBC. Osteoporosis is very common in Chinese patients with PBC, allowing for prior screening of BMD in those PBC patients with older age, lower BMI, previous steroid therapy and advanced liver disease.

Association of age-related declined renal function and osteoporosis based on trabecular bone score in Bushehr Elderly Health (BEH) program

PurposeOsteoporosis is a systemic disease characterized by decreased bone strength and an increased risk of fracture in old age. Age and pathologic renal failure are independent risk factors for osteoporosis. However, it is not determined whether age-related decreased renal function, in the context of senescence, can be considered as an independent risk factor for osteoporosis. Therefore, this study was conducted to evaluate the effect of senescence-induced renal failure on bone quality and trabecular bone score.MethodsThis study used a cross-sectional design and was carried out based on data collected during the Bushehr Elderly Health (BEH) program, Phase II. A total of 2,125 elderly participants aged over 60 years old entered the study after meeting the inclusion criteria and providing informed consent. They underwent examinations for weight, height, abdominal and hip circumference, as well as blood pressure measurement. All participants also underwent DXA to assess bone mass density (BMD). Trabecular bone score (TBS) was calculated using the DXA apparatus software output. Univariate and adjusted multivariate linear regression analyses were used to evaluate the associations.ResultsIn the univariate linear regression analysis, there was a direct correlation between age-related renal failure and TBS (β = 0.038, p < 0.0001), neck of femur BMD (β = 0.047, p < 0.0001), and lumbar BMD (β = 0.055, p < 0.0001). However, after adjusting for BMI, age, sex, smoking, and physical activity, no significant association was observed for these variables.ConclusionIt is hypothesized that age-related renal failure cannot be considered as an independent risk factor for osteoporosis in elderly individuals aged over 60 years old.

Correlation between Blood Lipid Level and Osteoporosis in Older Adults with Type 2 Diabetes Mellitus—A Retrospective Study Based on Inpatients in Beijing, China

to analyze the association between blood lipid metabolism and osteoporosis (OP) in older adults with type 2 diabetes mellitus (T2DM). a total of 1158 older patients with T2DM treated by the Department of Endocrinology, Peking University International Hospital, were retrospectively analyzed, including 541 postmenopausal women and 617 men. (1) Levels of low-density lipoprotein cholesterol (LDL-C) were significantly higher in the OP group, while levels of high-density lipoprotein cholesterol (HDL-C) were higher in the non-osteoporotic group (both p < 0.05). (2) Age, parathyroid hormone (PTH), total cholesterol (TC) and LDL-C were negatively linked to the patients' bone mineral density (BMD) (all p < 0.05), while the body mass index (BMI), uric acid (UA) level, HDL-C level and glomerular filtration rate (eGFR) were positively related to their BMD (all p < 0.05). (3) In postmenopausal women, after adjustment for other indexes, raised LDL-C is an independent risk factor for OP (OR = 3.38, 95% CI 1.64, 6.98, p < 0.05) while raised HDL-C is protective (OR = 0.49, 95% CI 0.24, 0.96, p < 0.05). However, raised HDL-C was protective against OP (OR = 0.07, 95% CI 0.01, 0.53, p < 0.05). In older T2DM patients, the effect of blood lipid levels is related to sex. Our study conducted a detailed sex stratification. In addition to seeing the traditional risk factors of OP, such as age, sex, and BMI, we comprehensively analyzed the correlation between the blood glucose level, complications, and blood lipids with OP. HDL-C is a protective factor for OP in both men and women, while LDL-C independently predicts OP in postmenopausal women.

HIGH INCIDENCE OF OSTEOPOROSIS IN CHRONIC LIVER DISEASE BEFORE LIVER TRANSPLANTATION

A prospective study was conducted in Nishtar Medical Hospital from January 2022 to January 2023 to assess the incidence of osteoporosis before liver transplant in patients with chronic liver disease. A total of 70 patients were included in the study. A liver biopsy was used to confirm the hepatological diagnosis. Dual-energy X-ray absorptiometry through a densitometer was used for measuring bone mineral density. Results showed that the prevalence of osteoporosis at the femoral neck and lumbar spine was 37%, and in only 14.3% of cases, bone density at these sites was normal. More patients had osteopenia and osteoporosis at the femoral neck (41.7%) compared to the lumbar spine (24.2%) (P=0.009). Osteoporosis was not associated with the severity of the disease; its prevalence was 39%, 32%, and 36% in those with Child-Pugh A, B, and C, respectively (P=0.78). Lower weight (P=0.0007) and increasing age (P=0.038) were independent risk factors for osteoporosis during chronic liver disease. Results show that osteoporosis is highly prevalent in subjects with chronic liver disease before a liver transplant score.

Optimising bone health management in advanced prostate cancer: A comparative cohort study.

133 Background: Survival in prostate cancer is increasing due to advances in hormonal therapy. The recommended duration of Androgen Deprivation Therapy (ADT) is 18 months or more for patients with Non-Metastatic (NM) high risk disease, and lifelong in Metastatic disease. ADT is, however, an independent risk factor for osteoporosis, a disease characterised by low Bone Mineral Density (BMD) and subsequent increased risk of fractures, which can lead to significant disability and early death. In patients with advanced prostate cancer, it is therefore recommended that BMD is assessed yet there remains no established national guidance on how bone health should be managed. Methods: In total, 515 case notes for patients with newly diagnosed advanced hormone sensitive prostate cancer were retrospectively reviewed for assessment of bone health management. Our data analysis included a comparison of outcomes between patient cohorts managed at a dedicated Cancer Bone Health Unit (CBHU) and the Northern centre for Cancer Care (Oncology Centre, OC). Results: 1) Baseline characteristics: The cohorts were well balanced in terms of age and cancer stage. Data was available for 410 patients in the CBHU and 105 in the OC. Median age was 75 (range 59-94) in the CBHU and 71 (range 46-86) in the OC. The majority of patients had metastatic disease and were therefore receiving lifelong ADT. 2) Fracture incidence: was consistently higher in the OC (p&lt;0.001). The most common fractures were hip, spine and wrist. Median time to first fracture in the CBHU was 112 (range 2 to 240) vs 83 weeks (8 to 229) in the OC (p=0.252). 3) Survival: for all patients 2 years after ADT commenced was 96.7% in the CBHU vs 91.8% in the OC (HR 0.321, 95% CI 0.19-0.55, p&lt;0.001). Median survival has not yet been reached. Conclusions: This comparative analysis suggests that a strategy of standardised bone health management within a CBHU is associated with reduced fracture incidence and may delay time to first fracture compared with clinician discretion in an OC. Additionally the data suggests that this strategy also improves survival at 2 years in patients with NM high risk disease. Bone health strategies for prostate cancer should be implemented within hospital trusts to provide standardised care across the region. This could reduce costs associated with fractures and improve quality of life for patients who avoid fractures through timely introduction of treatment. The Northern Cancer Alliance (NCA) has recently approved guidance on the management of bone health in prostate cancer, and implementation has since commenced.

Risk factors and prognostic value of osteoporosis in hospitalized patients with bronchiectasis

BackgroundThe risk factors for osteoporosis and its prognostic value in patients with bronchiectasis is not well characterized. We explored the risk factors for osteoporosis and its prognostic impact in hospitalized non-cystic fibrosis bronchiectasis (NCFB) patients in Southeast China.MethodsThis observational cohort study consecutively enrolled 179 hospitalized patients with NCFB bronchiectasis between 2017 and 2021. The risk factors and the impact of osteoporosis on all-cause mortality were assessed.Results21.2% (38/179) of hospitalized NCFB patients were diagnosed with osteoporosis. Patients with osteoporosis had more severe symptoms (assessed by chronic airway assessment test, CAT, median 22 vs. 17, P = 0.017), poorer quality of life (assessed by St. George Respiratory Questionnaires, SQRC, median 42 vs. 27, P = 0.007), more severe disease stage (assessed by bronchiectasis severity index, BSI, median 14 vs. 11, P = 0.02), more comorbidities (assessed by Bronchiectasis Aetiology Comorbidity Index, BACI, median 5 vs. 4, P = 0.021) than patients without. Age, female sex, anemia, post-infection, and history of regular inhaled corticosteroid treatment were independent risk factors for osteoporosis in those patients. 21 patients (11.7%) died over a median follow-up period of 32 months. The all-cause mortality in NCFB patients with osteoporosis [28.94% (11/38)] was significantly higher than those without osteoporosis [7.09% (10/141)] [hazard ratio (HR) 5.34, 95% confidence interval (CI) 2.26–12.67, P < 0.001]. After adjusting for BSI and other confounding factors, osteoporosis was still independently associated with all-cause mortality in hospitalized NCFB patients (HR 4.29, 95% CI 1.75–10.49, P < 0.001).ConclusionsOsteoporosis had an independent effect on all-cause mortality in hospitalized NCFB patients. Management of comorbidities, including bone health, is a critical aspect of treating NCFB patients.

Cross-sectional study and bioinformatics analysis to reveal the correlations of osteoporosis in patients with Parkinson's disease

ObjectivesOsteoporosis and Parkinson's disease (PD) are both aging-related diseases. PD patients with comorbid osteoporosis are vulnerable to the risk of fracture, which leads to a serious public health burden to the whole society. Therefore, this study sought to reveal the clinical and genetic correlations between PD and osteoporosis based on a cross-sectional study and bioinformatics analysis. MethodsA cross-sectional study of 95 PD patients and 99 healthy controls was conducted. Ordinal logistic regression analysis was utilized to investigate the clinical correlations between PD and osteoporosis. Two microarray datasets (GSE20292, GSE35958) including PD, osteoporosis and normal control samples were retrieved from the GEO database for GO analysis, KEGG pathway analysis and PPI network. ResultsPD patients had lower 25(OH)VitD, FN BMD, BMD and T-score of the LS and TH, as well as poorer bone mass diagnosis, yet higher PINP compared to healthy controls. Both age and UPDRS II score of PD patients were adversely correlated with BMD of LS and TH. PD diagnosis acted as an independent risk factor of osteoporosis, and PD patients had approximately double risk for osteoporosis. Bioinformatics analysis further revealed that SNAP25, AQP4, SV2B, KCND3, and ABCA2 had important diagnostic value and risk prediction value for both PD and osteoporosis. ConclusionsPD diagnosis can be used as an independent risk factor for osteoporosis. Moreover, SNAP25, AQP4, SV2B, KCND3 and ABCA2 as the top 5 hub genes have important diagnostic and risk predictive value for both PD and osteoporosis.

Association of geriatric nutritional risk index with the risk of osteoporosis in the elderly population in the NHANES.

Osteoporosis is common in the elderly, and malnutrition is considered a major risk factor for osteoporosis. This study investigated the relationship between the Geriatric Nutrition Risk Index (GNRI) and osteoporosis based on a large cross-sectional study of the National Health and Nutrition Examination Survey (NHANES). We included 7405 older adults from NHANES (2005 to 2018) and divided them into the High-GNRI and Low-GNRI groups based on GNRI levels to compare the prevalence of osteoporosis among the two groups. A multi-factor logistic regression analysis was used to determine whether GNRI was an independent risk factor for osteoporosis. Spearman's rank correlation coefficient was computed to investigate the linear relationship between geriatric nutritional risk index (GNRI) and bone mineral density (BMD) T-score. Finally, a generalized additive model (GAM) revealed whether there was a non-linear relationship between GNRI and osteoporosis. The prevalence of osteoporosis was higher in the Low-GNRI group than those in the High-GNRI group (12.2% vs. 8.2%; P = 0.001). Similarly, the femoral neck BMD T-scores (-1.09 ± 1.42 vs. -0.91 ± 1.31; P = 0.003). However, there was no significant difference between Low-GNRI group and High-GNRI group in lumbar BMD T-scores (1.700 ± 1.69 vs 1.85 ± 1.72; P>0.05). The multi-factor logistic regression analysis identified low GNRI as an independent risk factor for osteoporosis (OR: 1.544; 95% CI: 1.179-2.022; P < 0.001). Besides, GNRI showed a positive linear correlation (P < 0.001) with femoral neck BMD T-scores in older adults, with a progressive trend towards higher BMD as GNRI increased. By contrast, there was no linear correlation between GNRI and lumbar BMD T-score (P = 0.978). Lastly, the dose response curve revealed the non-linear negative correlation between GNRI and the risk of osteoporosis in the elderly (non-linear P < 0.001). With the increase of GNRI, the risk of osteoporosis gradually decreased, especially when GNRI was greater than 100, the downward trend was more significant. GNRI is an independent risk factor for osteoporosis in the elderly and is negatively and non-linearly associated with the risk of osteoporosis in the elderly population.

Long-term changes in bone mineral density in postoperative patients with esophageal cancer.

The aim of this study was to investigate long-term changes in bone mineral density (BMD) after esophagectomy, identify the risk factors for postoperative osteoporosis in patients with esophageal cancer and survival outcomes related to osteoporosis. We retrospectively evaluated BMD changes for 197 consecutive patients with thoracic esophageal cancer who were disease-free for 5 years after radical esophagectomy. Osteoporosis was diagnosed using computed tomography with an L1 attenuation threshold of ≤110 HU. Survival analysis was performed on 381 consecutive patients with 5-year follow-up after radical esophagectomy. BMD decreased annually after esophagectomy. The median attenuation (HU) was 134.2 before surgery and 135.2, 127.4, 123.3, 115.2, 105.6, and 102.4 at 6months and 1, 2, 3, 4, and 5 years after surgery, respectively. Osteoporosis was diagnosed in 25.9% patients before surgery and 23.3%, 29.4%, 40.1%, 46.7%, 54.8%, and 60.4% patients with osteoporosis were observed at 6months and 1, 2, 3, 4, and 5 years after surgery, respectively. Postoperative BMD did not decrease in patients aged ≤54 years, those who had never been smokers, and those with no weight loss after esophagectomy. Multivariate analysis identified that age (≥65 years) at surgery and smoking history were independent risk factors for osteoporosis at 5 years after esophagectomy. Patients with preoperative osteoporosis tended to have worse prognosis in disease-free survival and overall survival than those without osteoporosis, who were more likely to die due to non-esophageal cancer. Esophageal cancer survivors are more likely to develop osteoporosis after esophagectomy, and preoperative osteoporosis might be associated with prognosis.

Retrospective analysis of the relationship between bone mineral density and body composition in a health check-up Chinese population.

PurposeThis study was designed to explore the relationship between bone mineral density (BMD) and body composition indicators in Chinese adults (≥50 years) in order to provide a scientific basis for optimal bone health management.MethodIndividuals ≥50 years old who received physical examinations and routine check-ups at the Health Management Research Institute of PLA General Hospital from September 2014 through March 2022 were included as research subjects in this study. Basic clinical and demographic information were recorded for all subjects, along with smoking and drinking status, height and body weight. A panel of routine blood chemistry and metabolite markers were measured, along with lean muscle mass and body fat mass using body composition bioelectrical impedance analysis (BIA). Body mass index (BMI), body fat percentage (BFP), skeletal muscle mass index (SMI), and bone mineral density (BMD) were calculated for all individuals. For comparative analysis, individuals were grouped based on their BMI, BFP, SMI and BMD T-score. Follow-up examinations were performed in a cohort of 1,608 individuals matched for age, sex, smoking and drinking history for ≥5 years,ResultsIn this large cross-sectional study, age, smoking, homocysteine (Hcy) and blood glucose levels were established as independent risk factors for osteoporosis. Multi-factor logistic regression analysis showed that age, sex, BMI, intact parathyroid hormone (iPTH), SMI, BFP, smoking, blood levels of inorganic phosphate (P) and K+ were all significantly associated with osteoporosis risk (P<0.05). A subset of these factors- BMI, SMI, BFP and K+, were determined to be protective. In the cohort followed for ≥5 years, SMI and BMD decreased while BFP and BMI increased significantly (P<0.001) over time.ConclusionRisk of osteoporosis may be reduced by increasing body weight, particularly lean muscle mass, while simultaneously controlling BFP.

Ferroptosis - A new target of osteoporosis.

Osteoporosis is a bone metabolic disease characterized by reduced bone mass and deterioration of bone tissue microarchitecture, leading to enhanced skeletal fragility and susceptibility to fracture. Unbalanced bone remodeling is the primary pathogenetic factor of osteoporosis, in which osteoclast-mediated bone resorption exceeds osteoblast-mediated bone formation. Bisphosphonates and calcitonin are among the drugs commonly used to treat osteoporosis, in addition to the bone nutrients vitamin D and calcium supplements. The current treatments effectively prevent further bone loss by inhibiting the excessive activation of osteoclasts, accompanied by various degrees of side effects. Iron, one of the trace elements essential for life activities, has recently been recognized as an independent risk factor for osteoporosis. Abnormal iron metabolism increases the incidence of many bone diseases, especially osteoporosis. Iron metabolism does play a key role in bone homeostasis. Ferroptosis is a novel form of cell death that has been discovered in recent years. Its main features include iron overload and the accumulation of ROS. And lipid peroxidation is the key. There are increasing shreds of evidence that ferroptosis is involved in the occurrence and development of osteoporosis, and its regulation can effectively prevent osteoporosis. Therefore, this review further elucidates the role of ferroptosis in osteoporosis based on the mechanism and its relationship with osteoporosis and provides a new idea for treating osteoporosis.

Osteoporosis and Related Health Status Among the Elderly Urban Residents in Elderly-Care Inns in Beijing, a Multicenter DXA Survey.

BackgroundIdentification of the high risk population for osteoporosis and timely prevention are the best strategies at present. Detailed epidemiological investigation in a well-defined population is necessary to explore the population-based characteristics and risk factors of osteoporosis, thus to facilitate better prevention programs.MethodIn this prospective cross-sectional study, 1423 questionnaires were given out to the urban residents (female ≥ 40 years of age, male ≥50 years) who lived in the 27 Elderly-Care Inns interspersed among the seven central urban areas of Beijing. All participants were voluntary and underwent routine physical examination and spine and hip BMD measurements using the DXA instrument. The study protocols were approved by the Medical Ethics Committee of Dongzhimen Hospital, Beijing University of Chinese Medicine (JDZX2015079).ResultsAltogether 1407 participants fulfilled the survey. Among 359 men, the prevalence of osteoporosis, osteopenia, and normal BMD were 18.1%, 56.6%, and 25.3%, respectively; among 1048 women, the corresponding figures were 40.3%, 42.8%, and 16.9%, respectively. After adjustment of age and BMI, both hands grip strength, height loss over 3 cm, serum levels of β-CTx, PINP, and OST were the independent risk factors for osteoporosis in both men and women; besides, familial Alzheimer’s disease history in men; and history of steatohepatitis and fracture, serum levels of PTH and ALT, age of menarche, age of menopause, and duration of menstruation in women were also risk factors of osteoporosis. In both genders, the cost-effective method, which adopted both hands grip strength, height loss over 3 cm, and medical history, indicated a good predictive ability to evaluate the risk of osteoporosis (in men AUC=0.730, 95%CI=0.642~0.817; in women AUC=0.769, 95%CI=0.724~0.813).ConclusionsIn the population of elderly Beijing urban residents in Elderly-Care Inns, the prevalence of osteoporosis in women is higher than that in men and increases with aging more rapidly; the prevalence of osteopenia in men is higher than in women. The cost-effective method, including both hands grip strength, height loss over 3 cm, and familial Alzheimer’s disease history in men; fracture and steatohepatitis history as well as menstrual history in women is recommended in identifying the high-risk subjects for osteoporosis.

Iron overload-induced ferroptosis of osteoblasts inhibits osteogenesis and promotes osteoporosis: An in vitro and in vivo study.

Growing evidence indicates that iron overload is an independent risk factor for osteoporosis. However, the mechanisms are not fully understood. The purpose of our study was to determine whether iron overload could lead to ferroptosis in osteoblasts and to explore whether ferroptosis of osteoblasts is involved in iron overload-induced osteoporosis in vitro and in vivo. Ferric ammonium citrate was used to mimic iron overload conditions, while deferoxamine and ferrostatin-1 were used to inhibit ferroptosis of MC3T3-E1 cells in vitro. The ferroptosis, osteogenic differentiation and mineralization of MC3T3-E1 cells were assessed in vitro. A mouse iron overload model was established using iron dextran. Immunohistochemical analysis was performed to determine ferroptosis of osteoblasts in vivo. Enzyme-linked immunosorbent assays and calcein-alizarin red S labelling were used to assess new bone formation. Dual x-ray absorptiometry, micro-computed tomography and histopathological analysis were conducted to evaluate osteoporosis. The results showed that iron overload reduced cell viability, superoxide dismutase and glutathione levels, increased reactive oxygen species generation, lipid peroxidation, malondialdehyde levels and ferroptosis-related protein expression, and induced ultrastructural changes in mitochondria. Iron overload could also inhibit osteogenic differentiation and mineralization in vitro. Inhibiting ferroptosis reversed the changes described above. Iron overload inhibited osteogenesis, promoted the ferroptosis of osteoblasts and induced osteoporosis in vivo, which could also be improved by deferoxamine and ferrostatin-1. These results demonstrate that ferroptosis of osteoblasts plays a crucial role in iron overload-induced osteoporosis. Maintaining iron homeostasis and targeting ferroptosis of osteoblasts might be potential measures of treating or preventing iron overload-induced osteoporosis.

An Overlooked Bone Metabolic Disorder: Cigarette Smoking-Induced Osteoporosis.

Cigarette smoking (CS) leads to significant bone loss, which is recognized as an independent risk factor for osteoporosis. The number of smokers is continuously increasing due to the addictive nature of smoking. Therefore it is of great value to effectively prevent CS-induced osteoporosis. However, there are currently no effective interventions to specifically counteract CS-induced osteoporosis, owing to the fact that the specific mechanisms by which CS affects bone metabolism are still elusive. This review summarizes the latest research findings of important pathways between CS exposure and bone metabolism, with the aim of providing new targets and ideas for the prevention of CS-induced osteoporosis, as well as providing theoretical directions for further research in the future.

Bone health, intellectual disability and epilepsy: An observational community-based study.

ObjectivesIntellectual disability (ID) and epilepsy are independent risk factors for osteoporosis. Diverse predisposing factors influence this, for example in ID, genetics and poor nutrition and in epilepsy, anti‐seizure medication (ASM). Around 25% people with ID have epilepsy, majority treatment resistant. ASMs polypharmacy is common. However, little is known about the bone‐related characteristics of this vulnerable group. A prospective observational cohort study of bone profile across a community ID Epilepsy service was undertaken to understand this.Materials & MethodsParticipants were on minimum 2 years of ASMs. Baseline demographics, epilepsy data, bone metabolism biomarkers, bone mineral density (BMD) and vitamin D levels were collected. Doses needed to correct vitamin D insufficiency/deficiency were calculated.ResultsAt baseline, of 104 participants, 92 (90.2%) were vitamin D insufficient/deficient. Seventy‐six (73.1%) had a DEXA scan, 50 of whom—in the osteopaenic/osteoporotic range. DEXA scores between ambulant and non‐ambulant patients were significantly different (p = .05) but not for ID severity. A high alkaline phosphatase (ALP) predicted lower vitamin D levels. Borderline significance (p = .06) in calcium levels between normal and high ALP was identified. There were no significant associations between parathyroid hormone, inorganic phosphate and magnesium levels, with vitamin D status or DEXA hip T‐scores. Normalizing vitamin D levels (mean 101.4 nmol/L) required an average of 1951IU cholecalciferol daily.ConclusionsVitamin D deficiency is highly prevalent in people with ID and epilepsy treated with ASMs impacting likely on their bone health. Screening with vitamin D levels, ALP and DEXA in this group should be pro‐actively and routinely considered.