Young Adult Mean Research Articles

6536 National Trends in Prevalence of Prediabetes and Diabetes Among Women With Low Bone Mineral Density: 2009-2018

Abstract Disclosure: A. Atri: None. C. Anastasopoulou: None. Introduction: In recent years, bone fragility has emerged as a complication of prediabetes (preDM) and diabetes mellitus (DM), resulting in reduced bone mass and increased fracture risk, and is an important, though under-studied risk factor for osteoporosis. However, the converse relationship, trends in prevalence of preDM and DM in women with low bone mineral density (BMD) in the United States, are not well established. Methods: We used data from the National Health and Nutrition Examination Survey (NHANES) for the years 2009-10, 2013–14 and 2017–18 to include U.S. women aged ≥ 50 years with T-score ≤ -1. Osteoporosis assessment in NHANES was not completed in 2011–12 and 2015–16, and therefore not included in the analysis. Osteopenia and osteoporosis were defined by a femoral neck BMD ≤1 to 2.5, and ≤2.5 standard deviations (SDs) below the BMD of a young female adult mean (T-score). Femur neck BMD was measured by dual energy x-ray absorptiometry (DEXA). PreDM and DM were defined using HbA1c values of 5.7 - 6.4% and ≥ 6.5% respectively. Participants with missing HbA1c and BMD data were excluded. Descriptive statistics were used for comparing means and medians. The Cochran-Armitage test was utilized for trend analysis. Results: In this nationally representative sample of US women with low BMD, the median (IQR) T-score at femoral neck worsened from -1.74 (-1.4 to -2.17) in 2009-10 to -1.87 (-1.43 to -2.32) in 2017-18 (trend p = 0.001). Similarly, the prevalence of osteoporosis increased from 13.7% to 16.9% (trend p = 0.001). Overall, in this cohort, the national prevalence of both preDM and DM decreased from 40% to 32.9% and 9.6% to 9%, respectively (trend p = 0.001). Along with a reduction in the overall prevalence of osteopenia (86.3% to 83.1%, p=0.001), the prevalence of both preDM and DM decreased from 39.2% to 32.6% and 10% to 9% (p = 0.001). In those with osteoporosis, the prevalence of preDM decreased from 45.2% to 34.4% (p trend=0.001), however, the prevalence of DM increased from 7.5% to 8.7% (p trend =0.001). Overall rates of uncontrolled DM (HbA1c > 7%) in women with osteoporosis showed significant improvement (5.8% to 3.5%, p = 0.001). Discussion Despite worsening trend in femoral neck BMD among US women age ≥ 50 years from 2009-10 to 2017-18, the overall prevalence of preDM and DM improved by 7.1% and 0.6% respectively. However, this favorable trend was not observed among women with osteoporosis, where the overall prevalence of DM increased by 1.2%, though the rate of uncontrolled DM significantly decreased by 2.3%. Targeted interventions to improve blood glucose control among women with low BMD, especially those with osteoporosis are warranted, to improve bone health, as well as reduce fall and fracture risk. Presentation: 6/2/2024

Assessment of Bone Mineral Density Over 1 Year in a Cross-Sectional Cohort of Migraine Patients Receiving Anti-CGRP Monoclonal Antibodies.

Calcitonin gene-related peptide (CGRP), implicated in migraine pain, also possesses bone anabolic properties, which leads to the possibility that monoclonal antibodies targeting CGRP (anti-CGRPs) might increase the risk of bone density abnormalities. The objective of this study was to explore bone mineral density abnormalities in a cohort of migraine patients treated with anti-CGRPs. This was a single-center, cross-sectional, cohort study including migraine patients who underwent a densitometry assessment during anti-CGRP treatment. We assessed the frequency of osteopenia or osteoporosis (OSTEO+ status), defined as a bone mineral density T-score of -1 to -2.5, and <-2.5 standard deviations from the young female adult mean, respectively. Additionally, the association of OSTEO+ status with anti-CGRP treatment duration and primary osteoporosis' risk factors was investigated using logistic regression models. Data from 51 patients (43 female, mean age 46 ± 13.9 years) were evaluated. The mean duration of anti-CGRP treatment was 15.7 (±11.8) months. Twenty-seven patients (53%) were OSTEO+ (n = 22 osteopenia; n = 5 osteoporosis). In the final model, menopause [odds ratio 11.641 (95% confidence interval 1.486-91.197), p = 0.019] and anti-seizure drug use [odds ratio 12.825 (95% confidence interval 1.162-141.569), p = 0.037] were associated with OSTEO+ status. In our cohort of migraine patients, no evidence of an association between anti-CGRP treatment duration and an increasing risk of bone mineral density abnormalities was found. However, these findings are preliminary and necessitate further longitudinal research with larger cohorts and extended follow-up to be validated.

The observation that older men suffer from hip fracture at DXA T-scores higher than older women and a proposal of a new low BMD category, osteofrailia, for predicting fracture risk in older men.

The clinical significance of osteoporosis lies in the occurrence of fragility fractures (FFx), and the most relevant fracture site is the hip. The T-score is defined as follows: (BMDpatient-BMDyoung adult mean)/SDyoung adult population, where BMD is bone mineral density and SD is the standard deviation. When the femoral neck (FN) is measured in adult Caucasian women, a cutpoint value of patient BMD of 2.5 SD below the young adult mean BMD results in a prevalence the same as the lifetime risk of hip FFx for Caucasian women. The FN T-score criterion for classifying osteoporosis in older Caucasian men has been provisionally recommended to be - 2.5, but debates remain. Based on a systematic literature review, we noted that older men suffer from hip FFx at aFN T-score approximately 0.5-0.6 higher than older women. While the mean hip FFx FN T-score of around - 2.9 for women lies below - 2.5, the mean hip FF FN T-score of around - 2.33 for men lies above - 2.5. This is likely associated with that older male populations have a higher mean T-score than older female populations. We propose a new category of low BMD status, osteofrailia, for older Caucasian men with T-score ≤ - 2 (T-score ≤ - 2.1 for older Chinese men) who are likely to suffer from hip FFx. The group withT-score ≤ - 2 for older Caucasian men is comparable in prevalence to the group withT-score ≤ - 2.5 for older Caucasian women. However, older men in such category on average have only half the FFx risk as that of older women with osteoporotic T-score.

Therapeutic Intervention for Osteoporosis of Surgical Cases With Non-Vertebral Fractures for Three Years in a Newly Established Rural Hospital in Japan.

Objectives Our hospital was newly opened in the spring of 2020 in a rural area of Japan, with a remarkably developing aging society and population decline. This study aimed to clarify and evaluate the practice of osteoporosis care in our hospital for three years since its establishment. We report a retrospective review of therapeutic interventions for osteoporosis for patients who underwent surgical treatment for non-vertebral fragility fractures in our hospital. Methods We evaluated the practice of osteoporosis intervention in patients who underwent surgery for proximal humerus fractures (PHFs), distal radius fractures (DRFs), or proximal femoral fractures (PFFs) from April 2020 to the end of March 2023. Results There were 115 surgical cases with non-vertebral fractures (10 patients with PHF, 41 patients with DRF, and 64 with PFF). Among the patients who had received osteoporosis treatment at other hospitals before the injury, only 15 (13.0%) patients had been administered therapeutic intervention for osteoporosis by other clinics or hospitals. Also, 82 (71.3%) patients were newly diagnosed with osteoporosis in our hospital after surgery according to the Japanese osteoporosis guideline. New postoperative osteoporosis interventions were administered to 39 (47.0%) patients, of which the rate was higher than the previous reports in Japan. While there was no significant difference between upper limb fracture and PFF in the percentage per young adult mean of spine areal bone marrow density (aBMD), the femoral neck aBMDs in the upper limb fracture group were significantly higher than in the PFF group. The serum total P1NP levels were significantly lower and the 25(OH)D levels were also greater in the upper limb fracture group than in the PFF group, whereas the serum TRACP-5b levels were not significantly different between the two groups. Two (1.7%) patients were affected with secondary fractures during the study period. Conclusions The rates of therapeutic intervention for osteoporosis of patients with non-vertebral fractures, especially in those with upper limb fractures, in our hospital were considered to be greater than those in the previous reports. However, the intervention rate for patients with PFFs was not much, and there was still room for improvement in our hospital concerning osteoporosis diagnosis and treatment.

Pharmacist-initiated interventions to test quantitative bone mineral density and prescribe osteoporosis medications to prevent steroid-induced osteoporosis.

Fragility fractures associated with glucocorticoid-induced osteoporosis (GIO) can markedly impair quality of life. However, only 20% of patients are treated in compliance with the relevant management guidelines, and bone mineral density analysis with dual-energy X-ray absorptiometry (DXA) is only rarely performed. We report the intervention methods suggested by pharmacists and describe their efficacy. Patients who visited the outpatient clinic of the General Medicine Department of Ogaki Municipal Hospital and received steroids were enrolled. The rates of DXA implementation and compliance with GIO pharmacotherapy guidelines before and after pharmacist to physician-suggested interventions were compared. Guideline compliance was defined as prescription of osteoporosis drugs to patients with a score of ≥3. Administered prophylaxes and bone mineral density were subsequently assessed. The before and after intervention DXA rates were 1% (1/100 patients) and 96.0% (96/100 patients; P<0.01), respectively. Overall, 96.9% (93/96) of the patients met the GIO criteria for pharmacotherapy initiation (score ≥3), and the guideline compliance rates before and after the intervention were 39.8% (37/93) and 93.5% (87/93; P<0.01), respectively. Of the 56 patients who did not receive prophylaxis, 52 were recommended treatment, yielding an acceptance rate of 82.7% (43/52). Among the 37 patients receiving prophylaxis, 20 (54.1%) had a DXA-related young adult mean of ≤70%, of whom 11 (55.0%) agreed to drug therapy. The acceptance rate of pharmacotherapy recommendations for patients not receiving prophylaxis was higher than that for those receiving prophylaxis (P=0.03). Pharmacist-initiated interventions for GIO facilitates the administration of appropriate pharmacotherapy.

Rheumatic Heart Disease in East of Bali Indonesia

Background: Rheumatic heart disease remains to be the most acquired heart disease among people aged &lt;25 years. Despite improvements in high sociodemographic countries, low and low-middle sociodemographic countries have been less successful in lowering the burden of RHD.1 However, data of patient with RHD is still lacking in Indonesia, especially in Bali. Karangasem is a rural area, one of the regencies in the eastern part of Bali. Methods: This retrospective study was performed between January 2023 and January 2024 at two hospitals in Karangasem Regency, Karangasem Regional General Hospital and BaliMed Karangasem Hospital. These two hospitals were the only hospital in Karangasem regency. The study population comprised all patients who were diagnosed with RHD. Patient characteristics and echocardiographic parameters were collected retrospectively from medical records. Results: Data from 101 patients with RHD were collected. They were predominantly female (73.3%) young adults (mean ages 41.97 years), graduated from primary school (58.4%), unemployed (26.7%), and mostly from the Karangasem subdistrict (34.7%). Mitral stenosis and mitral regurgitation were the same counts (65.3%), with mixed valve lesions (mitral and aortic) as the most common lesion (45.5%). Fifty-eight patients (57.4%) had secondary tricuspid regurgitation, with 6 patients with TR V-Max &gt;3.4m/s. Atrial fibrillation was a common complication (47.5%). Most patient with RHD had preserved Left Ventricular Ejection Fraction (LVEF &gt;50%). Only a quarter of patients had reduced RV contractility (TAPSE &lt;17mm). All of the patients with AF were given warfarin. All under 40-year-old patients were given a benzathine penicillin G injection. Only 7 patients had a history of valve surgery. Conclusion: Mixed valve lesion (mitral and aortic) was the most observed condition of valve lesion in RHD with the same count of mitral stenosis and mitral regurgitation. Characteristic of patients in this study were predominantly female, young adult, graduated from primary school, unemployed, had preserved LV function, normal RV contractility, high prevalence of AF with all prescribed warfarin, all of under 40 years were given antibiotics prophylaxis.

P002 A comparison between radiologically reported osteopenia and the FRAX score as an indication for bone densitometry

Abstract Background/Aims Osteopenia is defined as a bone mineral density score between -1 and -2.5 standard deviations compared to a young adult reference mean (T-score) based on dual energy x-ray absorptiometry (DXA). Radiologists continue to use the term in a generic and qualitative manner to mean decreased bone mineral density, but they cannot distinguish between osteopenia and osteoporosis which means patients then go on to have a DXA. We would like to see if a FRAX (fracture risk assessment tool) can safely replace osteopenia as an indication for a DXA. Methods We retrospectively identified 2276 patients to have had a DXA scan from October 2022 to March 2023 according to the departmental database. Their referral forms were obtained from the Electronic Medical Record (EMR). Out of these, 150 patients were referred with a sole indication being radiologically reported osteopenia. Out of 150 patients, 22 were excluded as they were found to have other indications not reported on their referral from and seven more were excluded as three had bilateral hip replacement, three were below 40 and one was undergoing gender reassignment and was on oestrogen. The remaining 121 patients were included in the study and their post BMD ( bone mineral density) FRAX score was obtained from patient EMR. Pre BMD FRAX was also calculated using clinical information available on patient’s EMR retrospectively. NOGG ( National Osteoporosis Guideline Group) recommendation of treatment based on the fracture risk as per the FRAX were then compared between pre and post BMD retrospectively to see if there would be any change in treatment plan. Results Of total 121 patients included, 94 were female. Mean age was 68 years. Retrospective review of the case notes revealed that using a FRAX with BMD, total 34 (28.1%) patients needed treatment for osteoporosis while 87 (71.9%) did not. Of 87 patients not requiring treatment, 55 would not have received DXA scan if FRAX assessment was done without BMD. Of the 34 who did need treatment, 32 would still be recommended for a DXA while only two patients wouldn’t. However, these two patients had other clinical indications for osteoporosis assessment and would still have required a specialist referral such that a decision can be made about DXA. Conclusion If radiologically reported osteopenia as an indication for a DXA is replaced by FRAX, DXA would not be needed in nearly half of the patients. This will have potential to save scarce DXA resource without compromising patient safety, treatment plan, and will reduce waiting times. Disclosure S. Srinivas: None. K. Hood: None. H. Sapkota: None.

Association between physical activity, sedentary behavior patterns with bone health among Chinese older women

IntroductionWe examined the association between physical activity (PA) and sedentary behavior (SEB) time with bone health and whether it changes depending on different patterns. Materials and methodsCross-sectional data were derived from the baseline of the Physical Activity and Health in Older Women Study. PA and SEB were measured using Actigraph wGT3X-BT accelerometers. Bone mineral density (BMD) was derived from the SONOST-2000 ultrasound bone densitometer, with unhealthy bone defined as a BMD T-score of <2.5 standard deviation a young adult reference population's mean. A 10 min-bouted SEB was defined as an SEB duration of >10 min (allow 2 min 0 counts), similar to 30 min-bouted and 60 min-bouted SEBs. Sporadic and bouted PAs were defined by PA duration of <10 min or ≥ 10 min. Multivariate logistic regression analysis investigated the associations between PA and SEB patterns with bone health. ResultsAmong 1111 female participants, 42.12 % had unhealthy bones. In a fully-adjusted model, increasing 30 min/day of SEB was associated with a higher odds ratio (OR) for an unhealthy bone (OR, 1.08; P = 0.005), similar to the 10 (OR, 1.06; P = 0.012), 30 (OR, 1.06; P = 0.043), and 60 min-bouted (OR 1.08, P = 0.032) SEBs. Total light PA (LPA) time (OR, 0.97; P = 0.005) had a lower OR for unhealthy bone. After adjusting for sporadic LPA time, bouted LPA (OR, 0.97; P = 0.005) retained this association. No association was observed between total moderate-to-vigorous PA (MVPA) and bone health, sporadic MVPA, and bouted MVPA. ConclusionsPerforming bouted LPA and reducing 10 min-bouted SEB may maintain bone health.

Coronary coding in dTGA pre- and post-ASO-verification and necessary corrections following adult CMR.

In adult patients with transposition of the great arteries (dTGA) after arterial switch operation (ASO), the coronary artery circulation after neonatal surgical transfer remains a major culprit for long-term sequelae, including myocardial ischaemia and sudden cardiac death. As coronary imaging in paediatric age is often incomplete and classification mainly relies on the surgeon's description in the operation report, we intended to develop a systematic, understandable pattern of the coronary status for each young patient, combining unambiguous coding with non-invasive imaging. The monocentric prospective study evaluated 89 young adults (mean 23 years) after ASO for dTGA including cardiac magnetic resonance (CMR) coronary angiography. Following 'The Leiden Convention coronary coding system', we describe the systematic transformation process and provide a graphical illustration considering surgical and imaging views for the six main coronary types, followed by a comparison with adult CMR. Discordance between surgeon's and CMR classification is evaluated.In seven (7.9%) patients, a discordance between the surgeon's post-operative and the CMR classification was found; therefore, the initial classification had to be corrected according to adult CMR. Three cases (3.4%) with particularly challenging coronary variants (intramural and interarterial course, functional common ostium) are presented. Considering the risks of a possible neonatal coronary misclassification and of increasing additional acquired coronary artery disease with age, reliable cooperation between surgeons, cardiologists, and imaging specialists must be ensured. Therefore, after completion of growth, a systematic pattern of the coronary artery status, combining unambiguous coding with CMR imaging, should be established for each patient.

Femoral bone mineral density as a tool of personalized medicine for rheumatoid arthritis: Interleukin-6 inhibitors for patients with low density whereas tumor necrosis factor inhibitor for patients with preserved density?

There is a lack of indicators to distinguish between interleukin-6 inhibitors responders and tumor necrosis factor inhibitors responders in the treatment of rheumatoid arthritis. Osteoporosis is a complication of rheumatoid arthritis and is closely related to inflammatory pathology. The purpose of this study was to evaluate whether bone mineral density can distinguish interleukin-6 inhibitors responders from tumor necrosis factor inhibitors responders in rheumatoid arthritis. Either interleukin-6 inhibitors or tumor necrosis factor inhibitors was introduced as the first biologics to patients naïve to both corticosteroid and osteoporosis treatment. Correlations between baseline bone mineral density and Clinical Disease Activity Index after 3 months were analyzed. The subjects were 26 rheumatoid arthritis patients with a median age of 60 years old, disease duration of 1.4 years, Clinical Disease Activity Index of 13.7, and C-reactive protein of 1.69 mg/dL. The subjects were divided into two groups (high (H) and low (L)) according to their femoral bone mineral density with a cutoff of young adult mean of 80%. Six in group H and 11 in group L received interleukin-6 inhibitors, and nine in group H received tumor necrosis factor inhibitors. Clinical Disease Activity Index remission rate by interleukin-6 inhibitors was significantly greater in group L (8/11 (72.7%)) than in group H (1/6 (16.7%); p < 0.05). In the whole group H, significantly more patients obtained Clinical Disease Activity Index remission by tumor necrosis factor inhibitors (7/9, 77.8%) than by interleukin-6 inhibitors (1/6 (16.7%); p = 0.04). In patients with rheumatoid arthritis, interleukin-6 inhibitors may be more beneficial for patients with low femoral bone mineral density, whereas tumor necrosis factor inhibitors may be advantageous for those with preserved bone mineral density.

Intergenerational Assistance with Home Ownership: Understanding the Relational Development of Financialized Subjectivities

ABSTRACT Recently scholars have turned their attention to the role of intergenerational financial assistance in facilitating entry into home ownership for young adults. This practice has been identified as a means through which intergenerational inequalities may be translated into intragenerational inequalities. However, the question of what this form of financial dependence on family means for both young adults and their parents has received less attention. This article reports on the findings of a study conducted with 15 related donor-recipient pairs (30 in-depth interviews in total) in the UK in 2019. Drawing on these findings, we show that the provision and receipt of intergenerational financial assistance does not simply reflect family practices, but instead plays an active part in developing and conveying them. We ultimately contend that the practice of giving and receiving financial transfers shapes individuals’ broader orientations to the property market, and to financial decision-making and planning.

Age-related impairments and influence of visual feedback when learning to stand with unexpected sensorimotor delays.

While standing upright, the brain must accurately accommodate for delays between sensory feedback and self-generated motor commands. Natural aging may limit adaptation to sensorimotor delays due to age-related decline in sensory acuity, neuromuscular capacity and cognitive function. This study examined balance learning in young and older adults as they stood with robot-induced sensorimotor delays. A cohort of community dwelling young (mean = 23.6 years, N = 20) and older adults (mean = 70.1 years, N = 20) participated in this balance learning study. Participants stood on a robotic balance simulator which was used to artificially impose a 250 ms delay into their control of standing. Young and older adults practiced to balance with the imposed delay either with or without visual feedback (i.e., eyes open or closed), resulting in four training groups. We assessed their balance behavior and performance (i.e., variability in postural sway and ability to maintain upright posture) before, during and after training. We further evaluated whether training benefits gained in one visual condition transferred to the untrained condition. All participants, regardless of age or visual training condition, improved their balance performance through training to stand with the imposed delay. Compared to young adults, however, older adults had larger postural oscillations at all stages of the experiments, exhibited less relative learning to balance with the delay and had slower rates of balance improvement. Visual feedback was not required to learn to stand with the imposed delay, but it had a modest effect on the amount of time participants could remain upright. For all groups, balance improvements gained from training in one visual condition transferred to the untrained visual condition. Our study reveals that while advanced age partially impairs balance learning, the older nervous system maintains the ability to recalibrate motor control to stand with initially destabilizing sensorimotor delays under differing visual feedback conditions.

Relationship among Osteoporosis, Sarcopenia, Locomotive Syndrome, and Spinal Kyphosis in Older Individuals Living in a Local Mountain Area.

Cross-sectional cohort study. This study investigated the relationship among osteoporosis, sarcopenia, locomotive syndrome, and spinal kyphosis in older individuals living in a mountain area. Kyphosis greatly reduces the quality of life of older individuals. Osteoporosis and sarcopenia are kyphosiscausing factors. This cross-sectional study included 361 individuals aged ≥65 years (mean age, 75.0 years) living in a local mountain area and underwent medical check-ups from 2014 to 2018. The survey items included kyphosis index, body mass index, back pain prevalence, back pain Visual Analog Scale score, Oswestry Disability Index, walking speed, grip strength, skeletal mass index, osteoporosis (% young adult mean [YAM]), LOCOMO 5 score, and presence of sarcopenia (Asian Working Group for Sarcopenia). The participants were divided into the N (kyphosis index: <12; n=229, 63.4%), M (kyphosis index: 12-15; n=99, 27.4%), and K (kyphosis index: ≥15; n=33, 9.2%) groups. p -values of <0.05 were considered statistically significant. An association factor of kyphosis (kyphosis index: ≥15) was investigated with logistic regression analysis. Age and LOCOMO 5 scores were significantly higher (p <0.05) and %YAM and walking speed were significantly lower (p <0.05) in the K group than in the M and N groups. Other survey items showed significant differences. Only %YAM (odds ratio, 0.20; 95% confidence interval, 0.04-0.96) was an independent factor associated with a kyphosis index of ≥15. Decreased muscle mass and muscle strength would be related to kyphosis; however, no such relations were noted. Bone loss was significantly related to kyphosis. Osteoporosis-induced decrease in vertebral body height is present in the background. Sarcopenia and locomotive syndrome were not related to kyphosis, whereas decreased bone density was independently associated with kyphosis in older individuals living in a mountain area.

Influence of greater trochanteric bone density and three-dimensional morphology on perioperative greater trochanteric fracture following total hip arthroplasty via an anterolateral approach

BackgroundPerioperative greater trochanteric fracture following total hip arthroplasty (THA) using the anterolateral approach is a recognized perioperative complication. There was no previous study to determine the relationship between bone mineral density (BMD) and three-dimensional greater trochanter morphology for perioperative greater trochanter fractures. The purpose of this study is to identify the influence of greater trochanteric bone density and three-dimensional morphology on perioperative greater trochanteric fracture following THA using the anterolateral approach.MethodsWe investigated 209 hips done primary THA using the anterolateral approach and preoperative BMD test for the proximal femoral bone with a minimum of 6 months follow-up. We picked up all patients who had perioperative greater trochanteric fractures. Multivariate analysis was done in order to investigate the influence of the greater trochanter young adult mean (YAM) and three-dimensional morphology on perioperative greater trochanteric fractures.ResultsThere were 10 joints (10/209, 4.8%) with perioperative greater trochanteric fractures. Osteosynthesis was required only in one joint (1/209, 0.5%) because the bone fragments were significantly displaced proximally by the gluteus medius. Multivariate analysis showed the combination of Type B femoral shape (in cases where the top of the great trochanter was inside the longitudinal central axis of the planned femoral stem in computed tomography (CT)- based three-dimensional templating) and a YAM of < 80% was the only risk factor for fracture.ConclusionsThe preoperative greater trochanter BMD test (YAM < 80%) and three-dimensional femoral morphology (Type B femoral shape) provide useful information to mitigate the occurrence of perioperative greater trochanter fractures associated with THA using the anterolateral approach.

The Association between Sleep and Bone Mineral Density: Cross-Sectional Study Using Health Check-up Data in a Local Hospital in Japan.

This study aimed to investigate the association between daily sleep duration of <7 hours and lower bone mineral density (BMD) using data from annual health check-ups conducted in Japan between 2020 and 2022. Multivariate regression models were used, where BMD was the objective variable and daily sleep duration (<5 hours, 5 to <7 hours, 7 to <9 hours [reference], ≥9 hours) was the exposure variable adjusted for age, body mass index, physical activity, smoking status, and alcohol intake for men and women and further adjusted for menopausal status for women. The association between insomnia and BMD was also investigated. BMD was determined using calcaneal quantitative ultrasound and expressed as a percentage of the young adult mean (%YAM). In total, 896 men and 821 women were included. Median age was 54 years (interquartile range [IQR]: 46 to 64) for men and 55 years (IQR: 46 to 64) for women). Median BMD for men and women was 79%YAM (IQR: 71 to 89) and 75%YAM (IQR: 68 to 84), respectively. Approximately 80% of men and women slept <7 hours daily. Multivariate regression showed no association between sleep duration and BMD in men. However, women who slept 5 to <7 hours daily had significantly higher BMD by 3.9% compared with those who slept 7 to<9 hours (p = 0.004). No association between insomnia and BMD was found. Overall, a daily sleep duration of <7 hours was not independently associated with lower BMD compared to those who slept 7 to <9 hours in men and women. However, as there is evidence of both shorter and longer sleep durations being associated with an increased risk of adverse events, including cardiovascular events, our result needs to be interpreted with caution. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Cooperation and group similarity in children and young adults in the UK.

For cooperation to be beneficial, cooperators should be able to differentiate individuals who are willing to cooperate from free-riders. In the absence of kin or of familiar individuals, phenotypic similarity (e.g. in terms of language) can be used as a cue of how likely two or more individuals are to behave similarly (whether they will cooperate or free-ride). Thus, phenotypic similarity could affect cooperation. However, it is unclear whether humans respond to any type of phenotypic similarity or whether only salient phenotypic traits guide cooperation. We tested whether within-group, non-salient phenotypic similarity affects cooperation in 280, 3 to 10 year old children and in 76 young adults (mean 19.8 years old) in the UK. We experimentally manipulated the degree of phenotypic similarity in three computer-based experiments. We found no evidence of a preference for, or greater cooperation with, phenotypically similar individuals in children, even though children displayed ingroup preference. Conversely, young adults cooperated more with phenotypically similar than with phenotypically diverse individuals to themselves. Our results suggest that response to non-salient phenotypic similarity varies with age and that young adults may pay more attention to non-salient cues of diversity then children.

Abstract P311: The Association Of Locomotive Syndrome/low Bone Mineral Density And Increased Arterial Stiffness

Background: Both frailty and osteoporosis have been regarded as risk factors of cardiovascular disease (CVD). However, it has not been reported whether the combination of osteoporosis and frailty is associated with arterial stiffness, a marker for CVD. The objective of this study is to evaluate the association of and arterial stiffness. Hypothesis: We hypothesized combination of frailty and osteoporosis is associated with increased arterial stiffness. Methods: Japanese Subjects above 50 years old who underwent annual health-checkup were enrolled in this cross-sectional study. Subjects with history of CVD and dementia were excluded. Arterial stiffness was evaluated by brachial-ankle pulse wave velocity (baPWV). Forearm bone mineral density (BMD) was measured by dual energy X-ray absorptiometry and young adult mean (YAM) less than 80% was defined as low bone mineral density (LB). We evaluated frailty by screening Locomotive syndrome (LS) assessed by the questionnaires (GLFS-25) and physical performance tests consisted of those for a two-step test and a stand-up test according to the guidance of the Japanese Orthopedic Association. The association of combination of LS and LB, LS, LB and baPWV was assessed by multivariable linear regression analysis adjusted for conventional CVD risk factors. Results: Among 137 subjects (mean age: 59±6 years), 7 subjects (20%) had both LS and LB. The numbers of subjects who had only LS, only LB, and none of those were, 58, 10, 62, respectively. BaPWV in subjects with combination of LS and LB was highest compared to subjects with only sarcopenia, only obesity, and none of those (Figure, p=0.01). Multivariable linear regression analysis revealed that the combination of LS and LB, LS, LB, were gradually associated with increased arterial stiffness even after adjustment for conventional CVD risk factors. (β=57±21, p&lt;0.01). Conclusion: The combination of LA and LB was significantly associated with increased arterial stiffness. Further research on frailty/osteoporosis and arterial stiffness is warranted.

Reductions in Motor Unit Firing are Associated with Clinically Meaningful Leg Extensor Weakness in Older Adults.

Weakness, one of the key characteristics of sarcopenia, is a significant risk factor for functional limitations and disability in older adults. It has long been suspected that reductions in motor unit firing rates (MUFRs) are one of the mechanistic causes of age-related weakness. However, prior work has not investigated the extent to which MUFR is associated with clinically meaningful weakness in older adults. Forty-three community-dwelling older adults (mean: 75.4 ± 7.4years; 46.5% female) and 24 young adults (mean: 22.0 ± 1.8years; 58.3% female) performed torque matching tasks at varying submaximal intensities with their non-dominant leg extensors. Decomposed surface electromyographic recordings were used to quantify MUFRs from the vastus lateralis muscle. Computational modeling was subsequently used to independently predict how slowed MUFRs would negatively impact strength in older adults. Bivariate correlations between MUFRs and indices of lean mass, voluntary activation, and physical function/mobility were also assessed in older adults. Weak older adults (n = 14) exhibited an approximate 1.5 and 3Hz reduction in MUFR relative to non-weak older adults (n = 29) at 50% and 80% MVC, respectively. Older adults also exhibited an approximate 3Hz reduction in MUFR relative to young adults at 80% MVC only. Our model predicted that a 3Hz reduction in MUFR results in a strength decrement of 11-26%. Additionally, significant correlations were found between slower MUFRs and poorer neuromuscular quality, voluntary activation, chair rise time performance, and stair climb power (r's = 0.31 to 0.43). These findings provide evidence that slowed MUFRs are mechanistically linked with clinically meaningful leg extensor weakness in older adults.

Zoledronic acid for osteoporosis after distal radius fracture surgery: Prospective longitudinal study

BackgroundDistal radius fractures (DRFs) are the most frequent first-ever osteoporotic fragility fractures. However, most patients are treated only for fractures and not for osteoporosis. Therefore, we investigated early osteoporosis intervention using zoledronic acid. MethodsThis prospective study enrolled 30 patients aged 50 years or older who had no history of fragility fractures or osteoporosis treatment and who underwent surgical treatment for DRFs. Patients whose lumbar spine or femur bone mineral density (BMD) values were less than 80% of the young adult mean (YAM) were treated with a 5-mg intravenous infusion of zoledronic acid. Lumbar spine and femur YAM BMD values, TRACP-5b and PINP were statistically evaluated using the paired t-test. The relationship between adverse effects, age, body mass index (BMI), and creatinine clearance (CCr) was statistically examined using Mann-Whitney's U test. The incidence of the bone fusion and secondary fractures within the 60-months postoperative period were assessed. ResultsThe mean lumbar spine and femur YAM BMD values before treatment were 76.1 ± 13.1% and 70.7 ± 8.5%. This indicates osteopenia in both locations. These values differed significantly between the pre-treatment period and each subsequent period. Five patients with a target YAM BMD value over 80% within 60 months after treatment were observed. The TRACP-5b and PINP values differed significantly between the pre-treatment period and each subsequent period. Adverse drug reactions were observed in 12 patients (40%). Age, BMI, and CCr did not show statistically significant differences in the occurrence of adverse effects. Bone fusion was confirmed at a mean of 3.6 months postoperatively. Secondary fractures were observed in 3 patients within 60 months after treatment. ConclusionDRFs occur at a younger age than other fragility fractures, and it is important to intervene aggressively with osteoporosis treatment to prevent secondary fractures. Level of evidenceLevel V.

Which head element is more effective for cement augmentation of TFNA? Helical blade versus lag screw

BackgroundEarly fixation and rehabilitation is the gold standard treatment for intertrochanteric femur fractures. Cement augmentation through perforated head elements has been developed to avoid postoperative complications such as cut-out or cut-through. The purpose of this study was to compare two head elements in terms of cement distribution using computed tomography (CT) and to examine their initial fixation and clinical outcomes.MethodsElderly patients who had intertrochanteric fractures were treated with a trochanteric fixation nail advanced (TFNA) helical blade (Blade group) or a TFNA lag screw (Screw group). In both groups, 4.2 mL of cement was injected under an image intensifier (1.8 mL of cement was directed cranially and 0.8 mL each caudally, anteriorly, and posteriorly). Patient demographics and clinical outcome were investigated post-operatively. Cement distribution from the center of the head element was evaluated with CT. Maximum penetration depth (MPD) were measured in the coronal and sagittal planes. On each axial plane, the cross-sectional areas in the cranial, caudal, anterior and posterior directions were calculated. The sum of cross-sectional areas (successive 36 slices) was defined as the volume of the head element.ResultsThe Blade group included 14 patients, and the Screw group included 15 patients. In the Blade group, MPD in the anterior and caudal direction was significantly greater than that in the posterior direction (p < 0.01). In the Screw group, volume in the cranial and posterior direction was significantly greater than that in the Blade group (p = 0.03). Subsequently, the total volume in the Screw group was significantly larger than that in the Blade group (p < 0.01). No significant correlation was detected between bone mineral density, T score, young adult mean, and total cement volume. Change in radiographic parameters and clinical outcome such as Parker score and visual analog scale were similar in both groups. No patients suffered from cut-out / cut through or non-union.ConclusionsThe position of cement distribution through the lag screw is different from that through the helical blade, and the total volume of the head element is significantly larger in the lag screw. Both groups had similarly effective results in terms of mechanical stability after surgery, postoperative pain and early phase of rehabilitation.Trial registrationCurrent Controlled Trials ISRCTN45341843, 24/12/2022, Retrospectively registered.