Risk Factor For Osteoporotic Fractures Research Articles

Spinal osteoarthritis is a risk of vertebral fractures in postmenopausal women

Recent studies have revealed that despite high bone mineral density (BMD), osteoarthritis (OA) is a risk factor for osteoporotic fractures. However, the relationship between spinal OA and vertebral fractures has not yet been fully investigated. This longitudinal analysis used a subset of ongoing cohort study consist with Japanese postmenopausal women. The prevalence of spinal OA was determined using Kellgren–Lawrence grading method. The incidence of vertebral fractures were determined by semiquantitative analysis of spinal X-ray films. The relationship between the presence of spinal OA and incidence of vertebral fractures was evaluated using the Cox regression analysis. In total, 1480 women were followed up for 8.1 ± 6.4 years. Among them, 923 were diagnosed with spinal OA, and incident vertebral fractures were observed in 473 participants. After adjusting for confounding variables, the spinal OA (≥ grade 2) was a significant predictor of incident vertebral fractures (hazard ratio, 1.52; 95% confidence interval: 1.19–1.93, p = 0.001). Using ROC analysis, the thresholds of lumbar BMD for incident vertebral fractures were 0.952 g/cm2 for patients with spinal OA and 0.753 g/cm2 for patients without spinal OA. The presence of spinal OA is a risk factor for incident vertebral fractures despite high lumbar BMD.

Analysis of risk factors and predictive efficacy of senile osteoporosis fracture based on biochemical indicators of bone metabolism

Background: Osteoporosis is characterized by low bone mass and altered bone microarchitecture. Patients with osteoporosis are at significantly increased risk for fragility fractures, which ultimately suffer fractures. The occurrence and development of osteoporotic fractures are significantly associated with high mortality, reduced quality of life as well as comorbidities. Biochemical indicators of bone metabolism are important for assessing the risk of fracture occurrence. In this study, we aimed to investigate the risk factors for osteoporotic fracture in the elderly based on bone metabolism biochemical indexes and to analyze their predictive efficacy through relevant bone metabolism biochemical indexes.
 Methods: A total of 254 elderly osteoporosis (OS) patients diagnosed and treated in our hospital during May 2019 to April 2022 was randomly picked, of which 100 patients were finally chosen for subsequent analysis following the inclusion and exclusion criteria. Patients were divided into OS fracture group and non-fracture group according to whether they had OS fracture. The contents of bone mineral density (BMD) and bone metabolism biochemical indexes, including Dickkopf-1 (DKK-1), sclerostin (SOST), osteoprotegerin (OPG), osteopontin (OPN), osteocalcin (BGP) and 25 hydroxyvitamin d (25 (OH) D) were detected in lumbar L2~4 and left femoral greater trochanter. The correlation between bone metabolism and BMD was evaluated using Pearson analysis. The risk factors of OS fracture were analyzed using Multivariate logistic regression analysis. The predictive value of biochemical indexes of bone metabolism on the risk of OS fracture was analyzed using ROC curve. 
 Results: The proportion of patients with age and lack of sunlight in the OS fracture group was significantly higher than that in the non-fracture group (P < 0.05). The BMD in lumbar L2~4 and left femoral greater trochanter of patients in the OS fracture group was lower than that of patients in the non-fracture group (P < 0.05). At 14 weeks and 16 weeks after surgery, the levels of DKK-1, SOST and OPN in the OS fracture group were higher than these in the non-fracture group, and the levels of OPG, BGP and 25 (OH) D were lower than these in the non-fracture group (P < 0.05). BMD in lumbar L2~4, BMD in femoral greater trochanter, OPG, BGP and 25 (OH) D were the protective factors (P < 0.05), and the age, lack of sunlight, DKK-1, SOST and OPN were the risk factors affecting OS fractures (P < 0.05). BMD in lumbar L2~4 was negatively correlated with DKK-1, SOST and OPN (P < 0.05), and positively correlated with BGP and 25 (OH) D (P < 0.05). 25 (OH) D was positively correlated with femoral greater trochanter BMD (P < 0.05). OPG, OPN, BGP and 25 (OH) D had certain predictive value for the occurrence of OS fracture with the areas under the curve (AUC) of 0.709, 0.761, 0.720 and 0.730 respectively. The combined detection of all indicators had the AUC of 0.940 (P < 0.05), which had a high predictive value for OS fracture. 
 Conclusion: Biochemical indicators of bone metabolism were closely correlated with the risk of OS fracture and had a high predictive value as influencing factors for the occurrence of OS fracture. Therefore, an accurate combination of biochemical indices could reduce the risk of fracture in the elderly, thus facilitating the development of targeted treatment plans for elderly fracture patients.

Association between physical performance and bone mass in community-dwelling postmenopausal Japanese women: The Unzen study.

Low bone mass is an independent risk factor for osteoporotic fractures. We examined the association between physical performance and bone mass using quantitative ultrasound in community-dwelling postmenopausal Japanese women. We conducted a cross-sectional study on 524 community-dwelling postmenopausal Japanese women who were not being administered osteoporosis medications. Physical performance was assessed on the basis of grip strength, chair stand time, and functional reach. The stiffness index was measured as a quantitative ultrasound parameter for heel bone mass. Physical performance, assessed by grip strength, chair stand time, and functional reach, and the stiffness index significantly decreased with age (both p<0.001). The multiple linear regression analysis showed that grip strength (p = 0.001), chair stand time (p = 0.004), and functional reach (p = 0.048) were significantly associated with the stiffness index after adjusting for age, body mass index, smoking, drinking, and exercise. Physical performance was significantly associated with heel bone mass in community-dwelling postmenopausal Japanese women.

Fracture prediction in rheumatoid arthritis: validation of FRAX with bone mineral density for incident major osteoporotic fractures

Abstract Objectives FRAX uses clinical risk factors, with or without BMD, to calculate 10-year fracture risk. RA is a risk factor for osteoporotic fracture and a FRAX input variable. FRAX predates the current era of RA treatment. We examined how well FRAX predicts fracture in contemporary RA patients. Methods Administrative data from patients receiving BMD testing were linked to the Manitoba Population Health Research Data Repository. Observed cumulative 10-year major osteoporotic fracture (MOF) probability was compared with FRAX-predicted 10-year MOF probability with BMD for assessing calibration. MOF risk stratification was assessed using Cox regression. Results RA patients (n = 2099, 208 with incident MOF) and non-RA patients (n = 2099, with 165 incident MOF) were identified. For RA patients, FRAX-predicted 10-year risk was 13.2% and observed 10-year MOF risk was 13.2% (95% CI 11.6, 15.1). The slope of the calibration plot was 0.67 (95% CI 0.53, 0.81) in those with RA vs 0.98 (95% CI 0.61, 1.34) in non-RA patients. Risk was overestimated in RA patients with high FRAX scores (&amp;gt;20%), but FRAX was well calibrated in other groups. FRAX stratified risk in those with and without RA [hazard ratio (HR) 1.52 (95% CI 1.25, 1.72) vs 2.00 (95% CI 1.73, 2.31)], with slightly better performance in the latter (P for interaction = 0.004). Conclusions FRAX predicts fracture risk in contemporary RA patients but may slightly overestimate risk in those already at high predicted risk. Thus the current FRAX tool continues to be appropriate for fracture risk assessment in RA patients.

The Association of nutritional status and physical activity on osteoporotic refractures among older adults

BackgroundThis paper focuses on revealing the relationship between the Geriatric Nutritional Risk Index (GNRI) and Activity of Daily Living (ADL) with osteoporotic refracture. MethodsData from 1068 inpatients with osteoporotic fractures were analyzed. Binary logistic regression, Cox proportional hazard regression and Kaplan-Meier curves were performed for osteoporosis characteristics and its risk factors. Receiver operating characteristic (ROC) curve was developed to predict the cut-off value. ResultsThe study showed that older age, lower ADL and lower GNRI were independent risk factors for osteoporotic fracture with OR of 1.039, 0.946, 0.892 and HR of 1.033, 0.967, 0.947 respectively. According to the results of ROC, the predictive accuracy of GNRI was high with an area under ROC (AUC) of 0.715, sensitivity of 76.6%, specificity of 53.5% and a threshold value of 99.65. ConclusionOlder age, lower ADL and lower GNRI were independent risk factors for osteoporotic refracture.

Clinical significance of serum cystatin C-to-creatinine ratio as a surrogate marker for incident osteoporotic fracture predictions.

Detection of appropriate indicators is valuable for preventing incidental osteoporotic fractures. We statistically evaluated the significance of serum cystatin C-to-creatinine ratio (CysC/Cr) as a surrogate marker for incident major osteoporotic fractures (MOF) prediction. Eligible patients with simultaneous measurement of CysC/Cr and bone mineral density in the lumbar spine and proximal femur were selected, and their fracture histories until 5 years after baseline were observed in the retrospective area cohort data. Patients who were followed up until termination or the first osteoporotic fracture were included, and loss of follow-up or death was excluded. Candidate risk factors for osteoporotic fractures were tested for risk ratios using a cox regression analysis. Receiver operating characteristic tests were performed on factors with significantly higher risk ratios and evaluated with Kaplan-Meier survival analysis to determine the hazard ratios of the factors. A total of 175 patients of whom 28 had incident MOF, 38 men, and 137 women, were enrolled. The mean age was 70.2 years. A significantly higher risk ratio was shown in the presence of prevalent MOF, hyper fall-ability, lifestyle-related diseases, chronic kidney diseases ≥ Grade3a, and higher CysC/Cr. All parameters had cutoff indices and showed significantly higher hazard ratios. These results suggested that CysC/Cr may be a predictive marker of incident osteoporotic fractures. It might work as a screening tool for MOF risk.

Total Cholesterol Variability and the Risk of Osteoporotic Fractures: A Nationwide Population-Based Cohort Study.

Several risk factors for osteoporotic fractures have been identified but reports of the association of lipid parameters with the occurrence of osteoporotic fractures have been limited. We aimed to examine whether serum total cholesterol (TC) variability is associated with osteoporotic fractures. The study included 3,00,326 subjects who had undergone three or more health examinations between 2003 and 2008. The primary endpoint was the incidence of osteoporotic fractures, including vertebral, hip, distal radius, and humerus fractures. TC variability was evaluated based on the following three parameters: coefficient of variation (CV), standard deviation (SD), and variability independent of the mean (VIM). A total of 29,044 osteoporotic fracture events (9.67%) were identified during a median of 11.6 years of follow-up. The risk of osteoporotic fractures in the highest quartile was significantly higher compared with the lowest quartile according to the three indices of TC variability with adjusted hazard ratios (HR) and 95% confidence intervals (CI) as follows: CV (HR 1.11, 95% CI [1.08-1.15]), SD (HR 1.07, 95% CI [1.04-1.11]) and VIM (HR 1.07, 95% CI [1.04-1.11]). The Kaplan-Meier curves showed a significantly positive relationship between the higher quartile of TC variability and overall osteoporotic fractures. The association remained significant in subgroup analyses of vertebral and hip fractures, regardless of the indices of TC variability. Our study showed that visit-to-visit TC variability was found to be associated with osteoporotic fracture risk. Maintaining TC levels stable may help attenuate the osteoporotic fracture risk in the future.

Functional and Metabolic Consequences of Sarcopenia

The capacity of older men and women to adapt to regularly performed exercise has been demonstrated by many laboratories. Aerobic exercise results in improvements in functional capacity and reduced risk of developing type II diabetes in the elderly. High intensity resistance training (above 60% of the 1 repetition maximum) causes large increases in strength in the elderly, and resistance training significant increases muscle size. Resistance training also significantly increases energy requirements and insulin action of the elderly. We recently demonstrated that resistance training has a positive effect on multiple risk factors for osteoporotic fractures in previously sedentary post-menopausal women. Because the sedentary lifestyle of individuals in a long-term care facility may exacerbate losses of muscle function, we applied this same training program to frail, institutionalized elderly men and women. In a population of 100 nursing home residents, a randomly assigned high intensity strength training program resulted in significant gains in strength and functional status. In addition, spontaneous activity, measured by activity monitors, increased significantly in those participating in the exercise program; there was no change in the sedentary control group. Before the strength training intervention, the relationship of whole-body potassium and leg strength was relatively weak (r2 = 0.29, P < 0.001), indicating that in very old persons muscle mass is an important but not the only determiner of functional status. Thus exercise may minimize or reverse the syndrome of physical frailty prevalent among very old individuals. Because of their low functional status and high incidence of chronic disease, there is no segment of the population that can benefit more from exercise training than the elderly.

Distinct dietary risk factors for incident osteoporotic fractures in early and late postmenopausal phase women.

Available evidence on favorable nutritional factors for preventing osteoporosis remains controversial. Considering the recent increases in life expectancy, we investigated the relationship between incident osteoporotic fractures and dietary habits in early and late postmenopausal phase women. Subjects were Japanese postmenopausal outpatients recruited at a primary care institution in Nagano Prefecture (Nagano Cohort Study). Patients with critical or acute illness or secondary osteoporosis were not included in this study. In total, 1,071 participants were prospectively followed for a mean of 5.8years. The cohort was divided into early (≤ 70years) and late (> 70years) postmenopausal phases based on median age. Dietary nutrient intake was estimated by the food frequency questionnaire method. According to baseline nutrient intake characteristics, we focused on protein/energy and Ca/NaCl intake ratios, which were also divided by the median values. Kaplan-Meier plots revealed a significantly higher occurrence of fractures for the high protein/energy intake group in early postmenopausal subjects (P = 0.009), whereas the low Ca/NaCl intake group in late postmenopausal subjects exhibited a significantly earlier occurrence of fractures (P = 0.002). Multivariate Cox regression uncovered significant independent risks of higher protein/energy (HR 1.35; 95% CI 1.04-1.74) and lower Ca/NaCl (HR 0.79; 95% CI 0.63-0.99) intake ratios for incident osteoporotic fractures in the early and late postmenopausal cohorts, respectively. Distinct dietary risk factors for osteoporotic fractures were identified in early and late postmenopausal phase women. Appropriate nutritional guidance according to patient age will be important for maintaining bone health and quality of life.

The effect of Hyperhomocysteinemia on the Osteoclasts activity in Male New Zealand White Rabbits

Methionine is a specific amino acid which contains sulfur, and can be used to make proteins, found in fish, meat, and dairy products, the excess intake of L-methionine lead to elevated homocysteine (Hcy) level that known as Hyperhomocysteinemia (HHcy). Increased Hcy plasma may represent an independent risk factor for osteoporotic fractures, and therefore may also negatively affect bone metabolism. This study was designed to examine the impact of Hcy on osteoclast activity in Male Rabbits, following methionine overload. To achieve this study's aims, we recruiting (20) males of New Zealand white rabbits that were divided into (10/group) control group and a group treated with methionine. Then after the intubation of methionine overload, we measured the "Receptor Activator of Nuclear factor Kappa-b" (RANK) and "Receptor Activator of Nuclear factor Kappa-b ligand" (RANK-L) levels in the blood, in addition to histological examination of the trabecular structure of femur bone. The results show a significant (p≤0.001) increase in serum RANK and RANK-L levels of methionine treated group in comparison with the control group. The histological examination of the trabecular structure of femur bone shows an increase in osteoclasts percentage, activity, and large resorption pits in the methionine treated group. The HHcy that was induced by methionine overload, caused an increase in osteoclast activity and numbers in male rabbits suggested a mechanistic role for bone resorption by Hcy. Future research clarifying the mechanistic function of elevated concentrations of Hcy in osteoporosis may have important therapeutic implications.

Comparative analysis of risk factors for hip fracture in patients of different nationalities living in Kazakhstan

BACKGROUND: Osteoporosis is a multifactorial systemic skeletal disease characterized by a decrease in bone strength leading to an increased risk of fractures. Hip fracture is a serious complication of osteoporosis. It is expected in Kazakhstan by 2050 the annual number of hip fracture will increase by 140% compared to 2015 data and will amount to 28,048 cases. There are differences in the incidence of fractures and low bone mineral density in different ethnic groups. However, low bone mineral density is only one of many risk factors for osteoporotic fractures.&#x0D; AIM: To study the risk factors of osteoporosis and related osteoporotic fractures in patients with hip fracture living in Kazakhstan.&#x0D; MATERIALS AND METHODS: The case-control study included 98 patients with hip fracture of Kazakh (main group, n = 49) and other nationalities (control group, n = 49). In the registration card, risk factors for osteoporosis and osteoporotic fractures from the Fracture Risk Assessment (FRAX) model were distinguished, and the Find cases Assess Confirm Severity algorithm (2019) was used to diagnose sarcopenia. Statistical analysis was carried out using the Statistics 26 (IBM SPSS, США).&#x0D; RESULTS: The groups were comparable in terms of gender, disability, fracture location and functional activity, surgical treatment. An increase in cases of hip fracture at an older age was found in the main group than in the control group (р = 0.035).&#x0D; There were no differences in the groups for clinical risk factors for osteoporotic fractures (body weight, height, history of fractures, family history of fractures, medication, comorbidity), except for smoking (lower in Kazakhs than in the other group) (р = 0.033). Differences in 10-year probability of major osteoporotic fracture and hip fracture between groups (р = 0.34 and р = 0.74) were not found. The proportion of patients who entered the intervention threshold and at low risk did not differ in the groups (р = 0.623).&#x0D; The average SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls) score was lower among Kazakhs (р = 0.011), there is a difference between the groups when walking (р = 0.044), climbing stairs (р = 0.003). A decrease of grip strength was noted in the main group (р = 0.008), especially in men (р = 0.011), but low grip strength (р 0.001) and signs of sarcopenia (р 0.001) were determined only by age, not nationality.&#x0D; CONCLUSIONS: The Fracture Risk Assessment (FRAX) model and intervention threshold can be applied to all residents of Kazakhstan.

Metabolic properties of irisin in health and in diabetes mellitus

Irisin is a polypeptide hormone of muscle tissue (myokine), the synthesis and secretion of which increase against the background of physical exertion, which plays a significant role in the metabolism of fat, muscle and bone tissues. It is known that irisin promotes the transformation of white adipose tissue into brown adipose tissue. It has also been experimentally proven that the introduction of irisin contributed to an increase in bone mass and the prevention of osteoporosis and muscular atrophy. There are works indicating a positive effect of irisin in the functioning of bone, fat and muscle tissues in humans. Diabetes mellitus (DM) is an independent risk factor for osteoporotic fractures and the development of specific diabetic myopathy, at the cellular level similar to the aging of muscle tissue, and type 2 diabetes is also associated with the presence of obesity. Thus, it is of particular interest to study the effect of irisin on the state of bone, muscle and adipose tissues and glucose homeostasis in patients with diabetes. This literature review highlights the biological functions of irisin in healthy people and patients with DM.

Effect of Body Surface Area on Severe Osteoporotic Fractures: A Study of Osteoporosis in Changsha China.

Clinical vertebral fractures and femoral neck fractures are severe osteoporotic fractures that increase morbidity and mortality. Anthropometric variables are associated with an increased risk of osteoporotic fractures, but it is not clear whether body surface area (BSA) has an effect on clinically severe osteoporotic fractures. The study included total of 3,694 cases of clinical vertebral fractures and femoral neck fractures (2,670 females and 1,024 males) and 3,694 controls without fractures who were matched with the cases by sex and age. There was a significant positive correlation between BSA and bone mineral density (BMD) in female and male fracture patients (females: r = 0.430–0.471, P < 0.001; males: r = 0.338–0.414, P < 0.001). There was a significant systematic increase in BMD in both genders at various skeletal sites, grouped by BSA quartile. The osteoporosis rates of the lumbar spine (97.9%), femoral neck (92.4%) and total hip (87.1%) in the female Q1 group were significantly higher than those in the Q4 group (P < 0.001), which were 80.0%, 57.9% and 36.9%, respectively, in the Q4 group; the osteoporosis rates of the lumbar spine, femoral neck, and total hip were 53.9%, 59.4%, and 36.3% in the male Q1 group, and 15.2%, 21.9%, and 7.03% in the Q4 group, which were significantly lower than those in the Q1 group (P < 0.001). In age-adjusted Cox regression models, the risk of fracture in the remaining three groups (Q2, Q3, and Q4) for weight, BMI, and BSA for both genders, compared with the highest quartile (Q1 by descending quartile stratification) were significantly higher. In models adjusted for age and BMD, only men in the BSA Q3 (HR = 1.55, 95% CI = 1.09–2.19) and BSA Q4 groups (HR = 1.41, 95% CI = 1.05–1.87) had significantly higher fracture risks. In models adjusted for age, height, weight, BMI, and BSA, low BMD was the greatest fracture risks for both sexes. Our results showed that BSA was closely related to BMD, prevalence of osteoporosis, and fracture risk, and that a decline in BSA may be a new potential risk factor for osteoporotic fractures in Chinese men.

Correlation between Core Strength and Stability with Body Mass Index among Postmenopausal Women.

Women in postmenopausal period of their life face various physical and physiological changes causing lack of estrogen and progesterone hormones, changes in the reproductive and genitals organs, vasomotor system in the body along with mood related symptoms such as anxiety, etc. Lifestyle, body fat distribution and anthropometric changes adds on to the bone strength in postmenopausal women. It may be a risk factor for osteoporotic fracture, cardiovascular, metabolic diseases, etc. Core strength and stability is greatly influenced by body composition and adiposity. The aim of the study was to correlate the core strength assessed with the Body Mass Index (BMI) among postmenopausal women. The objective of the study is to find the correlation between the core strength assessed with the Body Mass Index using 60° flexion test, Beiring Sorenson test and Unilateral Hip Bridge Endurance test among postmenopausal women with age ranging from 46-70 years. 96 healthy postmenopausal women in Karad city with a natural history of menopause were selected for the study. Based upon BMI values, the subjects were grouped as Underweight (&lt;18.5 kg/m2), Normal weight (18.5-24.9 kg/m2), Overweight (25-29.9 kg/m2 and more). The outcome values for strength were correlated with the BMI of postmenopausal women. In the study, the Pearson correlation(r) was -0.361 and the P value was 0.0003 showing extremely significant correlation between the BMI and 60° Flexion test. For the Beiring Sorenson Test, the Pearson correlation value was -0.305 and the P value was 0.0025 showing very significant correlation between the BMI and Beiring Sorenson Test. Correlation of BMI and Unilateral Hip Bridge Endurance Test shows a Pearson Correlation value of -0.322 and the P value 0.0013 claiming very significant correlation between the BMI and Unilateral Hip Bridge Endurance Test. The study concludes that there is a significantly negative correlation between the core strength and stability with the Body Mass Index among postmenopausal women.

P142 Fracture risk in diabetes: to FRAX or not to FRAX?

Abstract Background/Aims Diabetes mellitus is associated with decreased bone strength as well as increased fracture risk. The risk of fragility fracture increases with an increase in the duration of diabetes and worsening of glycemic control. However, this increased fracture risk often goes unidentified. Identifying patients at risk of fracture is fundamental in helping to prevent fractures. WHO FRAX (fracture risk assessment) tool computing the 10-year probability of hip fracture or a major osteoporotic fracture helps ascertain fracture risk. In Type 2 Diabetes Mellitus (T2DM), the diagnosis of osteoporosis by dual-energy X-ray absorptiometry (DXA) and the FRAX are only partially useful in assessing fracture risk. Our aims were: 1. To identify the fracture risk in patients with diabetes and 2. To assess the impact of adding diabetes as a risk factor in the calculation of FRAX score. Methods One hundred patients above the age of 50 years with duration of diabetes above a year who attended the diabetes clinic from December 2020 to June 2021 were included. Data was collected on demographics (age, sex, ethnicity), diabetes-related factors (the type, duration, complications and medications) and clinical risk factors for osteoporotic fracture (parental fracture, previous fracture, smoking, alcohol intake) from patient interviews and the FRAX score was calculated. FRAX tool was modified for diabetes by adding either 10 years of age or Rheumatoid arthritis as risk factor. Results Mean age of our cohort of patients was 67 years and their mean BMI was 33 kg/sq m. Duration of diabetes was over 5 years in 95% of the patients. T2DM was seen in 82% and Type 1 Diabetes mellitus (T1DM) in 18%. The mean HbA1c was 8.4%. Unadjusted mean FRAX score for a major osteoporotic fracture was 8.9% and hip fracture 2.3%. High risk of future fracture was seen in 4% of the patients and intermediate risk in 23% and low risk in 73%. Four patients had Rheumatoid arthritis and 21 had previous fragility fractures. Modifying the FRAX tool by adding 10 years to age moved 15% more patients to the intermediate-risk category needing DXA and 5% more to the high-risk category needing osteoporosis treatment. However, adding Rheumatoid arthritis changed 20% more patients to the intermediate-risk category needing DXA and 7% more to the high-risk category needing osteoporosis treatment. Conclusion Modifying FRAX tool in patients with diabetes mellitus will enable more patients to have a DXA scan and to receive osteoporosis treatment and the strategy using rheumatoid arthritis as a risk factor identified more patients than adding 10 years of age. Disclosure M. Mathew: None. S. Dwivedi: None. H. Buch: None. S. Venkatachalam: None.

The association of OPG polymorphisms with risk of osteoporotic fractures: A systematic review and meta-analysis.

Background:Subjects with low bone mineral density and osteoporosis are more likely to suffer osteoporotic fractures during their lifetime. Polymorphisms in osteoprotegerin (OPG) gene are found to be associated with low bone mineral density and osteoporosis risk but their association with fracture risk is inconclusive. Here, we performed a meta-analysis to investigate the relationship between OPG polymorphisms with susceptibility to osteoporotic fractures.Methods:Eligible studies investigating the association between common OPG polymorphisms (A164G, T245G, T950C, and G1181C) and risk of osteoporotic fracture were retrieved from PubMed, EMBASE, Web of Science, and the Cochrane Library. Odds ratio (OR) and the 95% confidence interval (CI) were calculated in the allelic, dominant, recessive, and homozygous model. Subgroup analyses of vertebral fractures, Caucasians, and postmenopausal women were also performed.Results:A total of 14 studies comprising 5459 fracture cases and 9860 non-fracture controls were included. A163G was associated with fracture risk in dominant (OR = 1.29, 95%CI 1.11–1.50), recessive (OR = 1.64, 95%CI 1.10–2.44), and homozygous model (OR = 1.73, 95%CI 1.16–2.59). T245G was significantly correlated with susceptibility to fractures in all genetic models. Subjects with CC genotype of T950C had a reduced risk of fracture compared to those with CT or TT genotypes (OR = 0.81, 95%CI 0.70–0.94, P = .004). Subgroup analysis showed that A163G and T245G but not T950C and G1181C were associated with vertebral fracture risk.Conclusion:OPG A163G and T245G polymorphisms were risk factors of osteoporotic fractures while T950C had a protective role. These polymorphisms can be used as predictive markers of fractures.

Correlation between Core Strength and Stability with Body Mass Index among Postmenopausal Women.

Women in postmenopausal period of their life face various physical and physiological changes causing lack of estrogen and progesterone hormones, changes in the reproductive and genitals organs, vasomotor system in the body along with mood related symptoms such as anxiety, etc. Lifestyle, body fat distribution and anthropometric changes adds on to the bone strength in postmenopausal women. It may be a risk factor for osteoporotic fracture, cardiovascular, metabolic diseases, etc. Core strength and stability is greatly influenced by body composition and adiposity. The aim of the study was to correlate the core strength assessed with the Body Mass Index (BMI) among postmenopausal women. The objective of the study is to find the correlation between the core strength assessed with the Body Mass Index using 60° flexion test, Beiring Sorenson test and Unilateral Hip Bridge Endurance test among postmenopausal women with age ranging from 46-70 years. 96 healthy postmenopausal women in Karad city with a natural history of menopause were selected for the study. Based upon BMI values, the subjects were grouped as Underweight (&lt;18.5 kg/m2), Normal weight (18.5-24.9 kg/m2), Overweight (25-29.9 kg/m2 and more). The outcome values for strength were correlated with the BMI of postmenopausal women. In the study, the Pearson correlation(r) was -0.361 and the P value was 0.0003 showing extremely significant correlation between the BMI and 60° Flexion test. For the Beiring Sorenson Test, the Pearson correlation value was -0.305 and the P value was 0.0025 showing very significant correlation between the BMI and Beiring Sorenson Test. Correlation of BMI and Unilateral Hip Bridge Endurance Test shows a Pearson Correlation value of -0.322 and the P value 0.0013 claiming very significant correlation between the BMI and Unilateral Hip Bridge Endurance Test. The study concludes that there is a significantly negative correlation between the core strength and stability with the Body Mass Index among postmenopausal women.

Hip geometry in hip fracture patients in Greenland occurring over a 7.7-year period

BackgroundHip geometry influences hip fracture risk. Hip fractures are common, and they are associated with pain, disability, premature death and marked costs on society. Osteoporotic fractures are frequent in Arctic populations and increase with advancing age in this society with a steep rise in life expectancy. Greenland Inuit is a distinct ethnic group, and data on hip geometry is missing. We thus aimed to describe hip geometry in 7.7 years of consecutive hip fracture patients in Greenland.MethodsWe evaluated collodiaphysial angle, femoral neck length, the outer and inner diameter of the femur at 2 and 5 centimetres below the centre of the lesser trochanter and the cortical thickness from pelvic and hip radiographs in all patients operated in Greenland over 7.7 years. We included all 84 patients with one non-fractured hip visible for geometric analysis. Analyses were conducted in duplicate.ResultsWe found a collodiaphysial angle of 134.8/132.6o in men/women (p = 0.06) and a femoral neck length of 38.0/33.9 mm in men/women (p = 0.001). Cortical thickness was affected by sex in the adjusted analysis (p < 0.001). Cortical thickness index at 5 cm below the centre of the lesser trochanter decreased with age (p = 0.026) and may be influenced by height (2 cm below the centre of the lesser trochanter, p = 0.053).ConclusionOur findings differed from European data and suggest a delicate balance in hip geometry in Arctic populations. Ethnic peculiarities influence the structure of the hip and may influence fracture risk. A focus on hip geometry and risk factors for osteoporotic fractures in Arctic populations is warranted.

Clinical Risk Factors for Osteoporotic Fractures in Men With Non-Metastatic Prostate Cancer on Androgen Deprivation Therapy With or Without Anti-Osteoporosis Treatment

Introduction: Androgen deprivation therapy (ADT) decreases bone mineral density and increases osteoporotic fracture (OsteoFx) risk. Hypothesis: To assess OsteoFx clinical risk factors (CRF) most predictive of future OsteoFx among men with prostate cancer on ADT. Methods: 4370 electronic medical records were reviewed of adult men with prostate cancer on cancer therapy +/- anti-osteoporosis therapy (Anti-OsteoRx) from 2011–2019. Cancer therapy included ADT (anti-androgens, GnRH agonists & antagonists, orchiectomy) and supplemental cancer therapy (SupplRx) (prostatectomy, brachytherapy, radiation, immunotherapy, and chemotherapy). Anti-OsteoRx included bisphosphonates, denosumab, and parathyroid hormone analogs. Patients with other cancers within 5 years of initial visit, metastasis, and traumatic fractures were excluded. Retrospective analysis was done to determine baseline characteristics, type and duration of ADT, Anti-OsteoRx, SupplRx, and osteoporosis CRF. Results: 615 men on ADT +/- SupplRx +/- Anti-OsteoRx were included in the study. 10.08% had OsteoFx irrespective of SupplRx or Anti-OsteoRx. Comparing the OsteoFx group to the non-fracture group, the following CRF were found to be statistically significant (p <0.05): age at prostate cancer diagnosis (75.10 +/- 11.80 vs 71.59 +/- 9.80 y), diabetes mellitus (DM) (33.9 vs 19%), pre-existing comorbidities affecting bone (PreCo) (41.9 vs 24.8%), steroid use (11.3 vs 4.0%), and anti-convulsant and proton-pump inhibitor (med) use (45.2 vs 26.8%).9.89% of 374 men on ADT only without (wo) Anti-OsteoRx fractured. Statistically significant CRF for OsteoFx were age (76.86 +/- 10.55 vs 73.02 +/- 10.06 y), DM (40.5 vs 19.6%), PreCo (45.9 vs. 26.4%), and med use (48.6 vs. 25.5%).In the following subgroups there were no statistically significant difference in CRF:•7.64% of 170 men on ADT + SupplRx wo Anti-OsteoRx •19.23% of 52 men on ADT only + Anti-OsteoRx •10.52% of 19 men on ADT + SupplRx + Anti-OsteoRxTo increase statistical power, patients on ADT +/- SupplRx were assessed:•Among 71 men on ADT +/- SupplRx + Anti-OsteoRx, there were no statistically significant differences in CRF•Among the 544 men on ADT +/- SupplRx wo Anti-OsteoRx, significant CRF for OsteoFx were age (75.16 + 11.70 vs 71.37 + 9.85 y), DM (38 vs 19.4%), PreCo (38 vs 24.1%), steroid use (12 vs 3.8%), and med use (48 vs 24.3%)Discussion: Men with prostate cancer requiring ADT have a higher incidence of osteoporosis defined by DXA prior to initiating ADT compared to age-matched cohorts (Hussain et al). Our study revealed ADT with CRF is associated with OsteoFx irrespective of SupplRx or Anti-OsteoRx. Limitations include inability to evaluate efficacy of Anti-OsteoRx due to insufficient power. Conclusion: OsteoFx risk assessment utilizing CRF, FRAX, DXA with timely intervention may prevent OsteoFx in these high-risk patients.

Detecting pathological features and predicting fracture risk from dual-energy X-ray absorptiometry images using deep learning

Dual-energy X-ray absorptiometry (DXA) is the gold standard imaging method for diagnosing osteoporosis in clinical practice. The DXA images are commonly used to estimate a numerical value for bone mineral density (BMD), which decreases in osteoporosis. Low BMD is a known risk factor for osteoporotic fractures. In this study, we used deep learning to identify lumbar scoliosis and structural abnormalities that potentially affect BMD but are often neglected in lumbar spine DXA analysis. In addition, we tested the approach's ability to predict fractures using only DXA images. A dataset of 2949 images gathered by Kuopio Osteoporosis Risk Factor and Prevention Study was used to train a convolutional neural network (CNN) for classification. The model was able to classify scoliosis with an AUC of 0.96 and structural abnormalities causing unreliable BMD measurement with an AUC of 0.91. It predicted fractures occurring within 5 years from the lumbar spine DXA scan with an AUC of 0.63, meeting the predictive performance of combined BMD measurements from the lumbar spine and hip. In an independent test set of 574 clinical patients, AUC for lumbar scoliosis was 0.93 and AUC for unreliable BMD measurements was 0.94. In each classification task, neural network visualizations indicated the model's predictive strategy. We conclude that deep learning could complement the well established DXA method for osteoporosis diagnostics by analyzing incidental findings and image reliability, and improve its predictive ability in the future.