Suboptimal Bone Health Research Articles

Effects of age, sex, and ethnicity on bone health status of the elderly in Kuala Lumpur, Malaysia.

BackgroundOsteoporosis is a significant health problem in the developing countries and its prevalence data are important for the estimation of health care burden and policy making. This study aimed to determine the age-related changes in bone health and the prevalence of osteoporosis in males and females aged 50 years or above living in Kuala Lumpur, Malaysia.MethodsA cross-sectional study was conducted between December 2014 and December 2015. Subjects answered a demographic questionnaire and underwent body anthropometric and bone health measurement. Assessment of bone health was performed using a quantitative ultrasound device that generated speed of sound, broadband ultrasound attenuation, stiffness index, and T-score based on stiffness index value as bone health indices.ResultsThe prevalence of osteoporosis was 10.6% in males and 8.0% in females. Significant age-related decline of bone health indices (speed of sound, broadband ultrasound attenuation, stiffness index, and T-score) and a concurrent increase in the prevalence of osteoporosis and osteopenia were observed in females (P<0.05) but not in males (P>0.05). Ethnic differences in bone health indices and prevalence of osteoporosis/osteopenia were not observed (P>0.05).ConclusionA significant proportion of males and females age 50 years or above have suboptimal bone health. Preventive measures such as early screening should be implemented to retard the progression of osteoporosis.

Lessons from the Bone Chapter of the Malaysian Aging Men Study.

Male osteoporosis in Malaysia is a largely neglected problem. Therefore, a bone health study in men using quantitative ultrasonometry was launched as part of the Malaysian Aging Men Study in 2009–2012. This review aimed to summarize the findings of the aforementioned bone health study. The study examined the bone health of Chinese and Malaysian men aged 20 years and above living in Kuala Lumpur using a quantitative ultrasound device. Participants answered a questionnaire on their demographic details and physical activity status. Body anthropometry of the participants was measured and their blood collected for biochemical analysis. Results showed that a significant proportion of the Malaysian Chinese and Malay men had suboptimal bone health indicated by calcaneal speed of sound and vitamin D status. Age-related decline of the calcaneal speed of sound in these men was gradual and biphasic without ethnic difference. Body anthropometry such as height, weight, body mass index, and body fat percentage contributed to the variation of the calcaneal speed of sound in Malaysian men. Age-related changes in testosterone, insulin-like growth factor 1, and thyroid stimulating hormone also influenced the calcaneal speed of sound in these men. This study serves as a reminder that male osteoporosis in Malaysia should be an issue of concern. It is also a basis for a more comprehensive study on bone health in men in the future.

Sport Practice And Occurrence Of Bone Fracture In Adolescents During 9-months Of Follow-up

BACKGROUND: Sports participation has many benefits for adolescent health, including improvement of skeleton. However, involvement in different levels of sport impact may attain suboptimal bone health, which could lead to an increased risk for bone fractures. PURPOSE: To analyze the risk of fractures in adolescents engaged in different levels of sports impact. METHODS: 137 adolescents (92 boys and 45 girls) with mean age of 12.8±1.7 years were selected at public schools and sport clubs and they were evaluated during a nine month period. The adolescents were divided into three groups according to sport practice: Sedentary (n= 29), Swimming (n= 19) and Impact Sports (n= 82 [soccer, basketball, judo, karate and kung-fu]). Maturation status was indicated by age at peak height velocity (APHV). The coaches, parents and adolescents themselves reported bone fractures. Statistical analysis was composed of chi-square test and Cox Regression (Hazard ratio [HR] and its 95%CI [95%CI]) adjusted by sex, age, engagement in resistance training and APHV. RESULTS: Seven fractures were observed during the cohort study (5.1% [95%CI= 1.4 to 8.8]). Sex (p-value= 1.000), APHV (p-value= 0.621) and engagement in resistance training (p-value= 0.387) were not associated to fracture, while sport practice was (Sedentary= 13.8%, Swimming= 3.8% and Impact Sports= 2.4%; p-value= 0.025). The risk of fracture after 9-months of follow-up was lower in adolescents engaged in impact sports than in non-active ones (Control HR=1.00; Swimming HR=0.049 [95%CI= 0.002 to 1.016]; Impact Sports HR=0.063 [95%CI= 0.006 to 0.675]). CONCLUSION: The occurrence of bone fractures was lower in adolescents involved in high-impact sports compared to low-impact sports and sedentary adolescents.

New insights in professional horse racing; “in-race” heart rate data, elevated fracture risk, hydration, nutritional and lifestyle analysis of elite professional jockeys

ABSTRACTWeight-making practices have been shown to impair musculoskeletal and physiological function of jockeys. This study investigated the “in-race” heart rate (HR) responses and hydration status during competitive racing, as well as selected physiological and lifestyle parameters of professional jockeys based in Hong Kong. “In-race” HR responses and early morning hydration status of 20 male jockeys were examined in hot and moderate climactic occasions. Additionally, bone mineral density (BMD), dietary intake and lifestyle choices were assessed. Osteopenia was observed in the calcanei of jockeys (left: 0.51 ± 0.06; right: 0.46 ± 0.12 g · cm−2). Energy and protein intake were significantly lower on a race day compared to a non-race day (P < 0.05). “In-race” HRmax values were similar to those from VO2max laboratory tests (186 ± 14 vs. 185 ± 8 bpm). Hypohydration was observed on both racing days. (USG: 1.0247 ± 0.006 and 1.0256 ± 0.0258 mg · L−1 for hot and moderate conditions, respectively). Sauna usage (25.5%) and food restriction (20.4%) were the most common weight-making practices. Current lifestyle choices of jockeys result in suboptimal bone health, hydration status and nutritional intake, which can significantly enhance the fracture risk. Further research should develop exercise and nutrition guidelines for optimising their skeletal health.

Bone Health Care for Patients With Prostate Cancer Receiving Androgen Deprivation Therapy

Patients with prostate cancer often receive androgen deprivation therapy (ADT) as part of their treatment regimen. However, treatment with ADT causes multiple side effects, including reduced bone mineral density (BMD), lower lean body mass, and a higher risk for fractures. Several organizations provide clinical practice guidelines for osteoporosis screening, prevention, and treatment in this population, but adherence to these guidelines remains low. Areas for improvement in provider adherence include baseline and follow-up BMD testing, as well as counseling regarding healthy bone behaviors such as calcium/vitamin D intake, lifestyle changes, and physical exercise. Comparison of osteoporosis care in breast cancer and non-oncology populations shows that suboptimal bone health care is not isolated to prostate cancer. A summary of the literature examining improvements in patient adherence and provider delivery of bone health care is included in this review, but high-quality studies are lacking. Patients may be the most receptive to written educational information delivered at or near the time of ADT initiation. Involvement of a primary care practitioner and oncologist in care delivery is associated with higher BMD test use. Institution-level programs that automatically initiate osteoporosis screening and management may be effective at reducing the incidence of hip fracture. Lastly, suggestions are provided for future approaches to knowledge translation and quality of care studies to improve bone health.

Bone Mineral Density and Vitamin D Status Among African American Children With Forearm Fractures

To determine whether African American children with forearm fractures have decreased bone mineral density and an increased prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D level ≤ 20 ng/mL) compared with fracture-free control patients. This case-control study in African American children, aged 5 to 9 years, included case patients with forearm fracture and control patients without fracture. Evaluation included measurement of bone mineral density and serum 25-hydroxyvitamin D level. Univariable and multivariable analyses were used to test for associations between fracture status and 2 measures of bone health (bone mineral density and 25-hydroxyvitamin D level) while controlling for other potential confounders. The final sample included 76 case and 74 control patients. There were no significant differences between case and control patients in age, gender, parental education level, enrollment season, outdoor play time, height, or mean dietary calcium nutrient density. Cases were more likely than control patients to be overweight (49.3% vs 31.4%, P = .03). Compared with control patients, case patients had lower whole body z scores for bone mineral density (0.62 ± 0.96 vs 0.98 ± 1.09; adjusted odds ratio 0.38 [0.20-0.72]) and were more likely to be vitamin D deficient (47.1% vs 40.8%; adjusted odds ratio 3.46 [1.09-10.94]). These data support an association of lower bone mineral density and vitamin D deficiency with increased odds of forearm fracture among African American children. Because suboptimal childhood bone health also negatively impacts adult bone health, interventions to increase bone mineral density and correct vitamin D deficiency are indicated in this population to provide short-term and long-term benefits.

Vitamin D and K status influences bone mineral density and bone accrual in children and adolescents with celiac disease

Children with celiac disease (CD) are at risk for decreased bone mineral density (BMD) because of fat-soluble vitamin malabsorption, inflammation and/or under-nutrition. The study objective was to determine the interrelationships between vitamin K/D status and lifestyle variables on BMD in children and adolescents with CD at diagnosis and after 1 year on the gluten-free diet (GFD). Children and adolescents aged 3-17 years with biopsy proven CD at diagnosis and after 1 year on the GFD were studied. BMD was measured using dual-energy X-ray absorptiometry. Relevant variables included: anthropometrics, vitamin D/K status, diet, physical activity and sunlight exposure. Whole-body and lumbar-spine BMD-z scores were low (< or = -1) at diagnosis (10-20%) and after 1 year (30-32%) in the children, independent of symptoms. Whole-body BMD-z scores (-0.55±0.7 versus 0.72±1.5) and serum levels of 25(OH) vitamin D (90.3±24.8 versus 70.5±19.8 nmol/l) were significantly lower in older children (>10 years) when compared with younger children (< or =10 years) (P<0.001). Forty-three percent had suboptimal vitamin D status (25(OH)-vitamin D <75 nmol/l) at diagnosis; resolving in nearly half after 1 year on the GFD. Twenty-five percent had suboptimal vitamin K status at diagnosis; all resolved after 1 year. Children and adolescents with CD are at risk for suboptimal bone health at time of diagnosis and after 1 year on GFD; likely due in part to suboptimal vitamin D/K status. Therapeutic strategies aimed at optimizing vitamin K/D intake may contribute to improved BMD in children with CD.

Skeletal Health of Children and Adolescents With Inflammatory Bowel Disease

Current evidence points to suboptimal bone health in children and adolescents with inflammatory bowel disease (IBD) when compared with their healthy peers. This compromise is evident from diagnosis. The clinical consequences and long-term outcome of this finding are still unknown. The mechanism of suboptimal bone health in children and adolescents with IBD lays mainly in reduced bone formation, but also reduced bone resorption, processes necessary for bone growth. Factors contributing to this derangement are inflammation, delayed growth and puberty, lean mass deficits, and use of glucocorticoids. We recognize that evidence is sparse on the topic of bone health in children and adolescents with IBD. In this clinical guideline, based on current evidence, we provide recommendations on screening and monitoring bone health in children and adolescents with IBD, including modalities to achieve this and their limitations; monitoring of parameters of growth, pubertal development, and reasons for concern; evaluation of vitamin D status and vitamin D and calcium intake; exercise; and nutritional support. We also report on the current evidence of the effect of biologics on bone health in children and adolescents with IBD, as well as the role of bone active medications such as bisphosphonates. Finally, we summarize the existing numerous gaps in knowledge and potential subjects for future research endeavors.

Dawn of the “Bone Phenotype” in Cystic Fibrosis

To the Editor.— We read with interest the recent article by Grey et al,1 which illustrated admirably the extent of suboptimal bone health and vitamin D and K status among a pediatric population with cystic fibrosis (CF) with relatively well preserved lung function. They appropriately suggested that the vitamin deficiencies observed may be causative and explain the low bone mass and turnover detected as reflected by the measured bone biomarkers. At our tertiary referral center, we previously examined similar relationships between fat-soluble vitamin deficiencies, bone fragility, and pulmonary function in …

Bone health and back pain: What do we know and where should we go?

Bone health is generally not considered in patients who present with chronic back pain. Nonetheless, bone health and back pain share common genetic and environmental correlates suggesting a co-dependence. Evidence exists for a relationship between back pain and impaired bone health. Here we present the evidence, theoretic framework and clinical relevance. Bone health and back pain are important determinants of musculoskeletal health. Back pain experienced in youth is a risk factor for future back pain, while suboptimal bone health during development increases the risk of skeletal fragility in later life. Generally, bone health is not considered in patients with chronic back pain who do not demonstrate other well-recognised bone health risk factors or associated conditions. Nonetheless, evidence suggests that back pain and impaired bone health share common environmental and genetic correlates, indicating that bone health ought to be considered in the context of back pain in otherwise healthy individuals. This review describes the likely mechanisms explaining the relationship between back pain and impaired bone health, evidence concerning the relationship and suggestions for future research. A narrative literature search was conducted using CINAHL, Medline, PubMed and Web of Science electronic databases. A history of back pain is associated with decreased bone mineral density in adults, yet this tends to be site-specific. No studies were identified examining this association in youth, yet the negative effects of childhood skeletal trauma and obesity on bone and spinal health provide indirect evidence for an association. Further research is required to clarify the impact of back pain on bone health at different lifespan stages using prospective cohort designs.

Report on the vitamin D status of adult and pediatric patients with inflammatory bowel disease and its significance for bone health and disease

Vitamin D is a hormone responsible for calcium homeostasis and essential for bone mineralization throughout the lifespan. Recent studies revealed a high prevalence of hypovitaminosis D among healthy adults and children, especially in the northern hemisphere, and a link between this condition and suboptimal bone health. Moreover, maintenance of what are today considered optimal vitamin D stores has not been achieved throughout the year with currently recommended daily intake for vitamin D. The prevalence of hypovitaminosis D is even higher among adults with inflammatory bowel disease (IBD), a situation that may be caused by malabsorption and gastrointestinal losses through an inflamed intestine, among other factors. In children with IBD, existing reports of vitamin D status are scarce. The relationship between vitamin D status and bone health, although well-established in healthy adults and children, has been controversial among adults and children with IBD, and the reasons for this have not been investigated to date. Studies in animal models of colitis and in vitro human studies support a role of vitamin D in the regulation of the immune system of the gut and the potential of vitamin D and its derivatives as therapeutic adjuncts in the treatment of IBD. This role of vitamin D has not been investigated with translational studies to date. Currently, there are no guidelines for monitoring vitamin D status, treating hypovitaminosis D, and maintaining optimal vitamin D stores in patients with IBD. These tasks may prove particularly difficult because of malabsorption and gastrointestinal losses that are associated with IBD.