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Context: Osteoporosis is becoming a global epidemic in aging societies. Anti-osteoporotic medications can prevent fractures, and their pleiotropic effect on mortality is interesting but not well compared among each other. Objective: To provide real-world evidence on the pleiotropic effect of different anti-osteoporotic medications on all-cause mortality, stratified by fracture site, sex, and age. Methods: This longitudinal population-based postfracture cohort study, included mega-data from subjects ≥40 years of age with osteoporotic fracture who used anti-osteoporotic medications as recorded in Taiwan's National Health Insurance Research Database from 2009 to 2017 and followed until 2018. A multivariate Cox proportional hazards model with immortal time bias was used to assess the relationship between fracture sites and mortality stratified by anti-osteoporosis medication. Results: A total of 46 729 subjects with an average age of 74.45 years (80.0% female) and a mean follow-up period of 4.73 years were enrolled. In the total fracture group, compared with raloxifene and bazedoxifene, we found that alendronate/risedronate (hazard ratio [HR] 0.83; 95% CI, 0.79-0.88), denosumab (HR 0.86; 95% CI, 0.81-0.91), and zoledronic acid (HR 0.78; 95% CI, 0.73-0.84) resulted in significantly lower mortality. Similar trends were observed in the hip, vertebral, or nonhip/nonvertebral fracture groups. Subjects receiving long-acting zoledronic acid showed the lowest mortality in the subanalysis according to sex or age over 65 years. Conclusion: This real-world mega-data study suggests that the usage of osteoporotic medication, especially a long-acting regimen, may lower postfracture mortality. [ABSTRACT FROM AUTHOR]

Age-associated low bone mass disease is a growing problem in the US. Development of osteoanabolic therapies for treating skeletal fragility has lagged behind anti-catabolic therapies, but several bone-building molecules are clinically available. We reported previously that antibody-based neutralization of the Lrp5/Lrp6 inhibitor Dkk1 has minimal effects on bone gain, but can potentiate the already potent osteoanabolic effects of sclerostin inhibition (another Lrp5/Lrp6 inhibitor highly expressed by osteocytes). In this communication, we test whether an optimized ratio of sclerostin and Dkk1 antibodies (Scl-mAb and Dkk1- mAb, respectively), administered at low doses, can maintain the same bone-building effects as higher dose SclmAb, in adult (6 months of age) and aged (20 months of age) wild-type mice. A 3:1 dose of Scl-mAb:Dkk1- mAb at 12.5 mg/kg was equally efficacious as 25 mg/kg of Scl-mAb in both age groups, using radiographic (DXA, µCT), biomechanical, (3-point bending tests), and histological (fluorochrome-based bone formation parameters) outcome measures. For some bone properties, including trabecular thickness and bone mineral density in the spine, and endocortical bone formation rates in the femur, the 3:1 treatment was associated with significantly improved skeletal properties compared to twice the dose of Scl-mAb. Cortical porosity in aged mice was also reduced by both Scl-mAb and low-dose 3:1 treatment. Overall, both treatments were efficacious in the mature adult (6 mo.) and aged (20 mo.) skeletons, suggesting Wnt targeting is a viable strategy for improving skeletal fragility in the very old. Further, the data suggest that low dose of combination therapy can be at least equally efficacious as higher doses of Scl-mAb monotherapy. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19), which is caused by an infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly becoming a worldwide epidemic and poses a significant threat to human life and health. SARS-CoV-2 can cause damage to organs throughout the body through ACE2 receptors. It may have direct and indirect effects on osteoclasts, and osteoblasts and lead to osteoporosis. Vitamin D (VitD) is a key hormone for bone health and has immunomodulatory actions of relevance in the context of the COVID)19 pandemic. Vitamin D deficiency has a significant positive association with both infection and the mortality rate of COVID-19. Elderly patients infected by COVID-19 were more likely to develop acute respiratory distress syndrome (ARDS), which was primarily caused by an inflammation storm. The production of proinflammatory cytokines increases with COVID-19 infection and immobilization may result in bone loss and bone resorption in seriously ill patients, especially aging patients. It is well known that glucocorticoids are beneficial in the treatment of acute respiratory distress syndrome (ARDS) because they reduce inflammation and improve the functioning of the lung and extrapulmonary organs. Glucocorticoid therapy is widely used to treat patients with COVID-19 in most parts of the world. During COVID-19 clinical treatment, glucocorticoids may accelerate bone loss in elderly people, making them more susceptible to the development of osteoporosis. Therefore, it is worthwhile to draw the attention of clinicians and researchers to the linkages and interactions between COVID-19, glucocorticoids, and osteoporosis (especially in elderly patients). [ABSTRACT FROM AUTHOR]

Background Deficiency in some of the water-soluble vitamins such as vitamin B9 (folate) and vitamin B12 (cobalamin) is associated with multiple diseases seen in the elderly, for example, anemia, dementia, Alzheimer's disease, cancers, and osteoporosis. This study, using enzyme-linked immunosorbent assay, aimed to determine the serum levels of vitamins B9 (folate) and B12 (cobalamin)/homocysteine in the elderly. Packed cell volume and mean corpuscular volume were correlated with these vitamins. Materials and methods This was a descriptive, cross-sectional study done at the geriatric clinic of Lagos State University Teaching Hospital (LASUTH) Ikeja, Lagos, Nigeria. Following the receipt of the Institution's Ethics Committee approval, elderly participants, aged 65 years and above were recruited consecutively. Their blood was collected into EDTA and plain bottles for the determination of full blood count and folate and vitamin B12/homocysteine, respectively. Data were analyzed with the Statistical Package for the Social Sciences (SPSS) version 23.0. The P value was set at less than or equal to 0.05. Results A total of 90 participants were recruited consisting of 50 (55.6%) females and 40 (44.4%) males. The overall mean folate, vitamin B12, and homocysteine were 7.64 ± 2.39 ng/ml, 514 ± 237.95 pg/ml, and 8.37 ± 6.88, respectively. Only 2.2 and 1.1% of the elderly had vitamin 12 and folate deficiencies, respectively, and 13.3% had elevated homocysteine. Packed cell volume was statistically significantly correlated with folate, vitamin B12, mean corpuscular volume, and homocysteine (P=0.001). Conclusion Vitamin B12 and folate deficiencies are uncommon in the elderly population in Lagos. The incidence of hyperhomocysteinemia is also low among them. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Combined osteopenia/osteoporosis and sarcopenia is a major public health problem for old adults. In this study, we aimed to evaluate the impacts of combined osteopenia/osteoporosis with sarcopenia on balance and quality of life in patients older than 65 years. METHODS: In this sudy, 77 patients with sarcopenia, who were older than 65 years, were included. The diagnosis of sarcopenia was made according to the diagnostic criteria developed by The European Working Group on Sarcopenia in Older People (EWGSOP). Bone densitometry was performed to screen for osteoporosis or osteopenia. The balance was assessed with the anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and the general stability index (OSI), which were calculated using a Biodex Stability System device (BSS). The quality of life was assessed using SF-36. RESULTS: Patients with sarcopenia were included in this study. Of them, 40 had osteoporosis and 37 had osteopenia. The measures of balance and the OSI, APSI, and MLSI values were low in both groups of patients, but they were statistically significantly lower in the sarcopenia with osteoporosis group compared to the sarcopenia with osteopenia group (p=0.01; p=0.002; p=0.04, respectively). The quality of life was lower in all sub-categories of SF-36, excluding the mental health when sarcopenia was accompanied by osteoporosis compared to the joint occurrence of sarcopenia with osteopenia (p<0.05). CONCLUSION: Our study suggests that the joint occurrence of osteoporosis with sarcopenia is associated with a risk of balance loss, a decrease in quality of life, and a potentially increased fracture risk in older adults. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the age-dependent changes of the spine in postmenopausal women with adult scoliosis. Methods: We screened 180 postmenopausal women who presented within a year for an X-ray evaluation in our Radiology Department. Only postmenopausal women without previous surgery of the spine and with a Cobb's angle of more than 10° were included in the analysis. The acquired X-rays were assessed with the 'SCODIAC' software - evaluating the Cobb's angle, Ferguson's angle, the vertebrae's rotation and the overall torsion of the spinal cord. Results: 60/180 women met the inclusion and exclusion criteria and were included in the analysis, in four agegroups (per decade of age) of equal number of subjects (N=15). Their mean age was 70,5 years and mean age of menopause was 50 years. 23% were classified as 'obese', 52% 'overweight' and 25% 'normal'. Mean BMI was 27.45 Kgr/m². 28% were not screened for osteoporosis. 22% of the evaluated subjects had osteoporosis, 38% osteopenia and 12% were normal. The percentage of individuals suffering from degenerative scoliosis, was 27%, 67%, 87% and 73% for each age group respectively. The average of the overall torsion was 23.9o, 19.5o,23.7o and 32,1o. Percentage of subjects without any participation in 'exercise' was 47%, 40%, 87% and 67% respectively. Conclusion: Postmenopausal women presenting primary or secondary osteoporosis alongside high 'BMI' index and/or low levels of physical activity, are prone to cumulative degeneration of the spine resulting in clinical and sub-clinical scoliosis. [ABSTRACT FROM AUTHOR]

The cause of chronic inflammatory periodontitis, which leads to the destruction of periodontal ligament and alveolar bone, is multifactorial. An increasing number of studies have shown the clinical significance of NLRP3-mediated low-grade inflammation in degenerative disorders, but its causal linkage to age-related periodontitis has not yet been elucidated. In this study, we investigated the involvement of the NLRP3 inflammasome and the therapeutic potential of NLRP3 inhibition in age-related alveolar bone loss by using in vivo and in vitro models. The poor quality of alveolar bones in aged mice was correlated with caspase-1 activation by macrophages and elevated levels of IL-1β, which are mainly regulated by the NLRP3 inflammasome, in periodontal ligament and serum, respectively. Aged mice lacking Nlrp3 showed better bone mass than age-matched wild-type mice via a way that affects bone resorption rather than bone formation. In line with this finding, treatment with MCC950, a potent inhibitor of the NLRP3 inflammasome, significantly suppressed alveolar bone loss with reduced caspase-1 activation in aged mice but not in young mice. In addition, our in vitro studies showed that the addition of IL-1β encourages RANKL-induced osteoclastogenesis from bone marrow-derived macrophages and that treatment with MCC950 significantly suppresses osteoclastic differentiation directly, irrelevant to the inhibition of IL-1β production. Our results suggest that the NLRP3 inflammasome is a critical mediator in age-related alveolar bone loss and that targeting the NLRP3 inflammasome could be a novel option for controlling periodontal degenerative changes with age. [ABSTRACT FROM AUTHOR]

Introduction: Monoclonal gammopathy of uncertain significance (MGUS) is highly prevalent in older adults and affects bone structure, with osteoporosis and increased risk of fractures in up to 14% of affected patients. Dual-energy X-ray absorptiometry (DXA), the standard technique for diagnosing osteoporosis, is ineffective to reveal microstructure and bone quality in this disease. Materials and methods: We conducted a cross-sectional study of patients with MGUS, recruited consecutively from the Hematology and Internal Medicine Departments of Hospital del Mar, Barcelona, between January 2011 and January 2018. Medical records, clinical results and spinal X-ray images were collected. Bone mineral density (BMD) at hip and spine was measured by DXA and Bone Material Strength index (BMSi) by impact microindentation on the tibial mid-shaft. Results: Thirty-nine patients with MGUS and 65 age-matched controls without previous fractures were included. In the MGUS group, 11 (28.2%) patients had prevalent fractures, nearly half of them vertebral (n = 5, 45.45%). Compared to controls, MGUS patients had significantly lower BMSi, a mean (SD) of 70.72 (9.70) vs. 78.29 (8.70), p = 0.001, and lower spinal BMD values (0.900 [0.159] vs. 1.003 [0.168], respectively, p = 0.012), but no significant differences at femoral neck and total hip. No association was observed between BMSi and DXA. Bone remodeling markers (procollagen type-1 N propeptide, bone-alkaline phosphatase and C-terminal telopeptide of type I collagen) did not differ between the two groups. Conclusions: Spinal BMD and mechanical properties of bone tissue, as measured by impact microindentation, were impaired in patients with MGUS. These changes in bone tissue mechanical resistance were independent of DXA levels. [ABSTRACT FROM AUTHOR]

Deficiency of vitamin D or hypovitaminosis D is widespread irrespective of age, gender, race and geography and has emerged as an important area of research. Vitamin D deficiency may lead to osteoporosis (osteomalacia in adults and rickets in children) along with calcium deficiency. Its deficiency is linked with low bone mass, weakness of muscles and increased risk of fracture. However, further research is needed to link deficiency of vitamin D with extra-skeletal consequences such as cancer, cardiovascular disease, diabetes, infections and autoimmune disorders. The causes of vitamin D deficiency include length and timing of sun exposure, amount of skin exposed, latitude, season, level of pollution in atmosphere, clothing, skin pigmentation, application of sunscreen, dietary factors and genetic factors. The primary source is sunlight, and the dietary sources include animal products such as fatty fish, food items fortified with vitamin D and supplements. Different cut-offs have been used to define hypovitaminosis D and its severity in different studies. Based on the findings from some Indian studies, a high prevalence of hypovitaminosis D was observed among different age groups. Hypovitaminosis D ranged from 84.9 to 100 per cent among school-going children, 42 to 74 per cent among pregnant women, 44.3 to 66.7 per cent among infants, 70 to 81.1 per cent among lactating mothers and 30 to 91.2 per cent among adults. To tackle the problem of hypovitaminosis D in India, vitamin D fortification in staple foods, supplementation of vitamin D along with calcium, inclusion of local fortified food items in supplementary nutrition programmes launched by the government, cooperation from stakeholders from food industry and creating awareness among physicians and the general population may help in combating the problem to some extent [ABSTRACT FROM AUTHOR]

Background: Osteoporosis is a major health problem that is closely related to substantial morbidity, mortality and decline in life quality for the aging population. Although previous studies and epidemiological evidence have demonstrated an association between black tea consumption and the prevention of bone loss, the underlying mechanism remains unclear. So, the effect of black tea extract (BTE) and thearubigins (TRs) on osteoporosis in rats and osteoclast formation in vitro were investigated. Methods: In vivo , ovariectomized (OVX) rats were used to establish osteoporosis models. To validate the model and study the effects of BTE and TRs on osteoporosis, the female Wistar rats were divided into a sham-operated group and five OVX groups including model, Xian-Ling-Gu-Bao (XLGB) (as a positive control), BTE, TRs low-dose, and TRs high-dose group. The rats in the four treatment groups were given the corresponding test sample for 12 weeks. Then, the body weight, femur indices, and serum biomarkers were examined and analyzed. In vitro , RAW264.7 murine macrophages were used as model of osteoclast formation. The effects of BTE and TRs on osteoclasts formation and the specific genes and protein levels of osteoclasts were determined. Results: Although there was no significant effect on the OVX-induced body weight gain by BTE or TRs, the levels of maximum bending force, cortical bone thickness and biomarker of bone resorption (acid phosphatase) can be significantly ameliorated by BTE or TRs in OVX rats. Furthermore, both of BTE and TRs can inhibit the osteoclastogenesis and diminish the expression levels of the related genes and proteins. [ABSTRACT FROM AUTHOR]

Osteoporosis and associated fractures are common in women after midlife and will increase as the population ages. Osteoporosis-related fractures cause a significant increase in morbidity and mortality. Osteoporosis decreases the quality of life and productivity of many older women, with an increasing burden on health-care resources. Future risk of fracture can be managed by evidence-based interventions. It is thus appropriate to estimate the future risk of fracture in all women at the age of 50 years or at menopause, whichever occurs first. This can be achieved in a non-invasive fashion by targeted clinical history-taking. The future risk of fracture can be quantified using computerized models that integrate all risk factors, with or without dual-energy X-ray absorptiometry (DXA). Individuals found to be at increased risk of fracture need also to be assessed by DXA and, in the absence of lateral vertebral assessment, also by conventional X-ray imaging. All women should be screened by DXA at the age of 65 years, if not done before that time. At the age of 50, all women should be informed about a bone-friendly lifestyle. [ABSTRACT FROM AUTHOR]

With growing an aging population, the osteoporosis, also called "silent epidemic" has been paid more and more attention. Both oxidative damage and mechanical stimulation are the main reasons to induce osteoporosis. On the one hand, the oxidative damage can lead to osteoporosis by stimulating FoxOs signals to inhibit osteoblast differentiation, on the other hand, the disuse bone loss can also occur due to lack of load force stimuli with time. There is a close correlation between them. Nrf2 is a main defense mechanism against oxidative damage in cells, which can control various antioxidant protease transcription and plays an important role in the osteoporosis caused by oxidative damage. In this paper, we will review the mechanism of the microgravity and oxidative damage to cause the osteoporosis. The Nrf2 how to regulate and control the oxidative damage, as well as the effects on rehabilitating the bone development is also introduced. [ABSTRACT FROM AUTHOR]

Objective To explore the relationship between senile osteoporosis and the degree of weakness in middle-aged and elderly people，and to provide scientific basis for reducing weakness in the middle-aged and the elderly． Methods Ｒegistered elder people (≥75 years old) from 32 communities under the administration of 10 health service centers in Tangshan were selected from July 2016 to January 2017． The CFAI weak comprehensive evaluation tool was used as questionnaire and osteoporosis was diagnosed according to bone mineral density in the 3 A hospitals． Results The weakness rate of 3448 old persons was 100%， among which the serious weakness rate was 32. 6%． The incidence of osteoporosis among middle-aged and elder people was 11. 46%． Multi-factor analysis showed that age，marital status，education，and osteoporosis were the risk factors of weakness ( P ＜ 0.05)． Conclusion Attention should be paid to the prevention and treatment of senile osteoporosis so as to reduce the degree of weakness in the elder people． [ABSTRACT FROM AUTHOR]

Background: Despite knowing better how to screen older adults, understanding how frailty progression might be modified is unclear. We explored effects of modifiable and non-modifiable factors on changes in frailty in community-dwelling adults aged 50+ years who participated in the Canadian Multicentre Osteoporosis Study (CaMos).Methods: Rates of change in frailty over 10 years were examined using the 30-item CaMos Frailty Index (CFI). Incident and prevalent low-trauma fractures were categorized by fracture site into hip, clinical vertebral and non-hip-non-vertebral fractures. Multivariable generalized estimating equation models accounted for the time of frailty assessment (baseline, 5 and 10 years), sex, age, body mass index (BMI, kg/m2), physical activity, bone mineral density, antiresorptive therapy, health-related quality of life (HRQL), cognitive status, and other factors for frailty or fractures. Multiple imputation and scenario analyses addressed bias due to attrition or missing data.Results: The cohort included 5566 women (mean ± standard deviation: 66.8 ± 9.3 years) and 2187 men (66.3 ± 9.5 years) with the mean baseline CFI scores of 0.15 ± 0.11 and 0.12 ± 0.10, respectively. Incident fractures and obesity most strongly predicted frailty progression in multivariable analyses. The impact of fractures differed between the sexes. With each incident hip fracture, the adjusted mean CFI accelerated per 5 years by 0.07 in women (95% confidence interval [CI]: 0.03 to 0.11) and by 0.12 in men (95% CI: 0.08 to 0.16). An incident vertebral fracture increased frailty in women (0.05, 95% CI: 0.02 to 0.08) but not in men (0.01, 95% CI: -0.07 to 0.09). Irrespective of sex and prevalent fractures, baseline obesity was associated with faster frailty progression: a 5-year increase in the adjusted mean CFI ranged from 0.01 in overweight (BMI: 25.0 to 29.9 kg/m2) to 0.10 in obese individuals (BMI: ≥ 40 kg/m2). Greater physical activity and better HRQL decreased frailty over time. The results remained robust in scenario analyses.Conclusions: Older women and men with new vertebral fractures, hip fractures or obesity represent high-risk groups that should be considered for frailty interventions. [ABSTRACT FROM AUTHOR]

Study Design: High-resolution imaging and biomechanical investigation of ex-vivo vertebrae.Objective: The aim of this study was to assess bone microarchitecture of cadaveric vertebrae using ultra-high field (UHF) 7 Tesla magnetic resonance imaging (MRI) and to determine whether the corresponding microarchitecture parameters were related to bone mineral density (BMD) and bone strength assessed by dual-energy x-ray absorptiometry (DXA) and mechanical compression tests.Summary Of Background Data: Limitations of DXA for the assessment of bone fragility and osteoporosis have been recognized and criteria of microarchitecture alteration have been included in the definition of osteoporosis. Although vertebral fracture is the most common osteoporotic fracture, no study has assessed directly vertebral trabecular bone microarchitecture.Methods: BMD of 24 vertebrae (L2, L3, L4) from eight cadavers was investigated using DXA. The bone volume fraction (BVF), trabecular thickness (Tb.Th), and trabecular spacing (Tb.Sp) of each vertebra were quantified using UHF MRI. Measurements were performed by two operators to characterize the inter-rater reliability. The whole set of specimens underwent mechanical compression tests to failure and the corresponding failure stress was calculated.Results: The inter-rater reliability for bone microarchitecture parameters was good with intraclass correlation coefficients ranging from 0.82 to 0.94. Failure load and stress were significantly correlated with BVF, Tb.Sp, and BMD (P < 0.05). Tb.Th was only correlated with the failure stress (P < 0.05). Multiple regression analysis demonstrated that the combination of BVF and BMD improved the prediction of the failure stress from an adjusted R = 0.384 for BMD alone to an adjusted R = 0.414.Conclusion: We demonstrated for the first time that the vertebral bone microarchitecture assessed with UHF MRI was significantly correlated with biomechanical parameters. Our data suggest that the multimodal assessment of BMD and trabecular bone microarchitecture with UHF MRI provides additional information on the risk of vertebral bone fracture and might be of interest for the future investigation of selected osteoporotic patients.Level Of Evidence: N /A. [ABSTRACT FROM AUTHOR]

Osteoporosis is the most common age-related bone disease that is characterized by an imbalance between osteoblasts for bone formation and osteoclasts for bone resorption. Anti-catabolic drugs have been developed to inhibit osteoclast activity and to prevent bone loss in osteoporosis. However, because it is difficult to increase bone mass in osteoporotic bone, it would be beneficial to simultaneously enhance osteoblast function and thus form bone. Osterix (Osx) is an essential transcription factor for osteoblast differentiation. To date, many studies have focused on discovering Osx target genes and on increasing osteoblast differentiation. However, Osx targets and the mechanisms controlling osteoblast differentiation, are not well known. Here, we generated stable Osx -knockdown cell lines by employing shRNA in MC3T3-E1 osteoblastic cells. Stable Osx -knockdown osteoblasts exhibited a significant reduction in cell differentiation and nodule formation, which was similar to the reduced osteoblast activity observed in an Osx -deficient mouse model. Using an Affymetrix GeneChip microarray, we determined the differential gene expression profile in response to Osx knockdown, which provided insight into molecular mechanisms underlying osteoblast differentiation. Of 2743 genes with roles in cell differentiation, 15 were upregulated and 2 were downregulated in Osx -knockdown osteoblasts. In particular, the expression of fibrillin-2 and periostin was significantly increased in Osx -knockdown osteoblasts compared to that in control cells, as validated by RT-PCR and quantitative real-time PCR. Finally, this study showed differential gene expression profiles for Osx-mediated osteoblast differentiation, suggesting that fibrillin-2 and periostin will be target candidates of Osx in osteoblast differentiation. [ABSTRACT FROM AUTHOR]

It is important to investigate the irregularities in aging-associated changes in bone, between men and women for bone strength and osteoporosis. The purpose of this study was to characterize the changes and associations of mandibular cortical and trabecular bone measures of men and women based on age and to the evaluation of cortical shape categories, in a large Korean population. Panoramic radiographs of 1047 subjects (603 women and 444 men) aged between 15 to 90 years were used. Mandibular cortical width (MCW), mandibular cortical index (MCI), and fractal dimensions (FD) of the molar, premolar, and anterior regions of the mandibular trabecular bone were measured. Study subjects were grouped into six 10-years age groups. A local linear regression smoothing with bootstrap resampling for robust fitting of data was used to estimate the relationship between radiographic mandibular variables and age groups as well as genders. The mean age of women (49.56 ± 19.5 years) was significantly higher than that of men (45.57 ± 19.6 years). The MCW of men and women (3.17mm and 2.91mm, respectively, p < 0.0001) was strongly associated with age and MCI. Indeed, trabecular measures also correlated with age in men (r > −0.140, p = 0.003), though not as strongly as in women (r > −0.210, p < 0.0001). In men aged over 55 years, only MCW was significantly associated (r = −0.412, p < 0.0001). Furthermore, by comparison of mandibular variables from different age groups and MCI categories, the results suggest that MCW was detected to be strongly associated in both men and women for the detection of bone strength and osteoporosis. The FD measures revealed relatively higher association with age among women than men, but not as strong as MCW. [ABSTRACT FROM AUTHOR]

Objectives Paleopathological studies suggest different patterns of age-related bone loss and osteoporosis in past populations compared with those of modern times. However, the observed interpopulational differences are often difficult to interpret due to considerable environmental and biological heterogeneity between populations from which the analyzed skeletal samples come. In the present paper, we try to determine whether there was a directional trend in occurrence of this phenomenon in the past as a consequence of changes in life conditions over the last six thousand years of human history. Materials and methods The study involved 276 female skeletons from four geographically homogeneous populations dated from Neolithic to early modern times coming from a region located in present-day Poland. Bone mineral density and bone fractures were examined for all the skeletons. Polymorphisms of the vitamin D receptor gene associated with low BMD were analyzed using PCR in individuals randomly selected from all of the studied skeletal series. Results In all the analyzed populations, BMD was found to significantly decrease with age. The only statistically significant interpopulational differences were found for the Neolithic skeletal series, with females in all age groups exhibiting higher BMD values and no osteoporotic fractures compared with the historical populations. Discussion The much better bone maintenance in Neolithic women may have resulted from a favorable confluence of high levels of physical activity, exposure to UV radiation, and a diet with an appropriate calcium intake. [ABSTRACT FROM AUTHOR]

The differential diagnosis between benign and malignant vertebral fractures is a common challenge in clinical practice, especially because osteoporotic fractures become more frequent within the aging population and many malignant diseases spread to the bone first, impacting bone integrity. This article reviews the morphological features and computed tomography (CT) and magnetic resonance imaging (MRI) imaging findings that help differentiate between benign and malignant fractures. Newer techniques such as MR-based diffusion-weighted imaging, dynamic contrastenhanced MR, and chemical-shift imaging as well as hybrid techniques such as positron emission tomography-CT are also discussed briefly. [ABSTRACT FROM AUTHOR]

Low-intensity fractures are closely related with age-related musculoskeletal disorders, including osteoporosis, muscle dysfunction and sarcopenia, age-related chronic diseases, and pharmacological treatments. During the last years, a huge amount of information and recommendations has been released in relation to bone metabolism and mineral content. Muscle dysfunction and sarcopenia are highly prevalent during the second half of life, especially in older subjects. The development of sarcopenia may be slowed through healthy lifestyle changes, which include adequate dietary protein, vitamin D and mineral intakes, and regular physical activity. Prevention of falls should be integral, including correction in major involved factors in order to reduce fragility fracture, improve quality of life and appropriately focus clinical and economic resources. Therefore, to obtain better results a global approach is needed to prevent age-related fractures in frail patients that is not only centered on bone metabolism and antiresorptive drugs. [ABSTRACT FROM PUBLISHER]

Osteoporosis is a disorder of bones with increasing risk among women. However, a number of modifiable factors can help in combating this disorder. Present study examined the relationship of diet and physical activity and risk of osteoporosis through biochemical tests, bone mass density (BMD) scores, and standard questionnaires. Genetic risk for osteoporosis, presence of osteoarthritis, and thyroid problems were found among 8%, 7%, and 3% of participants, respectively; and 78% had onset of menopause between 47 to 55 years of age. Results revealed that less intake of proteins, minerals, and diverse fruit and vegetable consumption was significantly (p ≤ 0.05; 0.01) correlated with decreased BMD score and serum calcium. It was concluded that adequate intake of varied fruits and vegetables, good protein, habit of daily physical activity, adequate sun exposure, and dietary calcium, may play a promising role in decreasing the risk of osteoporosis among women of this age group. [ABSTRACT FROM PUBLISHER]

Introduction: Bilateral salpingo-oophorectomy (BSO) is a risk factor for osteoporosis. Previous studies have reported an association between genetic polymorphisms and the risk of developing osteoporosis. However, the relationship between osteoporosis and genetic polymorphisms in Japanese women treated with BSO is not well understood. To improve the quality of life for post-BSO patients, it is important to determine the genetic factors that influence their risk for osteoporosis. The aim of this study was to investigate the association between gene variations of estrogen metabolism-related genes and osteoporosis in surgically menopausal patients, which may improve the quality of life for surgically menopausal patients. Material and methods: This study included 203 menopausal women treated with BSO because of gynecologic disorders. One hundred and twenty-six women with artificial (surgical) menopause, who had undergone BSO in the premenopausal period, were compared with 77 women with natural menopause, who had undergone BSO in the postmenopausal period. The women were tested for bone mineral density to diagnose osteoporosis. Polymorphisms of estrogen receptor 1 (ESR1) and UDP-glucuronosyl transferase (UGT) genes UGT2B17 and UGT1A1 were analyzed, and their association with bone mass and osteoporosis was statistically evaluated. Results: No significant association was found between osteoporosis and polymorphisms in ESR1, UGT2B17, or UGT1A1 in both groups, suggesting that BSO might be a more significant physiological factor in influencing bone mass density compared to genetic variations. Conclusions: These results suggest that the ESR1, UGT2B17, and UGT1A1 polymorphisms are not genetic factors affecting osteoporosis in postmenopausal Japanese women. [ABSTRACT FROM AUTHOR]

Age-related osteoporosis and sarcopenia are ascribed in part to reductions in anabolic hormones. Dietary conjugated linoleic acid (CLA) improves lean and bone mass, but its impact during androgen deficiency is not known. This study tested if CLA would attenuate the effects of orchidectomy (ORX)-induced losses of bone and lean tissue. Male guinea pigs (n = 40; 70–72 weeks), were randomized into four groups: 1) SHAM + Control diet, 2) SHAM + CLA diet, 3) ORX + Control diet, 4) ORX + CLA diet. Baseline blood sampling and dual-energy X-ray absorptiometry (DXA) scans were conducted, followed by surgery 4 days later with the test diets started 7 days after baseline sampling. Serial blood sampling and DXA scans were repeated 2, 4, 8 and 16 weeks on the test diets. Body composition and areal BMD (aBMD) of whole body, lumbar spine, femur and tibia were measured using DXA. At week 16, muscle protein fractional synthesis rate (FSR), volumetric BMD (vBMD), microarchitecture and bone strength were assessed. Body weight declined after SHAM and ORX surgery, with slower recovery in the ORX group. Dietary CLA did not affect weight or lean mass, but attenuated gains in fat mass. Lean mass was stable in SHAM and reduced in ORX by 2 weeks with whole body and femur bone mineral content (BMC) reduced by 4 weeks; CLA did not alter BMC. By week 16 ORX groups had lower free testosterone and myofibrillar FSR, yet higher cortisol, osteocalcin and ionized calcium with no alterations due to CLA. ORX + Control had higher prostaglandin E 2 (PGE 2 ) and total alkaline phosphatase compared to SHAM + Control whereas ORX + CLA were not different from SHAM groups. Femur metaphyseal vBMD was reduced in ORX + CTRL with the reduction attenuated by CLA. Femur cortical thickness (Ct.Th.) and biomechanical strength were reduced and cortical porosity (Ct.Po.) elevated by ORX and attenuated by CLA. This androgen deficient model with a sarcopenic-osteoporotic phenotype similar to aging men responded to dietary CLA with significant benefits to femur density and strength. [ABSTRACT FROM AUTHOR]

Objectives Osteoporosis and stroke are common diseases in elder patients. The relationship between these two diseases is unclear. This study was intended to estimate the risk of stroke among elder persons aged ≥ 50 years within five years of being diagnosed with osteoporosis. Methods We retrieved data from the Longitudinal Health Insurance Database 2005 (LHID2005) in Taiwan to perform a nationwide population-based study. There were 2580 patients with osteoporosis aged 50 years of age and older in the study cohort. All of them had at least 2 ambulatory care claims or at least 1 inpatient service claim. Each osteoporotic patient was matched to 5 non-osteoporotic patients based on gender, age, and the index year. Subjects in both groups were followed up for five years. Risk of developing stroke and 5-year stroke-free survival rates were evaluated. Results The risk of developing stroke was 1.24 times higher in osteoporotic patients within a 5-year follow-up period compared to an age- and gender-matched cohort without osteoporosis (95% confidence interval = 1.11–1.39; p < 0.001). Patients with osteoporosis also had a significantly lower 5-year stroke-free survival rate. Conclusions Our results indicated that patients with osteoporosis history had higher risk for development of stroke. [ABSTRACT FROM AUTHOR]

Objective To compare the change of bone mineral density and the prevalence of osteoporosis between 10 years ago and the present among the people who participate in health examination in Nanning, Guangxi. Methods This cross-sectional survey enrolled 2524 20-80-year-old healthy adults who participated in health examination from January 2011 to June 2012 in People's Hospital of Guangxi Autonomous, and the data were compared with those of 1058 cases from the same hospital 10 years ago. Bone mass density (BMD) was detected using the same dual-energy X-ray absorptiometry (DEXA). Results The age of peak bone mass in males and females was 30-39 years old, which was the same as 10 years ago. In the 30-39 years old group, the BMD values of the femoral neck, Ward's triangle, Troch area, and the lumbar vertebrae (L2, L3, L4) were not significantly different both in males and females over the past 10 years. The incidence of osteoporosis in total elderly population, elderly males, and elderly females (16.56% vs 17.78%, 12.30% vs 18.28%, 19.21% vs 17.31%, respectively, P > 0.05) was not statistically different in 60 - 80 age group of between 10 years ago and the present. Conclusion Although the environment factors such as life style and self-care consciousness change a lot over the past 10 years, favorable factors and unfavorable factors that can influence bone metabolism coexist. As a result, there is no significant difference in the peak bone mass and the prevalence of osteoporosis in elderly adults. [ABSTRACT FROM AUTHOR]

Bone loss due to age and disuse contributes to osteoporosis and increases fracture risk. It has been hypothesized that such bone loss can be attenuated by modulation of the C-C chemokine receptor 2 (CCR2) and/or its ligands. The objectives of this study were to examine the effects of genetic elimination of CCR2 on cortical and trabecular bones in the mouse tibia and how bone loss was impacted following disuse and estrogen loss. Female CCR2 knockout (CCR2) and wildtype mice underwent ovariectomy (OVX) or denervation of musculature adjacent to the tibia (DEN) to induce bone loss. Cortical and trabecular structural properties as well as mechanical properties (i.e., strength) of tibial bones were measured. Compared to wildtype mice, CCR2 mice had tibiae that were up to 9 % larger and stronger; these differences could be explained mainly by the 17 % greater body mass ( P < 0.001) of CCR2 mice. The majority of the tibia's structural and functional responses to OVX and DEN were similar regardless of the lack or presence of CCR2, indicating that CCR2 is not protective against bone loss per se. These findings indicate that while CCR2 mice do have larger and stronger bones than do wildtype mice, there is minimal evidence that CCR2 elimination provides protection against bone loss during disuse and estrogen loss. [ABSTRACT FROM AUTHOR]

Objective: To examine when, where and how fractures occur in postmenopausal women. Methods: We analyzed data from the Global Longitudinal Study of Osteoporosis in Women (GLOW), including women aged ≥55 years from the United States of America, Canada, Australia and seven European countries. Women completed questionnaires including fracture data at baseline and years 1, 2 and 3. Results: Among 60,393 postmenopausal women, 4122 incident fractures were reported (86% non-hip, non-vertebral [NHNV], 8% presumably clinical vertebral and 6% hip). Hip fractures were more likely to occur in spring, with little seasonal variation for NHNV or spine fractures. Hip fractures occurred equally inside or outside the home, whereas 65% of NHNV fractures occurred outside and 61% of vertebral fractures occurred inside the home. Falls preceded 68–86% of NHNV and 68–83% of hip fractures among women aged ≤64 to ≥85 years, increasing with age. About 45% of vertebral fractures were associated with falls in all age groups except those ≥85 years, when only 24% occurred after falling. Conclusion: In this multi-national cohort, fractures occurred throughout the year, with only hip fracture having a seasonal variation, with a higher proportion in spring. Hip fractures occurred equally within and outside the home, spine fractures more often in the home, and NHNV fractures outside the home. Falls were a proximate cause of most hip and NHNV fractures. Postmenopausal women at risk for fracture need counseling about reducing potentially modifiable fracture risk factors, particularly falls both inside and outside the home and during all seasons of the year. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis (MS) is a demyelinating disease which can cause many disabilities for the patient. Recent data suggests that MS patients have higher risk for osteoporosis. This study was performed to investigate if the osteoporosis prevalence is higher in MS patients and to determine the possible factors affecting bone mineral density (BMD). Methods: 51 de7nite relapsing-remitting MS patients according to McDonald's criteria (45 females, 6 males aged between 20 and 50 years) participated in this study. The control group included 407 females aged from 20 to 49 years; they were healthy and had no history of the diseases affecting bone metabolism. Femoral and lumbar BMD were measured by Dual Energy X-ray Absorptiometry (DXA). The disability of MS patients was evaluated by Expanded Disability Status Scale (EDSS). The patient's quality of life was evaluated by the validated Persian version of multiple sclerosis impact scale (MSIS-29). Results: Patients' mean age was 36 ± 3.3 years and their mean disease duration was 8.7 ± 1.7 years. The mean EDSS score and the mean body mass index (BMI) of the patients were 3 ± 0.9 and 23.5 ± 2.3 kg/m2, respectively. 29% of the patients had never been treated by ß-interferon and 6% of them had not received glucocorticoids (GCs) pulses since their MS had been diagnosed. 26% of the patients had a history of fracture.18% of our patients were osteoporotic and 43% of them were osteopenic. Femoral BMD was significantly lower among MS patients than age matched controls (P < 0.001), but lumbar BMD showed no difference. There was no correlation between administration of GCs pulses, interferon and BMD; however, we found a significant correlation between EDSS score, quality of life (QoL), disease duration and BMD of both site. Conclusion: As a result of this study, bone loss inevitably occurs in MS patients. The major factor of BMD loss is immobility. Osteoporosis should be managed as part of MS patients' treatment protocols. [ABSTRACT FROM AUTHOR]

Osteoporosis in elderly men is becoming an important health issue with the aging society. Elderly men with androgen deficiency are exposed to osteoporosis and can be treated with testosterone replacement. In this study, Eurycoma longifolia (EL), a plant with androgenic effects, was supplemented to an androgen-deficient osteoporotic aged rat as alternative to testosterone. Aged 12 months old Sprague-Dawley rats were divided into groups of normal control (NC), sham-operated (SO), orchidectomised-control (OrxC), orchidectomised and supplemented with EL (Orx ++ El) and orchidectomised and given testosterone (Orx ++ T). After 6 weeks of treatment, serum osteocalcin, serum terminal C-telopeptide Type 1 collagen (CTX) and the fourth lumbar bone calcium were measured. There were no significant differences in the osteocalcin levels before and after treatment in all the groups. The CTX levels were also similar for all the groups before treatment. However, after treatment, orchidectomy had caused significant elevation of CTX compared to normal control rats. Testosterone replacements in orchidectomised rats were able to prevent the rise of CTX. Orchidectomy had also reduced the bone calcium level compared to normal control rats. Both testosterone replacement and EL supplementation to orchidectomised rats were able to maintain the bone calcium level, with the former showing better effects. As a conclusion, EL prevented bone calcium loss in orchidectomised rats and therefore has the potential to be used as an alternative treatment for androgen deficient osteoporosis. [ABSTRACT FROM AUTHOR]

Objective. We assessed the relationships between (I) ultrasonography calcaneus T-scores (PIXI) and mandibular cortex characteristics on oral panoramic radiographs in older subjects; and (II) osteoporosis and periodontitis. Material and methods. We examined 778 subjects (53% women) aged 59--96 years. Periodontitis was defined by alveolar bone loss assessed from panoramic radiographs. Results. PIXI calcaneus T-values ≤≤--2.5 (osteoporosis) were found in 16.3% of women and in 8.1% of men. PIXI calcaneus T-values <--1.6 (osteoporosis, adjusted) were found in 34.2% of women and in 21.4% of men. The age of the subjects and PIXI T-values were significantly correlated in women (Pearson's r == 0.37, P < 0.001) and men (Pearson's r == 0.19, P < 0.001). Periodontitis was found in 18.7% of subjects defined by alveolar bone level ≥≥5 mm. Subjects with osteoporosis defined by adjusted PIXI T-values had fewer remaining teeth [mean difference 4.1, 95% confidence interval (CI) --1.1 to --6.5, P < 0.001]. The crude odds ratio (OR) of an association between the panoramic assessment of mandibular cortex erosions as a sign of osteoporosis and the adjusted T-value (T-value cut-off <--1.6) was 4.8 (95% CI 3.1--7.2, P < 0.001; Pearson χχ2 == 60.1, P < 0.001). A significant OR between osteoporosis and periodontitis was only found in women for the T-value cut-off ≤≤--2.5 (crude OR 1.8, 95% CI 1.1--3.3, P < 0.03). Conclusions. An association between osteoporosis and periodontitis was only confirmed in women. The likelihood that the mandibular cortex index agrees with adjusted PIXI T-values is significant. [ABSTRACT FROM AUTHOR]

Abstract: Falls are a serious health problem for aged people, causing social and economic burden. Despite being an important determinant of balance, the positioning of the center of mass (COM) has not been evaluated as a risk factor for falls. This study examined the association between the percentage height of COM (%COM) and the risk of falls in the elderly. Healthy women aged 60 years and older were consecutively selected in a case–control study. Forty-eight individuals classified as “fallers” (having suffered two or more falls in the previous year) were the cases while 48 age and weight-matched women with one fall or no falls in the previous year were the controls (“non-fallers”). Body composition and bone mineral density (BMD) by DXA, 30-second chair stand test, abdominal circumference, Berg''s balance scale and %COM using the reaction board method were evaluated in all participants. Body composition parameters were not significantly different between groups. Spine and hip BMD tended to be lower in the fallers, but the difference was significant only at the femoral neck (0.80±0.10g/cm2 versus 0.87±0.76g/cm2; p <0.01). Berg''s balance scale scores were lower among fallers than non-fallers (p <0.05). Percentage height of COM was significantly higher among fallers (p <0.001) and this was associated with a higher number of fractures (p <0.05). Percentage height of COM is significantly higher in the elderly with frequent falls. Further work is needed in order to determine the value of board reaction measurements in a clinical setting to identify patients at high risk. [Copyright &y& Elsevier]

It has been previously suggested in the literature that with aging, degenerative changes as well as disc herniation start at the lower lumbar segments, with higher disc involvement observed in an ascending fashion in older age groups. We conducted a study to investigate this correlation between age and level of disc herniation, and to associate it with the magnitude of the Lumbar Lordotic Angle (LLA), as measured by Cobb's method. We followed retrospectively lumbosacral spine MRI's of 1419 patients with symptomatic disc herniation. Pearson's correlation was used in order to investigate the relationship between LLA, age, and level of disc herniation. Student's t-test was applied to assess gender differences. Young patients were found to have higher LLA (R = 0.44, P < 0.0001) and lower levels of disc herniation (R = 0.302, P < 0.0001), whereas older patients had higher level herniation in lower LLA group (mean LLA 28.6° and 25.4°) and lower level herniation in high LLA group (mean LLA 33.2°).We concluded that Lumbar lordotic Cobb's angle and age can be predictors of the level of lumbar disc herniation. This did not differ among men and women (R = 0.341, P < 0.0001). [ABSTRACT FROM AUTHOR]

Purpose: Exercise is important for the prevention of osteoporosis and the reduction of fracture risk because it improves muscle mass and strength, besides improving balance. We evaluated the effect of a specific exercise program on bone mass and quality and physical function capacity in postmenopausal women with low bone mineral density. Methods: Participants (N = 125) underwent a bone mass (Dual X-ray Absorptiometry), bone quality (osteosonography), and physical functional capacity assessment. Fifty-eight of them took part in an 11-month exercise program (E), that included a multicomponent (strength, aerobic capacity, balance, joint mobility) dual-modality (on ground and in the water; alternating group and home-based exercise periods) exercise regimen. The others represented a control group (C) that did not exercise. After the exercise program all participants were reevaluated. Results: After the training program: femoral neck T-score significantly improved in E; C significantly decreased all bone quality (osteosonography) parameters, whereas E showed no differences; E significantly improved all the physical function capacity parameters, while most of them decreased or did not change in C. Conclusions: A specific exercise program targeting osteoporosis improves physical function capacity, reduces physiological bone loss, and maintains bone quality in low bone mineral density postmenopausal women. [ABSTRACT FROM AUTHOR]

Abstract: The transition into menopause is a complex process that affects fertility and increases the risk for a number of health problems in aging women that include, but are not limited to osteoporosis, heart disease, diabetes mellitus and cognitive dysfunction. Improved nutrition and enhanced access to medical care have increased the average lifespan for women in developed countries, and many will spend more than one-third of their life in a post-menopausal state. Epidemiological studies indicate that a delayed natural menopause confers longevity and decelerates the appearance of much age-related morbidity, suggesting that developing treatments to delay menopause would significantly improve quality of life for women. Although menopause is ultimately defined by ovarian follicular exhaustion, several lines of scientific evidence in humans and animals now suggest that dysregulation of estradiol feedback mechanisms and hypothalamic-pituitary dysfunction contributes to the onset and progression of reproductive senescence, independent of ovarian failure. This article provides a brief update on our current understanding of the role of the hypothalamic-pituitary axis in the onset of and transition into female reproductive senescence. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Vertebral deformities in elderly people are conventionally termed “fractures”, but their onset is often insidious, suggesting that time-dependent (creep) processes may also be involved. Creep has been studied in small samples of bone, but nothing is known about creep deformity of whole vertebrae, or how it might be influenced by bone mineral density (BMD). We hypothesise that sustained compressive loading can cause progressive and measurable creep deformity in elderly human vertebrae. Methods: 27 thoracolumbar “motion segments” (two vertebrae and the intervening disc and ligaments) were dissected from 20 human cadavers aged 42–91 yrs. A constant compressive force of approximately 1.0 kN was applied to each specimen for either 0.5 h or 2 h, while the anterior, middle and posterior heights of each of the 54 vertebral bodies were measured at 1 Hz using a MacReflex 2D optical tracking system. This located 6 reflective markers attached to the lateral cortex of each vertebral body, with resolution better than 10 μm. Experiments were at laboratory temperature, and polythene film was used to minimise water loss. Volumetric BMD was calculated for each vertebral body, using DXA to measure mineral content, and water immersion for volume. Results: In the 0.5 h tests, creep deformation in the anterior, middle and posterior vertebral cortex averaged 4331, 1629 and 614 micro-strains respectively, where 10,000 micro-strains represents 1% loss in height. Anterior creep strains exceeded posterior (P <0.01) so that anterior wedging of the vertebral bodies increased, by an average 0.08° (STD 0.14°). Similar results were obtained after 2 h, indicating that creep rate slowed considerably with time. Less than 40% of the creep strain was recovered after 2 h. Increases in anterior wedging during the 0.5 h creep test were inversely proportional to BMD, but only in a selected sub-set of 20 specimens with average BMD<0.15 g/cm3 (P =0.042). Creep deformation caused more than 5% height loss in four vertebrae, three of which had radiographic signs of pre-existing damage. Conclusion: Sustained loading can cause progressive anterior wedge deformity in elderly human vertebrae, even in the absence of fracture. [Copyright &y& Elsevier]

Abstract: Introduction: A major predictor of age-related osteoporotic fracture is peak areal bone mineral density (aBMD) which is a highly heritable trait. However, few linkage and association studies have been performed in men to identify the genes contributing to normal variation in aBMD. The aim of this study was to perform a genome wide scan in healthy men to identify quantitative trait loci (QTL) that were significantly linked to aBMD and to test whether any of these might be sex-specific. Methods: aBMD at the spine and hip were measured in 515 pairs of brothers, aged 18–61 (405 white pairs, 110 black pairs). Linkage analysis in the brother sample was compared with results in a previously published sample of 774 sister pairs to identify sex-specific quantitative trait loci (QTL). Results: A genome wide scan identified significant QTL (LOD>3.6) for aBMD on chromosomes 4q21 (hip), 7q34 (spine), 14q32 (hip), 19p13 (hip), 21q21 (hip), and 22q13 (hip). Analysis suggested that the QTL on chromosomes 7q34, 14q32, and 21q21 were male-specific whereas the others were not sex-specific. Conclusions: This study demonstrates that six QTL were significantly linked with aBMD in men. One was linked to the spine and five were linked to the hip. When compared to published data in women from the same geographical region, the QTL on chromosomes 7, 14 and 21 were male-specific. The occurrence of sex-specific genes in humans for aBMD has important implications for the pathogenesis and treatment of osteoporosis. [Copyright &y& Elsevier]

Abstract: Background: The incidence of osteoporotic hip fractures increases with age, more sharply in women than in men, as a result of qualitative and quantitative bone alterations. Mineralization (a qualitative parameter) showed no differences with age or sex in cancellous bone in earlier studies. Few studies assessed such differences in cortical bone, a major contributor to femoral bone strength. The aim of this in vitro cross-sectional study of a large group of human femoral midshafts was to look for age- and sex-related differences in the degree and distribution of cortical mineralization that might be implicated in bone fragility. Methods: Cortical bone specimens from 193 femurs were studied using quantitative microradiography, with an aluminum step-wedge reference. The femurs were from 99 females and 94 males in a Caucasian anthropological collection covering a broad age spectrum. We determined the mean degree of mineralization of osteons (On.DMB-Al), interstitial tissue (Int.DMB-Al), and total bone (Tt.DMB-Al), and representative parameters of density histograms. Results were expressed as relative values. Age- and sex-related differences in DMB-Al values were evaluated using non-parametric tests. Results: Degree of tissue mineralization (Tt.DMB-Al) decreased significantly with age in females (r =−0.257; P =0.010) but did not change in males. Tt.DMB-Al was higher in females than males until 50 years of age (P =0.001) but was lower in elderly females than elderly males (P =0.016). DMB-Al distribution varied significantly with sex and age. The first DMB-Al quartiles in osteons and interstitial tissue were not different between males and females, but the third quartile and interquartile range differed significantly (P =0.032 and P =0.000, respectively). The mineralization difference between the two tissues indicated greater bone heterogeneity in females than males (P =0.000). Conclusions: In this in vitro cross-sectional study of anterior midfemoral cortical specimens, the degree and distribution of mineralization varied with age and sex. In females, mineralization started at a higher level than in males but was lower in the sixth decade, falling below the level in males. Mineralization was far more stable throughout life in males. In elderly females, the lower degree and greater heterogeneity of mineralization may have consequences on bone strength and the risk of fracture. [Copyright &y& Elsevier]

Abstract: The risk of bone fracture increases with age because of a variety of factors that include, among others, decreasing bone quantity and quality. Despite recent advances, the roles of bone microstructure and trace mineralization in the fracture process are not well understood. In this study, we utilize a combination of in-situ fracture toughness testing, digital strain mapping, and X-ray photoelectron spectroscopy techniques to characterize the near-tip strain field, fracture toughness, and chemical elements on the fracture surface of bone specimens from donors of two ages (48-year-old and 78-year-old females). We show that age-related embrittlement of bone fracture is associated with higher near-tip strains by lamellar shear and crack deflection at lamellar interfaces in the young bone and their absence in the old bone. The different near-tip deformation behaviors may be associated with the presence of Si and Zn in the young bone but more Ca and P and the lack of Si and Zn in the old bone. [Copyright &y& Elsevier]

Abstract: Oxidative stress has recently been identified as a pivotal pathogenetic factor of bone loss in mice, but its importance in humans is not clear. We aimed to investigate the association between urinary 8-iso-PGF2α levels, a major F2-isoprostane and a reliable in vivo biomarker of oxidative stress, and bone mineral density (BMD), and to study whether vitamin E in the form of serum α-tocopherol, a scavenger of peroxyl radicals, modifies the association. In 405 men, urinary 8-iso-PGF2α and serum α-tocopherol were measured at age 77 years and BMD at age 82 years. One SD increase in 8-iso-PGF2α corresponded to an approximately 2–4% decrease in average adjusted BMD values of total body, lumbar spine, and proximal femur (all P <0.001). Serum α-tocopherol levels seemed to modify the association between urinary 8-iso-PGF2α and BMD. Men with α-tocopherol levels below the median combined with high oxidative stress, i.e., 8-iso-PGF2α above the median, had 7% (95% CI 3–11%) lower BMD at the lumbar spine and 5% (95% CI 2–9%) lower BMD at the proximal femur. In elderly men high oxidative stress is associated with reduced BMD, which is more pronounced in individuals with low serum levels of the antioxidant vitamin E. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of this study was to determine whether the addition of the measurement of bilateral hip bone mineral density (BMD) has an impact on indications for osteoporosis (OP) treatment in community-dwelling elderly individuals, based on criteria from the National Osteoporosis Foundation (NOF). Methods: In total, 605 consecutive community-dwelling elderly individuals who were 65 years and older were evaluated. Dual energy X-ray absorptiometry was used to determine the lowest T-score in the lumbar spine+unilateral hip, the bilateral hips, and the lumbar spine+bilateral hips. Risk factors associated with the lowest T-score in these three conditions were applied to indicate treatment in accordance with NOF criteria. McNemar''s test was used to assess the difference of adding bilateral hip BMD measurements. Results: There was a significant difference in the frequency of pharmacological indication using NOF criteria together with the lowest T-score for the three tests (72.8% for lumbar spine+bilateral hips and 71.2% for lumbar spine+unilateral hip; p =0.002). A higher frequency of treatment indication was also observed for lumbar spine+unilateral hip (71.2%) compared to bilateral hips (61.1%) (p <0.001). The discrepancies in treatment appeared to be more evident in women when analyzed by gender distribution. Conclusion: Our finding supports the theory that evaluation of the bilateral hips with the lumbar spine seems to be more sensitive measure for identifying patients with an osteoporosis treatment indication. Furthermore, despite the well-known artifact in the lumbar spine, this site should not be excluded when determining the indication for OP treatment in elderly people. [Copyright &y& Elsevier]

Abstract: Interpretation of densitometric results requires a comparison with reference bone mineral density (BMD) values of normal age and sex-matched persons. Thus the aim of this study was to determine these values for healthy Tunisian women, to estimate the prevalence of osteoporosis and to compare our findings with other populations. A cross-sectional study of 1378 Tunisian women aged between 20 and 96 years was carried out using DXA (GE-Lunar Prodigy). Subjects with suspected conditions affecting bone metabolism were excluded. Measurements were taken at the lumbar spine and femoral neck. These values were expressed at T-scores, with reference to the mean BMD values of the group aged 20–40 years. The peak bone mass, estimated in this age group was 1.174+0.127g/cm2 at the lumbar spine and 1.016±0.118g/cm2 at the femoral site. It was attained respectively within the age of 25 years and 36 years. For both sites, the expected decline in BMD was shown when the successive age groups [40–49 years] and [50–59 years] were compared. Bone loss was rapid during the first 5 years after menopause. Thereafter BMD declined slowly but continually. The prevalence of osteoporosis in the women over 50 years of age, taking account of peak bone mass observed in our cohort, was 23.3% at the spine and 17.3% at the femoral neck with a combined prevalence of 23.4%. These rates attained respectively 30.4%, 11.8% and 32.9% when we considered the Italian values, which demonstrate the variability of osteodensitometric depending to the reference population adopted. [Copyright &y& Elsevier]

Abstract: Osteoporosis is a major health problem in both elderly women and men. Epidemiological evidence has shown an association between tea consumption and the prevention of age-related bone loss in elderly women and men. Ingestion of green tea and green tea bioactive compounds may be beneficial in mitigating bone loss of this population and decreasing their risk of osteoporotic fractures. This review describes the effect of green tea or its bioactive components on bone health, with an emphasis on (i) the prevalence and etiology of osteoporosis; (ii) the role of oxidative stress and antioxidants in osteoporosis; (iii) green tea composition and bioavailability; (iv) the effects of green tea and its active components on osteogenesis, osteoblastogenesis, and osteoclastogenesis from human epidemiological, animal, as well as cell culture studies; (v) possible mechanisms explaining the osteoprotective effects of green tea bioactive compounds; (vi) other bioactive components in tea that benefit bone health; and (vii) a summary and future direction of green tea and bone health research and the translational aspects. In general, tea and its bioactive components might decrease the risk of fracture by improving bone mineral density and supporting osteoblastic activities while suppressing osteoclastic activities. [Copyright &y& Elsevier]

The article discusses research on the relationship between osteoporosis in women and the loss of alveolar crestal bone. Topics include the measurement of alveolar crestal height (ACH) using oral radiographs, bone density measurement, and the impact of aging on the relation between T score and ACH in women.

As life expectancy increases, a growing percentage of older individuals with age-related diseases such as osteoporosis and sarcopenia are expected. Patients with both conditions, i.e. patient with osteosarcopenia, are suggested to have a higher risk of fall and fracture compared to individuals with either condition. To investigate the potential relationship between low bone mineral density (BMD) and muscle dysfunction in a Danish cohort of older home-dwelling individuals. Furthermore, to examine the prevalence of osteosarcopenia and alterations in prevalence depending on cut-off values chosen. Measures of BMD, relative appendicular lean mass and hand grip strength were assessed in 529 individuals aged 65+ from the population-based cross-sectional Copenhagen Sarcopenia Study (CSS). Osteoporosis was diagnosed according to the World Health Organization guidelines. Sarcopenia was diagnosed in accordance with the guidelines from the European Working Group on Sarcopenia in Older People (EWGSOP2) with application of cut-off values from the EWGSOP2 paper compared to cut-off values derived from a local cohort (CSS). 19.2% had osteoporosis (66 women and 35 men), whereas 2.7% (6 women and 8 men) and 4.2% (7 women and 15 men) had sarcopenia with application of EWGSOP2 and CSS cut-off values, respectively. Using the EWGSOP2 cut-off values, 1.5% (4 women and 4 men) were diagnosed with osteosarcopenia compared to 1.4% (4 women and 3 men) using CSS cut-off values. In the osteoporosis sub-population, 8% (EWGSOP2) and 7% (CSS) had sarcopenia and within the sarcopenia sub-population, 61.5% (EWGSOP2) and 33.3% (CSS) had osteoporosis. At all sites, BMD was lower among individuals with sarcopenia and sarcopenia increased the risk of osteoporosis (odds ratios: EWGSOP2: 7.3 (p < 0.001) and CSS: 2.2 (ns)). Osteosarcopenia was present in 1.5% of a group of healthy home-dwelling older individuals. Notably, individuals with sarcopenia had lower BMD and a higher risk of osteoporosis, whereas the opposite (prevalence of sarcopenia in individuals with osteoporosis) was not as frequent. Our data indicate that screening for sarcopenia and osteoporosis should be performed simultaneously in older individuals at high risk of falls and fractures. However, further studies with outcome-related results are needed to identify optimal measures of osteosarcopenia and cut-off values for sarcopenia. • Osteosarcopenia is present in about 1.5% of a healthy home-dwelling older population. • Individuals with sarcopenia generally have a lower BMD compered to non-sarcopenia individuals. • Individuals with sarcopenia are more likely to have osteoporosis. • A phenomenon of overlapping diseases, i.e. of osteoporosis and sarcopenia, cannot be ruled out. [ABSTRACT FROM AUTHOR]

To compare the effects of high-load (≥ 70 of 1RM) and low-load (< 70 of 1RM) resistance training (RT) on femoral neck and lumbar spine bone mineral density (BMD) in middle-aged and older people. Systematic review with meta-analysis. English language searches of the electronic databases PubMed/Medline, Scopus and Web of Science. Inclusion criteria: (i) older or middle-aged (≥ 45 years old) participants of both sexes with or without comorbidities, (ii) studies that compared high-load (≥70% 1 RM) versus low-load (<70% 1RM) RT, (iii) studies that examined femoral neck or lumbar spine BMD. From 1052 studies found, six were included in qualitative and quantitative analysis. The meta-analysis revealed no difference between groups for femoral neck (weighted mean difference [MD] and 95% confidence interval (CI) = 0.00 g/cm2 [95% CI, −0.01 to 0.01]; P = 0.63) and lumbar spine (MD = 0.01 g/cm2 [95% CI, −0.00 to 0.02]; P = 0.12) BDM. There was a substantial heterogeneity for femoral neck (I 2 = 47%; P = 0.07) and lumbar spine (I 2 = 59%; P = 0.02). Subgroup analysis revealed a significant effect of high-load RT on femoral neck BMD when participants presented normal BMD values (MD = 0.01 g/cm2 [95% CI, −0.00 to 0.02]; P = 0.04) and on interventions lasting up to 6 months (MD = 0.01 g/cm2 [95% CI, −0.00 to 0.02]; P = 0.03). Both high- and low-load RT have similar effects on femoral neck and lumbar spine BMD in aging people. • Low-load resistance training (<70% of 1RM) promotes similar effects on FN and LS BMD in comparison with high-load (≥70% of 1RM) • The intensity threshold to provide positive adaptations on BMD might be as low as 40% of 1RM, as long as effort is adequate • Other factors than mechanical loading seems to influence osteogenesis triggered by RT [ABSTRACT FROM AUTHOR]