HDL cholesterol and bone mineral density in normal-weight postmenopausal women: is there any possible association?

AIM: Epidemiological investigation of the association between lipid profile, atherosclerosis and bone mass has produced conflicting RESULTS: The present paper reports the assessment of the lipid profile, bone mineral density (BMD) and turnover in a cohort of Italian women. METHODS: In this cross sectional study we enrolled 173 women in menopause (101 osteoporotic and 72 normal). In each subject the authors evaluated BMD, bone turnover, lipid profile (total cholesterol, high density lipoprotein [HDL], low density lipoprotein [LDL] and triglycerides), and risk factors for osteoporosis, cardiovascular diseases and eating habits using a questionnaire. RESULTS: HDL was significantly higher in osteoporotic patients than in controls and the risk of osteoporosis was significantly higher in women with higher level of HDL. The authors suggest that the level of HDL could be used as screening for postmenopausal osteoporosis: the cut-off points recommended are HDL >61 mg/dL to detect women with a high risk (sensitivity 74%) and <45 mg/dL to detect those with a low risk (specificity 83%). CONCLUSION: This study provides evidences of the relation between HDL, but not total cholesterol or LDL levels with BMD in a cohort of normal-weight women and equally distributed cardiovascular risks. It also suggests that a proatherogenic lipid profile is associated with higher bone mineral density, and that HDL can be used in deciding whether a patient's BMD should be measured.     

Use of calcium, folate, and vitamin D₃-fortified milk for 6 months improves nutritional status but not bone mass or turnover, in a group of Australian aged care residents

In residential care, inadequate calcium and folate intakes and low serum vitamin D (25(OH)D) concentrations are common. We assessed whether daily provision of calcium, folate, and vitamin D?-fortified milk for 6 months improved nutritional status (serum micronutrients), bone quality (heel ultrasound), bone turnover markers (parathyroid hormone, C-terminal collagen I telopeptide, terminal propeptide of type I procollagen), and/or muscle strength and mobility in a group of Australian aged care residents. One hundred and seven residents completed the study (mean (SD) age: 79.9 (10.1) years; body weight: 68.4 (15.4) kg). The median (inter-quartile range) volume of fortified milk consumed was 160 (149) ml/day. At the end of the study, the median daily vitamin D intake increased to 10.4 (8.7) μg (P < .001), which is 70% of the adequate intake (15 μg); and calcium density (mg/MJ) was higher over the study period compared with baseline (161 ± 5 mg/MJ vs. 142 ± 4 mg/MJ, P < .001). Serum 25(OH)D concentrations increased by 23 ± 2 nmol/L (83 (107)%, P < .001), yet remained in the insufficient range (mean 45 ± 2 nmol/L). Consumption of greater than the median intake of milk (160 ml/day) (n = 54, 50%) increased serum 25(OH)D levels into the adequate range (53 ± 2 nmol/L) and reduced serum parathyroid hormone by 24% (P = .045). There was no effect on bone quality, bone turnover markers, muscle strength, or mobility. Consumption of fortified milk increased dietary vitamin D intake and raised serum 25(OH)D concentrations, but not to the level thought to reduce fracture risk. If calcium-fortified milk also was used in cooking and milk drinks, this approach could allow residents to achieve a dietary calcium intake close to recommended levels. A vitamin D supplement would be recommended to ensure adequate vitamin D status for all residents.     

Association between bone mineral density and lifestyle factors or vitamin D receptor gene polymorphism in adult male workers: a cross-sectional study

Objectives  

The aim of this cross-sectional study was to investigate the association between bone mineral density (BMD) and lifestyle factors, as well as the influence of vitamin D receptor (VDR) gene polymorphism, in adult male workers.     

Correlation between bone mineral density and body composition in Japanese females aged 18–40 years with low forearm bone mineral density

Objectives  To clarify the relationship between bone mineral density (BMD) and body composition in Japanese women aged 18–40 years with low forearm BMD. Methods  The subjects were Japanese199 women who had been selected for inclusion in the study based on a low forearm BMD determined at the Annual Women’s Health Examination. The subjects’ mean (± standard deviation) age, body height, body weight, and body mass index (BMI) were 33.5 (±4.3) years, 158.1 (±5.1) cm, 49.6 (±5.7) kg, and 19.8 (±2.1), respectively. The BMD of the lumbar spine, total body, and left arm were measured using dual-energy X-ray absorptiometry (DXA). Fat mass (FM), bone-free lean tissue mass (LTM), and body fat percentage (BF%) were measured simultaneously with DXA. Results  In the structural equation model, the standardized regression weights for the path from BMI to BMD of all sites were 0.273–0.434. Conversely, the BF% to BMD of the total body and left arm were −0.192 and −0.296, respectively. In multiple regression analysis, the FM index (FMI) was significantly associated with the BMD of the lumbar spine as a weight-bearing site. The LTM index (LTMI) was significantly associated with the BMD of the total body and left arm as a non-weight-bearing site. Conclusions  Young females with low forearm BMD had low body weight and BMI. Thinness was shown to be a risk factor for low BMD, in accordance with results reported elsewhere. A gain in body weight may have the effect of increasing BMD, but our results suggest that to increase BMD, the gain in body weight must include increases in LTM, and not FM alone.     

What is the influence of weight change on forearm bone mineral density in peri- and postmenopausal women? The health study of Nord-Trondelag, Norway

Weight loss in the elderly increases bone loss and the risk of fractures, especially at the hip and spine. The influence of weight change on non-weight-bearing parts of the skeleton is less well known. The purpose of this study was to investigate an association between weight change during the peri- and postmenopausal years and forearm bone mineral density (BMD). Among 8,856 women aged 45-60 years attending the first Health Study of Nord-Tr?ndelag, Norway (HUNT I, 1984-1986), a random sample of 2,795 women was invited to forearm densitometry (single x-ray absorptiometry technology) at HUNT II (1995-1997), after a mean period of 11.3 years. A total of 2,005 women (mean age: 65.1 years) were eligible. The mean weight had increased 3.4 kg; the gain was greater in the youngest women. A total of 382 women (19.1%) had lost and 1,331 women (66.3%) had gained weight. Weight change explained little of the BMD variance, 0.7% and 0.4% for weight loss and weight gain, respectively. Weight loss was an independent and statistically significant negative predictor of BMD, adjusted for body weight, age, age at menopause, smoking, and ovarian hormone treatment, particularly among women with a baseline body mass index greater than 25 kg/m2. No independent association between weight gain and forearm BMD was found.     

Are the serum 25-hydroxyvitamin D concentrations in winter associated with forearm bone mineral density in healthy elderly Japanese women?

The objective of this study was to investigate whether the serum 25-hydroxyvitamin D (25[OH]D) concentrations in winter are associated with the BMD in elderly Japanese women. The subjects were 117 healthy elderly Japanese women. Serum 25(OH)D concentrations were determined by high-performance liquid chromatography. Forearm BMD in the non-dominant arm was measured by dual-energy X-ray absorptiometry (DXA) using a DTX-200 Osteometer. The mean age of the subjects was 66.1 (SD 6.5) years (range: 46-80). The average 25(OH)D concentration was 59.1 nmol/L (SD 16.1), and five of the subjects had low 25(OH)D concentrations (< 30 nmol/L). Forearm BMD decreased linearly with age (r2 = 0.275). There was no linear association between the serum 25(OH)D concentrations and the forearm BMD (p = 0.9483). Multiple regression analysis did not reveal any association between the two (p = 0.5318) when age (p < 0.0001, r2 = 0.271) and weight (p < 0.0001, r2 = 0.153) were taken into account. Our cross-sectional study failed to reveal any association between the serum 25(OH)D concentrations and the forearm BMD in elderly Japanese women, suggesting that 25(OH)D does not play an important role in the determination of BMD. A follow-up study should be conducted to confirm the results of our cross-sectional study.     

The effect of brisk walking on postural stability,bone mineral density,body weight and composition in women over 50 years with a sedentary occupation: a randomized controlled trial

Background

To assess the effect of brisk walking on postural stability, bone mineral density (BMD) and body composition in women over 50 years of age with a sedentary occupation.

Methods

A 10-week walking intervention based on self-regulated brisk walking (BW) to or from work of 30–35 min at least 5 times per week. The research included a total of 104 women (58 women in intervention group). The mean center of pressure (COP) velocity in medial-lateral and anterior-posterior directions, mean total COP velocity with eyes open and closed, BMD of the distal forearm and the calcaneus, body weight, fat mass, and lean body mass were assessed.

Results

The BW intervention was completed by 76 % of participants. A significant effect (time?×?group interaction) was confirmed only in the mean COP velocity in the anterior-posterior direction with eyes closed (F?=?7.41, P?=?0.008). The effect of BW was not confirmed in BMD, body weight, or body composition. The results indicate that the effect of the intervention is influenced by baseline body mass index in body weight, fat mass and visceral adipose tissue.

Conclusions

BW prevents the deterioration of postural stability with eyes closed, which can have a direct effect on reducing the risk of falls under worse spatial orientation and visibility. The presented intervention model is insufficient for weight loss, changes in BMD, or body composition, and its effect should be assessed during a longer period of time.

Trial registration

German Clinical Trials Register DRKS00007638, registered March 10, 2015 (retrospectively registered).

     

Forearm bone mineral density by age in 7,620 men and women: the Tromsø study, a population-based study

Population-based studies of adult forearm bone mineral density (BMD) by age are scarce, and standardized reference values are lacking. In this cross-sectional study, men aged 55-74 years, women aged 50-74 years, and representative 5-10% samples of remaining age groups between 25 and 84 years living in Troms?, Norway, were invited for forearm BMD measurement in 1994-1995. The authors measured 3,062 men and 4,558 women (response rate, 78%) by single x-ray absoptiometry at distal and ultradistal forearm sites. Up to age 50, the mean BMD difference was -0.1% per 1-year age group in both sexes. After age 50, the mean BMD difference per 1-year age group was -0.6% in men and -1.3% (distal) and -1.5% (ultradistal) in women. The BMD by age curve was linear for men throughout senescence, but women had a slope change to -0.7% (distal) and -0.8% (ultradistal) per 1-year age group from the 65- to 69-year age group. BMD levels and BMD by age association in the general population (n = 7,620) and in the population without bone-threatening diseases or medication (n = 5,179) were similar. Only longitudinal studies can clarify whether cohort effects or longitudinal BMD development patterns explain these cross-sectional results.     

Longitudinal changes in forearm bone mineral density in women and men aged 25-44 years: the Tromsø study: a population-based study

The aim of this study was to describe and compare bone mineral density (BMD) development in Norwegian women and men aged 25-44 years in a population-based, longitudinal study. BMD was measured twice at distal and ultradistal forearm sites by single x-ray absorptiometry in 258 women and 147 men (mean follow-up time, 6.4 (standard deviation, 0.6) years). At the distal site, a small annual gain of approximately 0.1% became a small loss beginning at age 34 years in men and age 36 years in women. At the ultradistal site, BMD change was predicted by age in women only, and bone loss started at age 38 years. A high degree of tracking of BMD measurements was observed for both sexes and both sites, r > 0.93. Depending on total BMD change, participants were grouped into "losers", "nonlosers", and "gainers", and more than 6% lost more than the smallest detectable amount of BMD: > or =3.46% at the distal site and > or =5.14% at the ultradistal site. In both sexes, bone mineral content (grams) decreased, whereas area (centimeters squared) increased significantly in "losers" compared with "gainers". This finding might represent physiologic compensation preserving bone strength. No cohort effects were observed when 1994 and 2001 measures from similar age groups were compared.     

Active and passive smoking and the risk of myocardial infarction in 24,968 men and women during 11 year of follow-up: the Tromsø Study

Active smoking is a well-established risk factor for myocardial infarction, but less is known about the impact of passive smoking, and possible sex differences in risk related to passive smoking. We investigated active and passive smoking as risk factors for myocardial infarction in an 11-year follow-up of 11,762 men and 13,206 women included in the Tromsø Study. There were a total of 769 and 453 incident cases of myocardial infarction in men and women, respectively. We found linear age-adjusted relationships between both active and passive smoking and myocardial infarction incidence in both sexes. The relationships seem to be stronger for women than for men. Age-adjusted analyses indicated a stronger relationship with passive smoking in ever-smokers than in never-smokers. After adjustment for important confounders (body mass index, blood pressure, total cholesterol, HDL cholesterol and physical activity) the associations with active and passive smoking were still statistically significant. Adjusting for active smoking when assessing the effect of passive smoking and vice versa, indicated that the effect of passive smoking in men may be explained by their own active smoking. In women, living with a smoker ≥30 years after the age of 20 increased the myocardial infarction risk by 40 %, even after adjusting for active smoking. Passive smoking is a risk factor for myocardial infarction on its own, but whereas the effect for men seems to be explained by their own active smoking, the effect in females remains statistically significant.     

To drink or not to drink: how are alcohol,caffeine and past smoking related to bone mineral density in elderly women?

OBJECTIVES: To determine relationship between alcohol, caffeine, past smoking and bone mineral density of different skeletal sites in elderly women, accounting for other biological and life-style variables. METHODS/DESIGN: A cross-sectional study in 136 Caucasian women, mean +/- SD age 68.6 +/- 7.1 years, all healthy and free of medications affecting bones, including estrogen. Bone mineral density (BMD) of multiple skeletal regions and body composition were measured by dual X-ray absorptiometry. Serum vitamin D (25-OHD) and parathyroid hormone (PTH) were analyzed and used as confounders. Calcium (Ca) intake was assessed by food frequency questionnaire. Alcohol and caffeine consumption was assessed by questionnaires determining frequency, amount and source of each. There were no current smokers, but the history of smoking was recorded, including number of years and packages smoked/day. Past physical activity was assessed by Allied Dunbar National Fitness Survey and used as confounder. Statistical significance was considered at p or=median, 750 mg/day). The past smokers who smoked on average 24 years of approximately 1 pack cigarettes/day had lower BMD in total body, spine and femur than never-smokers when evaluated in subgroup analyses, and the association was attenuated in participants with >or=median Ca intake. There was no significant association between past smoking and BMD of any skeletal site in multiple regression analyses. CONCLUSION: The results support the notion that consumption of small/moderate amount of alcohol is positively, while caffeine and past smoking are negatively associated with most of the skeletal sites, which might be attenuated with Ca intake above 750 mg/day.     

What do we currently know about nutrition and bone health in relation to United Kingdom public health policy with particular reference to calcium and vitamin D?

Public health policy in the UK related to nutrition and bone health has been shaped by reports from the Department of Health (DH), Food Standards Agency and WHO. Dietary reference values (DRV) for a number of nutrients were published in 1991 by the DH Committee on Medical Aspects of Food and Nutrition Policy. The subsequent DH report on nutrition and bone health in 1998 concentrated particularly on Ca and vitamin D, but also briefly addressed the effect of body weight, alcohol and other nutrients. Although this reviewed more recent evidence relating to the effect of higher intakes of Ca and vitamin D from longitudinal and interventional studies, no changes were made to the existing DRV. The Food Standards Agency published a report from their Expert Group on Vitamins and Minerals in 2003, which recommended safe upper limits for eight vitamins and minerals, with guidance provided on a further twenty-two nutrients, where there was less information on safety. The WHO report on diet, nutrition and the prevention of chronic diseases in 2003 addressed the prevention of osteoporosis, making recommendations on Ca, vitamin D, Na, fruit and vegetables, alcohol and body weight. The present paper examines current views on what constitutes an adequate dietary Ca intake and optimal vitamin D status, the DRV for vitamin D in subjects with little or no exposure to sunlight and the results of recent epidemiological studies on the relationship between fracture risk and body weight, alcohol intake and the consumption of other nutrients.