Effect of Cigarette Smoking on Bone Mineral Density in Healthy Taiwanese Middle-Aged Men

The effect of cigarette smoking in relation to bone mineral density (BMD) remains inconclusive, especially in middle-aged men. This cross-sectional study was conducted to examine the effect of smoking on BMD in 837 healthy Taiwanese males (532 never-smokers, 258 current smokers, 47 former smokers; aged 46–64 yr), recruited at their routine health examination. Subjects with suspected conditions affecting bone metabolism or receiving any medications affecting bone metabolism were excluded. BMD of the lumbar spine (LSBMD) and femoral neck (FNBMD) was measured with dual-energy X-ray absorptiometry. After adjustment for confounding variables (age, weight, physical activity, alcohol consumption, and caffeine intake), we found that the mean value of LSBMD was significantly (2.9%) lower in current smoker compared with never-smokers (p = 0.024), but no significant difference was observed in FNBMD. No statistically significant association was observed between former smokers and never-smokers in any of the BMD sites, indicating that quitting smoking did have a positive effect on bone density. Compared with never-smokers, current heavy smokers who consumed at least 20 cigarettes/d (n = 94) had 3.8% lower LSBMD (p = 0.04), but no significant difference was observed in FNBMD. In the correlation analysis, the duration of smoking was negatively associated with LSBMD (r = −0.166, p = 0.004), but no association was shown in FNBMD. Our results suggested that both smoking status and duration of smoking were deleterious factors on the bone density of the lumbar spine, and the effect was cumulative with duration and quantity.     

Bone Mineral Density of the Spine and Femur in Healthy Moroccan Women

Bone mineral density (BMD) measurements using dual-energy X-ray absorptiometry (DXA) are widely used to diagnose osteoporosis and assess its severity. Previous studies show the necessity to establish reference data for bone mass measurements for each particular population. Such data are lacking for the Moroccan population. The aim of this study was to determine spine and femur BMD reference values for the Moroccan female population and to compare them with values from western and other Arab countries. A cross-sectional study of 569 Moroccan women, (randomly selected in the area of Rabat, the capital of Morocco, aged between 20 and 79 yr) was carried out to establish reference values of BMD. Measurements were taken at the lumbar spine and proximal femurs using DXA (Lunar Prodigy Vision, GE). The data were compared with published normative data taken by United States (U.S.), European, Kuwaiti, Lebanese, and Saudi women over 6 decades of age. The percentage of osteoporosis in postmenopausal women using our reference curve was compared to that observed when the other curves (US, European and Arab) implemented in the Lunar machine was used. Our results showed that the Moroccan women showed the expected decline in BMD at both sites with age after peaking at 20–29 years of age. Moroccan females have lower BMD at the spine than U.S., Europeans, and Kuwaitis (approximately 10–12% for patients older than 50 yr). The BMD values of the total femur in Moroccan females were close to western (European and American), and Kuwaitis, but higher than Lebanese and Saudis. Using our reference database, 37.9% of postmenopausal women had spine osteoporosis vs. 39.6% and 23.4% using US/European and Arabic Lunar reference values respectively. At the femurs, 6.7% had osteoporosis vs. 2.5% using the Arabic Lunar reference values. In conclusion, our study emphasizes the importance of using population-specific reference values for BMD measurements to avoid over or underdiagnosis of osteoporosis.     

A 3-Year Longitudinal Study of the Effect of Physical Activity on the Accrual of Bone Mineral Density in Healthy Adolescent Males

It has previously been suggested that physical activity predominantly influences the accumulation of bone density before puberty. The purpose of the present study was to examine the effect of physical activity on the accumulation of bone mass in male athletes between 16 and 19 years of age. The cohort studied consisted of 12 badminton players (aged 16.1 ± 0.5), 20 ice hockey players (aged 16.1 ± 0.5), and 24 age-matched controls (aged 16.1 ± 0.6). The bone mineral density (BMD, g/cm²) of the total body, spine, dominant and nondominant humerus, head and femoral neck was measured twice with a 3-year interval by dual energy X-ray absorptiometry (DXA). In addition, at the femoral neck, volumetric bone mineral density (vBMD, mg/cm³) was estimated. At baseline, the athletes as a whole group had significantly higher BMD at the total body (P = 0.03), dominant (P = 0.006) and nondominant humerus (P = 0.009) and femoral neck (P = 0.007) compared to the controls. At the 3-year followup, the athletes had significantly higher BMD at all sites (total body; P = 0.003, spine; P = 0.02, dominant humerus; P = 0.001, nondominant humerus; P = <0.001, femoral neck; P = 0.001) except for the head (P = 0.91) compared with controls. The athletes also had higher vBMD at the femoral neck compared with the controls (P = 0.01). Furthermore, to be an athlete was found to be independently associated with a higher increase in nondominant humerus BMD ( = 0.24; P < 0.05) and femoral neck BMD ( = 0.30; P < 0.05) compared with the controls, during the study period. In summary, these results suggests that it is possible to achieve continuous gains in bone mass in sites exposed to osteogenic stimulation after puberty in males by engaging in weight-bearing physical activity.     

Analysis of the Increase in Bone Mineral Density After Surgical Treatment of Primary Hyperparathyroidism

Aim: To analyze the effect of the surgery in bone mineral density (BMD) and to study the value of preoperative clinical and analytical factors as predictors of bone increase. Material and Methods: Prospective observational study. Postmenopausal women who were operated for primary hyperparathyroidism were included. A bone densitometry of the lumbar spine and femoral neck and analytical determinations (parathyroid hormone [PTH], alkaline phosphatase, albumin, phosphate, creatinine, 25-hydroxy-vitamin D3, creatinine clearance, and calciuria) were performed previous to the intervention and after 12 months from surgery. Results: Two hundred and twenty-eight patients were operated on for primary hyperparathyroidism were considered for study, 108 postmenopausal women entered in the final analysis. The mean age was 63 ± 7 yr. After the intervention, a significant increase in BMD was observed in the two locations analyzed, although this increase was significant greater at the level of the lumbar spine. In the lumbar spine, 68 patients (63%) recorded a significant postoperative increase in bone density. Median postoperative BMD was 0.860 g/cm² (interquartile range: 0.93). The observed average percentage of density increase was 6.63 ± 17.9. In femoral neck, 61 patients (56.6%) registered a significant increase in bone density. Median postoperative BMD value was 0.741 g/cm² (interquartile range: 0.76). The average percentage of density increase was 3.19 ± 17.9. In the lumbar spine, patients with osteoporosis before surgery increased postoperative BMD more frequently than those with osteopenia or normal density. Patients who increased BMD preoperatively presented lower bone density levels both in the lumbar spine (median: 0.775, interquartile range: 0.882) and in the hip (median: 0.655, interquartile range: 0.562) than patients in whom it was not observed postoperative increase. PTH preoperative serum was lower among patients who increased bone density in the femur (median: 141 pg/ml, interquartile range: 291) than among those who did not (median: 152 pg/ml, interquartile range: 342) (p?=?0.01). In the multivariate analysis, the increase in BMD in the lumbar spine was related to preoperative BMD (odds ratio [OR] 0.084, 95% confidence interval [CI]: 0.007–0.961); in femoral neck it was related to preoperative BMD (OR 0.001; 95% CI: 0.0–0.028) and to the preoperative PTH serum concentration (OR 0.99; 95% CI: 0.98–0.99). Conclusions: After surgery, a significant increase in BMD was observed in the lumbar spine and femoral neck. In the multivariate analysis, preoperative bone density was the factor that showed the highest predictive value of the increase in BMD after surgery.     

The Range of Bone Mineral Density in Healthy Canarian Women by Dual X-ray Absorptiometry Radiography and Quantitative Computer Tomography

Bone mass measurements play a crucial role in the diagnosis of osteoporosis. According to a World Health Organization (WHO) Working Group, osteoporosis in women can be diagnosed if the value for bone mineral density (BMD) is 2.5 or more standard deviations below the mean value of a young reference population. This definition obviously requires the availability of normal data, which should ideally be obtained locally. The objective was establish normal values of BMD in the female Canarian population, by dual X-ray absorptiometry (DXA) in the lumbar spine and the proximal femur, and by quantitative computed tomography (QCT) in the lumbar spine, and to study the correlation between the results of both techniques and the changes with age. Seven hundred forty-four Healthy Canarian women, from 20-80 yr old were examined. Measurement of bone density was performed by an Hologic QDR 1000 densitometer (DXA) in the lumbar spine and proximal femur, and by a Toshiba scanner model 600 HQ in the lumbar spine. Both methods show that the peak bone mass is achieved in the fourth decade (30-39 yr). Bone density decreases thereafter with age in the lumbar spine (r = -0.3364 DXA and r = -0.6988 for QCT) and in the femoral neck (r = -0.3988). Bone density mean values obtained by DXA are very similar to those described in Spain and in other European female populations, using the same densitometer. The correlations between both techniques (DXA and QCT) were high and statistically significant (p < 0.001 in every case). Normal values in the normal Canarian women for DXA and QCT are provided. Our results are very similar to those previously described. These two techniques have a close correlation.     

Factors Affecting Peak Bone Density in Japanese Women

Both genetic and environmental factors have been shown to contribute to the determination of bone density. To clarify the interaction between genetic and environmental factors affecting peak bone mass, we investigated the correlation between bone mineral density (BMD) and physical constitution, vitamin D receptor (VDR) genotype, age, age of menarche, history of menstrual dysfunction, and exercise in 157 healthy young Japanese women. History of exercise and menstrual dysfunction were significant independent predictors of BMD. The VDR genotype also affects peak bone density. Exercise has been shown to increase BMD in a similar way for each VDR genotype including those women who have the particular genotype associated with low bone density. This data indicate that there are complex gene-environmental interactions particularly in relation to menstrual history, exercise, and genetic factors during childhood/adolescence that may have implications for the development of adult BMD in women. Received: 28 November 1997 / Accepted: 11 May 1998     

去势治疗对前列腺癌患者骨密度的影响

目的 :探讨去势治疗对前列腺癌患者骨密度 (BMD)的影响。　方法 :4 9例完成BMD测定的前列腺癌患者分为 2组 :非去势组 2 1例 ,在去势治疗前即已完成BMD测定 ;去势组 2 8例 ,均为去势治疗 1年以上者。BMD测定采用双能X线吸收法 (DEXA法 ) ,测定部位为腰椎 (L2～ 4)和股骨颈。为校正年龄、性别和体重因素对BMD的影响 ,与年龄、种族等相配对的Z评分被用于结果评估。　结果 :13例 (6 2 % )非去势组患者和 2 3例 (82 % )去势组患者均存在不同程度的BMD水平下降。在非去势组 ,腰椎 (L2～ 4)Z评分为 - (0 .9± 0 .7)分 ,股骨颈Z评分为 - (0 .6± 0 .5 )分 ;而在去势组 ,腰椎 (L2～ 4)Z评分为 - (1.8± 1.1)分 ,股骨颈Z评分为 - (1.6± 1.0 )分。与非去势组相比 ,去势组患者BMD水平明显偏低 ,差异有显著性 (P <0 .0 1)。　结论 :去势治疗前 ,前列腺癌患者常伴有不同程度的骨量减少和骨质疏松 ,去势治疗与前列腺癌患者BMD水平下降明显相关。在对前列腺癌患者采用去势治疗之前 ,BMD测定是必要的。     

Influence of Strontium on Bone Mineral Density and Bone Mineral Content Measurements by Dual X-Ray Absorptiometry

The presence of Sr in bone influences bone mineral density (BMD) and content (BMC) measurements by dual-energy X-ray absorptiometry (DXA). This interaction is of interest, since strontium ranelate (S12911) demonstrated positive effects on bone metabolism in various animal models of osteoporosis, and is currently being evaluated for treatment of postmenopausal osteoporosis. The present in vitro study aimed to determine adjustment factors for DXA measurements of BMC and BMD at different Sr concentrations in order to estimate the corresponding values that would have been measured without Sr. A series of mixtures of Ca and Sr hydroxyapatites were prepared, with biologically relevant Sr/Ca ratios ranging from 0 to 3.5 mol/mol%, and a constant total concentration of divalent cations (145 mmol). The mixtures were conditioned in plastic dishes 4.5 cm in diameter, to obtain an areal density close to the human vertebral mineral density of 0.7-1.1 g/cm(2). DXA measurements of the mixtures were made with a wide range of different instruments and various acquisition modes. A direct linear relationship (r(2) > 0.99) was found between strontium content and overestimation of BMD and BMC. There were no significant differences in adjustment factors for BMC or BMD between the different machines or acquisition modes, and the presence of Sr in the water bath used to mimic soft tissues did not affect the accuracy and precision of the method. This demonstrates that reliable DXA determinations of BMD may be carried out in the presence of Sr, and may be interpreted in terms of calcium hydroxyapatite equivalent if the bone Sr content of the measured bone is known. The same adjustment factor (10% overestimation for 1 mol/mol% Sr) can be used for all presently available types of instrument and acquisition modes.     

Older Age and Higher Body Mass Index Are Associated With a More Degraded Trabecular Bone Score Compared to Bone Mineral Density

Trabecular bone score (TBS) may detect subjects with a more degraded microarchitecture but whose bone mineral density (BMD) reflects normal or osteopenia. The purpose of this study was to evaluate whether age and body sizes were associated with the discordance between BMD and TBS. We analyzed BMD and TBS in 1505 Korean women over 40?yr of age who had no history of osteoporotic fractures or conditions that affect bone metabolism. We considered 3 groups to have TBS values that reflected a more degraded TBS than their BMD values: (1) normal BMD but partially degraded TBS, (2) normal BMD but degraded TBS, and (3) osteopenia but degraded TBS. We compared subjects in these 3 groups with other subjects in terms of age and body sizes, and used multivariable logistic regression to analyze the odds ratios (ORs) for the occurrence of a more degraded TBS than their BMD level using age and body mass index (BMI). One hundred sixty subjects (10.6%) were found to have a more degraded TBS than their BMD level; these subjects were older, heavier, and had higher BMIs than the other subjects. Age (OR: 1.038, 95% confidence interval: 1.020–1.057, p <?0.001) and BMI (OR: 1.223, 95% confidence interval: 1.166–1.283, p <?0.001) were statistically significant in the multivariable analysis for the occurrence of this feature. Women with a more degraded TBS than their BMD level are older and have higher BMIs than the other subjects. It may be helpful to consider the possibility of trabecular bone degradation when clinically evaluating fracture risk in patients who are older or who have high BMIs with normal BMD or osteopenia.     

Bone Mineral Density and Bone Size in Men With Primary Osteoporosis and Vertebral Fractures

The bone mineral density (BMD) at the lumbar spine, proximal femur, and total skeleton was evaluated in 38 men with primary osteoporosis and vertebral fractures. BMD of the patients was significantly reduced over all skeletal areas compared with controls. The Z-score of the lumbar spine (−2.8 ± 0.9) was less than that of the other areas (P < 0.001) except the legs (−2.5 ± 1.1) (p.n.s.) showing that bone loss had a tendency to be greater over the axial skeleton. Vertebral dimensions compared with age-matched controls were as follows: projected L2–L4 area (cm 2): 45.7 ± 5.6 versus 53.7 ± 3.6 (P < 0.001); vertebral width (cm): 4.37 ± 0.44 versus 4.90 ± 0.36 (P < 0.001). Serum biochemical parameters and testosterone levels were similar between osteoporotic and control men. We conclude that men with vertebral osteoporotic fractures have reduced vertebral BMD and vertebral dimensions compared with age-matched controls. Thus, these findings indicate that the achievement of a reduced bone size at the end of the growth period or a failure of periosteal increase during adult life is likely to contribute to the pathogenesis of the vertebral fractures observed in older men. Received: 31 January 1997 / Accepted: 2 July 1997     

Does Bone Mineral Density and Knowledge Influence Health-Related Behaviors of Elderly Men at Risk for Osteoporosis?

To determine if bone mineral density (BMD) substantially influences health-related behaviors in men at risk for osteoporosis, we surveyed 102 men who were participating in a study of prostate cancer and bone loss. Subjects included 68 men with prostate cancer, 44 of whom were hypogonadal on androgen deprivation therapy, and 34 healthy age-matched controls without prostate cancer. At least 6 mo after an initial evaluation, assessment of BMD, and osteoporosis information session, men were administered a questionnaire regarding their healthrelated behaviors. We found that men with osteopenia were 4 times as likely (13%) and men with osteoporosis were more than 10 times as likely (41%) to start taking bisphosphonates compared to men with a normal bone mass (3%, p < 0.0001). Men with low bone mass were more likely to begin taking calcium (p < 0.05) and vitamin D supplements (p < 0.05). Hypogonadal men were 10 times as likely to begin using bisphosphonates (34%) compared to the control group (3%, p < 0.0001) and twice as likely to begin using calcium supplements (57% vs 24%, p < 0.05). Caffeine consumption, alcohol consumption, dietary calcium intake, exercise, and smoking habits were not different in men with osteoporosis or those who were hypogonadal compared to controls. We conclude that men with low bone mass and hypogonadism were more likely to start using bisphosphonates, calcium supplements, and vitamin D supplements after having a bone density test. However, they were not more likely to make significant health-related lifestyle changes after obtaining the results of their bone mass.     

Longitudinal Evaluation of Bone Mineral Density and Body Composition in Patients With Positive Celiac Serology

Untreated celiac disease is associated with lower bone mineral density (BMD), body weight and fat mass compared with controls. There are few longitudinal studies examining changes in body composition after celiac disease diagnosis.The aim of this study was to compare changes in BMD and body composition in celiac seropositive cases who had undergone baseline and follow-up dual energy x-ray absorptiometry (DXA) with seronegative controls. Celiac serologic and BMD databases for the Province of Manitoba, Canada, were linked. Endomysial antibody (EMA) seropositive cases and EMA seronegative controls over age 40 who had serologic testing within 6 months of DXA testing and a follow-up DXA were extracted from the databases. Changes in BMD, BMI and body composition were compared in the 2 groups. The 43 EMA seropositive cases had lower baseline spine and hip BMD, BMI and fat measurements compared with 233 EMA seronegative controls. For seropositive versus seronegative individuals there were greater increases in mean spine BMD (4.6%/year vs 0.7% spine, p < 0.0001), hip BMD (3.0 %/year vs 0.2%/year hip, p < 0.0001), and body weight (2.8%/year vs 0.3%/year, p < 0.0001). Increases in mean abdominal fat (2.4%/year vs 0.4%/year, p < 0.0001) were also greater in seropositive versus seronegative individuals, while increases in hip fat were less marked (0.9%/year vs 0.3%/year, p = 0.0071). This longitudinal database study documents significant improvements in BMD in seropositive cases. BMI and fat measures also increased, with the abdominal fat compartment demonstrating the greatest increase. Further studies are needed to determine the clinical significance of this regional increase in abdominal fat.     

A Pilot Study of Body Composition and Bone Mineral Density in Healthy Men From Argentina

A precise assessment of bone mineral density (BMD) and body composition can be performed using dual-energy X-ray absorptiometry (DXA). Values of body composition for males would be useful to evaluate the occurrence of alterations in body composition in a number of diseases. The objectives of this study were to establish BMD and body composition values in healthy men and to analyze age-related changes. BMD and body composition of total body and subareas were determined in 116 healthy men (aged 20–79 yr) using DXA. Comparison between 20–29- and 70–79-yr-old men showed that older subjects were shorter (p < 0.03), and had a higher body mass index (p < 0.01). Fat mass increased (+46.7%; p < 0.001) especially in the trunk. Lean mass (LM) decreased (−9.4%; p < 0.05) mainly in the arms and legs. Bone mineral content (BMC) and BMD decreased (−15.3% [p < 0.001], −6.3% [p < 0.05], respectively). Correlation was observed between BMC and LM (r = 0.7, p < 0.01). Values of BMD and body composition in healthy men were obtained. A relation was observed between bone mass and body composition, suggesting that the age-related decrease in LM may be associated to bone mass loss. Further studies should be conducted to elucidate the role of body composition in the occurrence of osteoporosis in men.     

Trabecular Bone Score Is a Valuable Addition to Bone Mineral Density for Bone Quality Assessment in Older Mexican American Women With Type 2 Diabetes

Altered bone quality due to the underlying metabolic changes of type 2 diabetes (T2D) has been hypothesized to affect bone strength, leading to increased fracture risk in patients with T2D. Lumbar spine trabecular bone score (LS-TBS), an indirect measure of trabecular microarchitecture, provides information on bone quality and has been associated with T2D. However, trabecular bone score (TBS) is also affected by demographic patterns and body size, and is expected to be different in people from various ethnic or racial backgrounds. Therefore, it is important to understand associations between T2D and TBS for each ethnic or racial group separately. Although the relationship between TBS and age has been reported to be similar between non-Hispanic Caucasians and Mexican Americans (MAs), data on associations of LS-TBS with T2D in older MAs are lacking. Here, we report associations between TBS and T2D in 149 older MA men and women. Participants are part of a cohort known as the Cameron County Hispanic Cohort in Texas who have high prevalence of obesity and poor glycemic control. Bone mineral density was not altered for MA women with T2D, but was significantly higher in MA men with T2D compared with MA men without diabetes. Low LS-TBS was associated with T2D in women in our study. Although low TBS was associated with older age in men, TBS did not show any significant association with T2D for men. These results are similar to those found in other studies of non-Hispanic whites with diabetes. LS-TBS may add value in diagnosing poor bone quality in older MA women with T2D regardless of bone mineral density scoring.     

广州汉族成年人维生素D受体基因分布及其与骨密度关系的研究

目的　了解中国广州地区人群VDR基因多态性的分布及其与骨密度的关系。方法　选取居住广州地区的汉族成年人 396例。应用PCR RFLP等生物学技术检测VDR基因 ,用双能X线骨密度仪 (DEXA)对入选的大部分对象进行了全身、腰推正侧位 ,股骨近端BMD检测。结果　VDR基因分布频率是BB 6 5 %、Bb 4 8 2 %、bb 4 5 3% ;本组对象峰值骨量出现在 30～ 39岁组 ,并且以Bb基因型的BMD值最高 ;3种基因型按BMD大小排列顺序为 :Bb >BB >bb ,但只有Bb与bb两基因型的BMD存在着差异。结论　①VDR基因多态性与种族、居住地区和人群不同有关。②峰值骨量出现在 30～39岁组 ,以Bb基因型对应较高的BMD ,bb基因型对应较低的BMD。③VDR基因型与BMD间存在着关联 ,但对其骨质疏松相对高危人群的预测价值有待进一步的深入研究。     

Total Body and Regional Bone Mineral Density in Men: Effect of Age

Bone density is related to the risk of fracture, with a decrease in bone density resulting in an increased risk of fracture. The aims of this study were to characterize the relationship between bone mineral density (BMD) and age at different skeletal sites in men, and to determine whether the BMD pattern with age reflects the pattern of fracture in men. We studied 178 healthy Caucasian men, ages 20–79 years (approximately 30 per decade) from a general practitioner register. Spinal radiographs were obtained from men over 50 years of age and graded by a radiologist for spinal osteoarthritis by the method of Kellgren. BMD was measured by dual-energy X-ray absorptiometry at the anteroposterior (AP) lumbar spine, femoral neck, Ward’s triangle, trochanter, ultradistal forearm and total body (providing estimates for the pelvis, head, arms, legs, trunk, ribs and spine). Severe osteoarthritis (grades 3 and 4) was associated with increased spine BMD, and therefore individuals with severe osteoarthritis were excluded from analysis of the spine. There was a decrease in height of vertebrae L2–4 in men between 20 and 79 years of age (4%), resulting in a decrease in projected area. The change in BMD in standard deviation units (T-score) between 20 and 79 years was calculated: there were significant decreases at the femoral neck (–1.6), Ward’s triangle (–2.4), total body (–0.6), and its subregions the pelvis (–1.4), trunk (–0.8), ribs (–0.7) and legs (–0.7). There was no change in BMD with age at the AP lumbar spine, ultradistal forearm, or the total body subregion of the head. Similar results were found after adjusting for height and weight. Thus, there was only a small decrease in total body BMD across life, but a substantial decrease in BMD of the pelvis and proximal femur, sites rich in trabecular bone. These are the same sites associated with substantial increases in fracture incidence in men with aging. Received: 31 March 1998 / Accepted: 25 November 1998