The osteoporosis care cascade in postmenopausal women with and without cardiovascular disease: a nationally representative cross-sectional study using dual-energy X-ray absorptiometry
The CVD and non-CVD groups did not differ in awareness or treatment rates, suggesting that cardiovascular follow-up does not facilitate osteoporosis detection and Multivariable logistic regression identified predictors of unawareness and non-treatment.
Diabetes mellitus substantially increases the risk of osteoporosis and fractures, but the mechanisms remain unclear. Dyslipidemia, particularly the role of high-density lipoprotein (HDL), may influence bone mineral density (BMD), yet evidence in diabetic patients is limited. This study aimed to explore the association between HDL and BMD in US adults with diabetes using a nationally representative dataset. We analyzed data from 5 National Health and Nutrition Examination Survey cycles (2005–2018). A total of 5014 diabetic participants with available HDL and dual-energy X-ray absorptiometry (DXA)-measured BMD were included. Weighted multivariable linear regression models, smooth curve fitting, and 2-piecewise linear regression were employed to examine linear and nonlinear associations. Subgroup and sensitivity analyses were also conducted to assess robustness. Among 5014 participants (mean age 40.1 ± 31.2 years; 50.8% male), mean femoral neck and lumbar spine BMD were 0.81 and 1.03 g/cm2, respectively, with a mean HDL of 48.9 mg/dL. Higher HDL levels were inversely associated with BMD at both the femoral neck (β = −0.0011, 95% CI: −0.0015 to −0.0007) and lumbar spine (β = −0.0012, 95% CI: −0.0018 to −0.0007) after full adjustment. Participants in the highest HDL quartile had significantly lower BMD compared with those in the lowest quartile (femoral neck: −0.0294 g/cm2; lumbar spine: −0.0378 g/cm2). Smooth curve fitting indicated nonlinear, negative associations. Subgroup analyses revealed stronger inverse associations in men, participants with hypertension, those <60 years at the femoral neck, and those ≥60 years at the lumbar spine. Sensitivity analyses confirmed the robustness of the results. Higher HDL levels were consistently and independently associated with lower BMD in US adults with diabetes. These findings challenge the traditional view of HDL as universally protective, suggesting that in the diabetic context, elevated HDL may exert detrimental effects on bone health. Further longitudinal and mechanistic studies are warranted to clarify causal pathways and guide osteoporosis prevention strategies in this high-risk population.
This comparative cross-sectional study evaluated bone mineral density (BMD) and its association with glycemic control and biochemical bone markers among adults with and without type 2 diabetes mellitus (T2DM) in the Qassim region, Saudi Arabia. A comparative cross-sectional study was conducted among 73 adults (comprising individuals with T2DM and non-diabetic controls) recruited from healthcare facilities in the Qassim region, Saudi Arabia. Clinical, demographic, and bone health data were collected using a structured questionnaire and hospital medical records. Glycated hemoglobin (HbA1c), serum calcium, alkaline phosphatase (ALP), fracture history, and bone mineral density were evaluated. BMD was measured at the lumbar spine and femoral neck using dual-energy X-ray absorptiometry (DXA) and classified according to the World Health Organization (WHO) criteria. Statistical analyses were performed using SPSS version 23.0. T2DM was diagnosed in 69.9% of participants; 48.0% had osteopenia and 19.2% had osteoporosis. Chronological age was associated with progressive bone mineral density loss across successive cohorts (Pearson χ² = 11.14, p = 0.025). Among participants with T2DM, mean HbA1c increased progressively with longer diabetes duration (Spearman’s rho = 0.310, p = 0.027). In an exploratory multinomial logistic regression model, higher HbA1c was associated with lower bone mineral density categories each 1% increase in HbA1c was associated with higher odds of osteopenia (adjusted odds ratio [aOR] = 2.34, 95% confidence interval [CI]: 1.12–4.88; p = 0.024) and osteoporosis (aOR = 3.89, 95% CI: 1.45–10.42; p = 0.007). Serum calcium and alkaline phosphatase (ALP) were not significantly associated with bone mineral density. Low bone mineral density was common in this study population. Higher HbA1c levels were associated with lower bone mineral density categories in an exploratory regression model adjusted for the variables included in the analysis. These findings support further investigation of the relationship between glycaemic control and bone health in larger prospective studies with comprehensive adjustment for clinical confounders.
H. Alharbi, A. H. Mohammed, Sahar Mohammed Alatni et al.· BMC Endocrine Disorders· 0 citations
Indirect bone microarchitecture analysis using DXA-derived TBS predicts fragility fracture risk independently of spine BMD and with comparable predictive performance in postmenopausal women in Poland.
M. Warzecha, Edward Czerwiński, J. Amarowicz· Rheumatology· 0 citations
Depression is an under-recognized risk factor for osteoporosis (OP) and adversely affects quality of life (QOL). Data on depressive symptoms among postmenopausal women aged ≥50 years with osteoporosis in India are limited. This study aimed to assess depressive symptoms and their impact on QOL among postmenopausal women with osteoporosis from low- and middle-income urban communities.
A total of 688 menopausal women aged ≥50 years were recruited through community-based camps (2016–2019), of whom 14.2%, 31.5%, and 54.2% were diagnosed as normal, osteopenia, and osteoporosis, respectively, by dual-energy X-ray absorptiometry (DXA) scans. A subset of 100 postmenopausal women aged 50–75 years with osteoporosis and ≥5 years since menopause was included using a consecutive convenience sampling technique. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and QOL was assessed using the WHOQOL-BREF through face- to- face (in-person) interviews. Participants were also assessed for non-communicable diseases (NCD) and musculoskeletal complaints.
Mild, moderate, and moderately severe depressive symptoms were observed in 17%, 4%, and 1% of the participants, respectively. The comparison of WHOQOL-BREF with depressive symptoms revealed that the physical domain of WHOQOL was significantly associated with depressive symptoms, indicating that women with depressive symptoms had substantially lower median scores [63.0 (IQR:50.0-69.0) vs. 88.0 (IQR: 81.0-94.0), Mann-Whitney U=128.0, z= -6.136,
p
<0.001, r=0.61].
Screening with the PHQ-9 and WHOQOL-BREF in community-based NCD camps may help in the early identification of depressive symptoms among menopausal women with osteoporosis. Integrating mental health screening with current geriatric and primary healthcare services through national initiatives, such as the National Mental Health Programme and Ayushman Bharat, may improve the overall quality of life.
Neera A. Mehta, Lalita S. Savardekar, Swati B. Shelke et al.· BMC Women's Health· 0 citations
Osteoporosis is the most prevalent metabolic bone disease and is associated with an increased risk of fragility fractures. Current guidelines recommend bone mineral density (BMD) assessment by DXA primarily in women aged ≥65 years or in younger women with clinical risk factors. However, DXA is frequently performed in women under 65 years without guideline-based indications. Objective: To describe the prevalence of densitometric osteoporosis in women under 65 years undergoing DXA in the absence of clinical risk factors. Methods: A descriptive cross-sectional study was conducted at a referral center. Women aged 40–65 years consecutively referred for DXA between February and September 2024 were included. Participants with FRAX® clinical risk factors, major osteoporotic fractures, secondary metabolic bone diseases, or dietary restrictions were excluded. BMD was assessed at the lumbar spine, total hip, and femoral neck. Osteoporosis was defined as a T-score ≤ -2.5. Results: A total of 119 women were included (mean age 53 years; range 43-62). Mean T-scores were -0.9±1.3 at the lumbar spine, -0.9±1.1 at the total hip, and -1.0±1.0 at the femoral neck. BMD values within the osteoporotic range was observed in 13% (n=15) at the lumbar spine and in 7% (n=8) at both the total hip and femoral neck. Overall, 17% (n=20) had BMD values within the osteoporotic range at at least one skeletal site. Conclusion: Densitometric osteoporosis was identified in a relevant proportion of women younger than 65 years without traditional risk factors, supporting an individualized approach to bone health assessment.
Josefina Rosmino, M. Pavlove, M. L. Brance et al.· EndoAr· 0 citations
BACKGROUND
This cross-Sectional study aimed to elucidate the relationship between body fluid distribution and bone mineral density (BMD) as well as the risk of osteoporosis in men aged under 50.
METHODS
The study included male participants aged under 50 from the National Health and Nutrition Examination Survey (NHANES). BMD was measured via dual-energy X-ray absorptiometry (DXA). Body fluid distribution was defined as extracellular fluid (ECF), intracellular fluid (ICF), and total body water (TBW) assessed by bioelectrical impedance analysis. Weighted logistic regression and weighted linear regression were adopted to unveil the associations of body fluid distribution with osteoporosis risk and BMD. Subgroup analyses were carried out. Restrictive cubic spline (RCS) models were leveraged to unravel potential non-linear relationships of body fluid distribution with osteoporosis risk and BMD.
RESULTS
1,815 participants (weighted samples: 46,823,836) were encompassed in our analysis. Among the participants, 10 cases of osteoporosis were identified (weighted samples: 319,031). The results showed significant correlations of increases in ECF, ICF, and TBW with a decrease in osteoporosis risk and an elevation in BMD. RCS analysis indicated an approximately linear relationship between body fluid components and both osteoporosis risk and BMD. Subgroup analysis revealed consistent trends between body fluid components, osteoporosis risk, and BMD across various subgroups.
CONCLUSIONS
Increases in ECF, ICF, and TBW were significantly linked to a lowered osteoporosis risk and enhanced BMD. These findings may aid clinicians in the early identification and intervention of patients at risk for bone loss. However, due to the cross-sectional design, causality cannot be inferred, and prospective studies are warranted.
Wanxin Su, Sizhe Xiao, Yanhui Li et al.· American Journal of the Medi...· 0 citations