Associations between Bone Material Strength Index, Calcaneal Quantitative Ultrasound, and Bone Mineral Density in Men

Impact micro-indentation (IMI) measures bone material strength index (BMSi) in vivo. This study investigated how IMI is associated with calcaneal quantitative ultrasound and bone densitometry parameters in men. BMSi was measured on the tibial plateau using the OsteoProbe in 377 men (age 33-96 years) from the Geelong Osteoporosis Study. Broadband ultrasound attenuation (BUA), speed of sound (SOS), and stiffness index (SI) were assessed at the calcaneus using an ultrasonometer. Areal BMD was measured at several skeletal sites using dual-energy x-ray absorptiometry. Linear associations between parameters were tested using Pearson's correlation. Multivariable regression techniques were used to determine associations between BMSi and other measures of bone, independent of confounders. BMSi was negatively correlated with age (r = -0.171, P =.001), weight (r = -0.100, P =.052), and body mass index (r = -0.187, P =.001), and positively with height (r = +0.109, P =.034). There was some evidence to support a positive association between BMSi and BUA (β = 0.052, P =.037), SOS (β = 0.013, P =.144), and SI (β = 0.036, P =.051). After age adjustment, this association was attenuated. No correlations were observed between BMSi and BMD at any skeletal site (r values ranged from -0.006 to +0.079, all P ≥.13). There was a small positive association between BMSi and quantitative ultrasound (QUS) parameters, which were not independent of age. No associations were detected between BMSi and BMD. This suggests that BMSi and QUS are capturing common age-dependent properties of bone. Further research on the utility of IMI alone and complementary to conventional bone testing methods for predicting fracture risk is warranted

Fracture Risk and Use of Angiotensin-Converting Enzyme Inhibitors or Angiotensin II Receptor Blockers

Medications used to treat hypertension may affect fracture risk. This study investigated fracture risk for users of angiotensin converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB). Participants (899 men, median age 70.3 yr (59.9-79.1), range 50.0-96.6 yr; 574 women, median age 65.5 yr (58.1-75.4), range 50.1-94.6 yr) were from the Geelong Osteoporosis Study. Medication use was self-reported and incident fractures were ascertained using radiological reports. Bone mineral density (BMD) was measured at the femoral neck. Participants were divided into four groups: (1) non-users without hypertension, (2) non-users with hypertension, (3) ACEI users and (4) ARB users. Dosage was calculated using the defined daily dose (DDD) criteria. Participants were followed from date of visit to first fracture, death or 31 December 2016, whichever occurred first. Cox proportional hazards models were used for analyses. At least one incident fracture was sustained by 156 men and 135 women over a median(IQR) of 11.5(6.2-13.2) and 10.9(6.3-11.6) years of follow-up, respectively. In unadjusted analyses, compared to non-users without hypertension, men in all three other groups had a higher risk of fracture (Hazard Ratio (HR, 95%CI) 1.54, 1.00-2.37; 1.90, 1.18-3.05; 2.15, 1.26-3.66), for non-users with hypertension, ACEI and ARB users, respectively). Following adjustment for age, prior fracture and BMD, these associations became non-significant. A dose effect for ARB use was observed; men using lower doses had a higher risk of fracture than non-users without hypertension, in both unadjusted (2.66, 1.34-5.29) and adjusted (2.03, 1.01-4.08) analyses, but this association was not observed at higher doses. For women, unadjusted analyses showed a higher risk for ACEI users compared to non-users without hypertension (1.74, 1.07-2.83). This was explained after adjustment for age, alcohol consumption, prior fracture and BMD (1.28, 0.74-2.22). No other differences were observed. In men, lower dose (0 < DDD ≤ 1) ARB use was associated with an increased risk of fracture. ACEI or ARB use was not associated with increased risk of incident fracture in women. These findings may be important for antihypertensive treatment decisions in individuals with a high risk of fracture. Keywords: Angiotensin II receptor blockers; Angiotensin converting enzyme inhibitors; Fracture risk

Excessive daytime sleepiness and falls among older men and women: cross-sectional examination of a population-based sample

Background: Excessive daytime sleepiness (EDS) has been associated with an increased risk for falls among clinical samples of older adults. However, there is little detailed information among population-representative samples. The current study aimed to assess the relationship between EDS and falls among a cohort of population-based older adults. Methods: This study assessed 367 women aged 60-93years (median 72, interquartile range 65-79) and 451 men aged 60-92years (median 73, interquartile range 66-80) who participated in the Geelong Osteoporosis Study between the years 2001 and 2008. Falls during the prior year were documented via self-report, and for men, falls risk score was obtained using an Elderly Fall Screening Test (EFST). Sleepiness was assessed using the Epworth Sleepiness Scale (ESS), and scores of&ge;10 indicated EDS. Differences among those with and without EDS in regard to falls were tested using logistic regression models. Results: Among women, 50 (13.6 %) individuals reported EDS. Women with EDS were more likely to report a fall, and were more likely to report the fall occurring outside. EDS was similarly associated with an increased risk of a fall following adjustment for use of a walking aid, cases of nocturia and antidepressant medication use (adjusted OR&isin;=&isin;2.54, 95 % CI 1.24-5.21). Multivariate modelling revealed antidepressant use (current) as an effect modifier (p&isin;&lt;&isin;.001 for the interaction term). After stratifying the data by antidepressant medication use, the association between EDS and falls was sustained following adjustment for nocturia among antidepressant non-users (adjusted OR&isin;=&isin;2.63, 95 % CI 1.31-5.30). Among men, 72 (16.0 %) individuals reported EDS. No differences were detected for men with and without EDS in regard to reported falls, and a trend towards significance was noted between EDS and a high falls risk as assessed by the EFST (p&isin;=&isin;0.06), however, age explained this relationship (age adjusted OR&isin;=&isin;2.20, 95 % CI 1.03-1.10). Conclusions: For women, EDS is independently associated with at least one fall during the previous year, and this is more likely to occur whilst located outside. Amelioration of EDS may assist in improving functional outcomes among these individuals by reducing the risk for falls

Muscle strength and gait speed rather than lean mass are better indicators for poor cognitive function in older men

We aimed to examine muscle strength, function and mass in relation to cognition in older men. This cross-sectional data-set included 292 men aged &ge;60 yr. Handgrip strength (kg) was measured by dynamometry, gait speed by 4-metre walk (m/s) and appendicular lean mass (kg) by dual-energy x-ray absorptiometry. Cognition was assessed across four domains: psychomotor function, attention, visual learning and working memory. Composite scores for overall cognition were calculated. Bivariate analyses indicated that handgrip strength and gait speed were positively associated with cognitive function. After accounting for confounders, positive associations between individual muscle (or physical) measures and cognitive performance were sustained for handgrip strength and psychomotor function, gait speed and psychomotor function, gait speed and attention, handgrip strength and overall cognition, and gait speed and overall cognition. In multivariable models, handgrip strength and gait speed independently predicted psychomotor function and overall cognition. No associations were detected between lean mass and cognition after adjusting for confounders. Thus, low muscle strength and slower gait speed, rather than low lean mass, were associated with poor cognition in older men

Muscle strength and areal bone mineral density at the hip in women: a cross-sectional study

BACKGROUND: Muscle strengthening exercises are promoted for building and maintaining a healthy skeleton. We aimed to investigate the relationship between muscle strength and areal bone mineral density (BMD) at the hip in women aged 26-97 years. METHODS: This cross-sectional study utilises data from 863 women assessed for the Geelong Osteoporosis Study. Measures of hip flexor and abductor strength were made using a hand-held dynamometer (Nicholas Manual Muscle Tester). The maximal measure from three trials on each leg was used for analyses. BMD was measured at the hip using dual energy x-ray absorptiometry (DXA; Lunar DPX-L). Total lean mass, body fat mass and appendicular lean mass were determined from whole body DXA scans. Linear regression techniques were used with muscle strength as the independent variable and BMD as the dependent variable. Models were adjusted for age and indices of body composition. RESULTS: Measures of age-adjusted hip flexor strength and hip abductor strength were positively associated with total hip BMD. For each standard deviation (SD) increase in hip flexor strength, the increase in mean total hip BMD (SD) was 10.4 % (p = 0.009). A similar pattern was observed for hip abductor strength, with an increase in mean total hip BMD of 22.8 % (p = 0.025). All associations between hip muscle strength and total hip BMD were independent of height, but were nullified after adjusting for appendicular lean mass or total lean mass. CONCLUSIONS: There was a positive association observed between muscle strength and BMD at the hip. However, this association was explained by measures of lean mass

All-cause mortality risk in Australian women with impaired fasting glucose and diabetes

AIMS: Impaired fasting glucose (IFG) and diabetes are increasing in prevalence worldwide and lead to serious health problems. The aim of this longitudinal study was to investigate the association between impaired fasting glucose or diabetes and mortality over a 10-year period in Australian women. METHODS: This study included 1167 women (ages 20-94&thinsp;yr) enrolled in the Geelong Osteoporosis Study. Hazard ratios for all-cause mortality in diabetes, IFG, and normoglycaemia were calculated using a Cox proportional hazards model. RESULTS: Women with diabetes were older and had higher measures of adiposity, LDL cholesterol, and triglycerides compared to the IFG and normoglycaemia groups (all p &lt; 0.001). Mortality rate was greater in women with diabetes compared to both the IFG and normoglycaemia groups (HR 1.8; 95% CI 1.3-2.7). Mortality was not different in women with IFG compared to those with normoglycaemia (HR 1.0; 95% CI 0.7-1.4). CONCLUSIONS: This study reports an association between diabetes and all-cause mortality. However, no association was detected between IFG and all-cause mortality. We also showed that mortality in Australian women with diabetes continues to be elevated and women with IFG are a valuable target for prevention of premature mortality associated with diabetes

An Evaluation of Ethograms Measuring Distinct Features of Enrichment Use by Captive Chimpanzees (Pan troglodytes)

Environmental enrichment provides mental stimulation and minimizes abnormal behaviors in captive animals. In captive chimpanzees, individual animals may vary in the ways in which they benefit from enrichment or use enrichment devices, so investigating nuances in enrichment use may improve the welfare of captive chimpanzees. In the current study, three ethograms measuring distinct features of enrichment use (i.e., enrichment object, manipulation behavior, and social context) were evaluated by coding videos of captive chimpanzees (Pan troglodytes) at Chimpanzee Sanctuary Northwest in Cle Elum, WA. A total of 732 min and 58 s of video footage was coded from a larger video archive (i.e., 2054 videos) of enrichment use that spanned a decade. A principal component analysis (PCA) revealed that different categories of enrichment objects were more often associated with specific manipulation behaviors and social contexts, suggesting that enrichment objects might fulfill different behavioral and social needs in captivity. Specifically, toy objects were associated with active tactile behaviors in affiliative contexts while oral behaviors were used with foraging objects in solitary contexts. Additionally, individual chimpanzees showed unique preferences for enrichment objects, indicating that caregivers of captive chimpanzees should consider individual needs instead of a “one size fits all” approach to enrichment provisions

Comparison of incidence, rate and length of all-cause hospital admissions between adults with normoglycaemia, impaired fasting glucose and diabetes: a retrospective cohort study in Geelong, Australia

OBJECTIVE: To determine whether adults with normoglycaemia, impaired fasting glucose (IFG) and diabetes differed according to the incidence, rate, length and primary reasons for hospital admission.&nbsp;DESIGN: Retrospective cohort study.&nbsp;SETTING: Barwon Statistical Division, Geelong, Australia. PARTICIPANTS: Cohort included 971 men and 924 women, aged 20+ years, participating in the Geelong Osteoporosis Study. Glycaemic status was assessed at cohort entry using fasting plasma glucose, use of antihyperglycaemic medication and/or self-report. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measure was any admission to the major tertiary public hospital in the study region over the follow-up period. Secondary outcome measures were admission rate and length (days).&nbsp;RESULTS: Over a median follow-up of 7.4 years (IQR 5.3-9.6), participants with diabetes, compared with those with normoglycaemia, were two times as likely to be hospitalised (OR 2.07, 95%&thinsp;CI 1.42 to 3.02), had a higher admission rate (incidence rate ratio 1.61, 95%&thinsp;CI 1.17 to 2.23) and longer hospital stay (third quartile difference 7.7, 95%&thinsp;CI 1.3 to 14.1 and ninth decile difference 16.2, 95%&thinsp;CI 4.2 to 28.3). IFG group was similar to normoglycaemia for the incidence, rate and length of admission. Cardiovascular disease-related diagnoses were the most common primary reasons for hospitalisation across all glycaemic categories.&nbsp;CONCLUSIONS: Our results show increased incidence, rate and length of all-cause hospital admission in adults with diabetes as compared with normoglycaemia; however, we did not detect any associations for IFG. Interventions should focus on preventing IFG-to-diabetes progression and reducing cardiovascular risk in IFG and diabetes.</div

Sarcopenic obesity and falls in the elderly

Background: Sarcopenic obesity refers to age-related loss of skeletal muscle mass and function, in the face of obesity. We aimed to examine the association of falls with sarcopenic obesity and its components, among elderly individuals in the population.Methods: Participants were 353 men and 245 women aged 65-98 yr of the Geelong Osteoporosis Study. Body fat and lean mass were measured using dual energy X-ray absorptiometry; body fat mass was expressed as a percentage of weight (%BF) and appendicular lean mass was adjusted for height (rALM, kg/m2). Poor physical performance was assessed using the timed up-&amp;-go (TUG) test. Sarcopenic obesity referred to low-rALM (Tscore&lt;- 1), poor physical performance (TUG&gt;10 s) and obesity (%BF &gt;25% for men, &gt;35% for women). Fallers were identified by self-report as having had at least one fall in the previous 12 mo. Associations between sarcopenic obesity (and its components) and falls were determined using logistic regression after adjusting for age and sex.Results: In total, 219 (36.6%) had low-rALM, 205 (34.2%) had poor physical performance, 466 (77.9%) were obese and 69 (11.5%) had all three thereby meeting our criteria for sarcopenic obesity. There were 170 (28.4%) fallers; falls were more common for those with sarcopenic obesity than without (28 (40.6%) vs 142 (26.8%); p=0.017). The likelihood of a fall in association with sarcopenic obesity and its components were: sarcopenic obesity OR=1.65 (95%CI 0.96-2.85), sarcopenia OR=1.52 (0.93-2.47), poor physical performance and obesity OR=1.74 (1.16-2.61), low-rALM OR=1.41 (0.96-2.06), poor physical performance OR=1.88 (1.26-2.80), obesity OR=0.88 (0.57-1.35).Conclusion: While obesity per se was not associated with falls, there was an increased risk of falls individuals with sarcopenic obesity that was of borderline statistical significance and this appears to be largely a consequence of poor physical performance

Foot and ankle fracture incidence in South-Eastern Australia: an epidemiological study

Objective: The aim of this study was to report the incidence of all foot and ankle fractures during 2006 and 2007 among residents from the Barwon Statistical Division, located in south-eastern Australia.Methods: Incident fractures were ascertained using X-ray reports from the imaging centres serving the region during the years 2006 and 2007. All fractures with ICD-9 code 824 (ankle) or 825 (foot) were included in this study. Age, proportions of left/right side fractures, cause of fracture and incidence rates (per 10,000 person-years) were all determined for foot and ankle fractures separately as well as for the two sites combined.Results: There were 312 males and 274 females identified with foot fractures and 344 males and 410 females with ankle fractures. The median age for both foot and ankle fracture was lower in males compared to females. The proportions of left and right side fractures were approximately equal; no sex or site (foot or ankle) showed higher proportions of either left or right side fractures. Among those for whom cause of fracture was known, most foot or ankle fractures (&gt;75%) in both sexes were caused by an accidental fall. For both sexes, there was a bimodal pattern of incidence across the age groups, with peaks around adolescence/early adulthood and in the elderly. Incidence rates (per 10,000 person-years) for foot and ankle fractures combined were similar in both sexes; 25.85 and 25.88 for males and females, respectively. However, the incidence rate for foot/ankle fractures combined in those aged 50 years or over was lower in males than in females.Conclusion: Males sustained foot and ankle fractures at a lower median age than females and most fractures were the result of an accidental fall. Males sustain fractures mainly during adolescence and young adulthood, whereas fractures in females were sustained largely by individuals over 50 years of age. Despite this, the overall incidence rates were similar for both sexes