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

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 ≥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

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

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

The Dietary Inflammatory Index Is Associated With Low Muscle Mass and Low Muscle Function in Older Australians

Age-associated chronic, low grade systemic inflammation has been recognised as an important contributing factor in the development of sarcopenia; importantly, diet may regulate this process. This cross-sectional study examined the association of diet-related inflammation with components of sarcopenia. Participants (n = 809) aged 60–95 years from the Geelong Osteoporosis Study were studied. Body composition was measured by dual energy X-ray absorptiometry. In this study, low appendicular lean mass (ALM/height2, kg/m2) was defined as T-score \u3c −1 and low muscle function as Timed-Up-and-Go \u3e10 s over 3 m (TUG \u3e 10). Dietary inflammatory index (DII®) scores, based on specific foods and nutrients, were computed using dietary data collected from a food frequency questionnaire. Associations between DII scores and low muscle mass and low muscle function, alone and combined, were determined using linear and logistic regression. After adjusting for covariates, higher DII score was associated with lower ALM/height2 (β −0.05, standard error (SE) 0.02, p = 0.028), and higher natural log-transformed (ln) (TUG) (β 0.02, standard error 0.01, p = 0.035) and higher likelihood for these components combined (odds ratio 1.33, 95% confidence interval 1.05 to 1.69, p = 0.015). A pro-inflammatory diet, as indicated by higher DII score, is associated with lower muscle mass, poorer muscle function and increased likelihood for the combination of low muscle mass and low muscle function. Further studies investigating whether anti-inflammatory dietary interventions could reduce the risk of sarcopenia are needed

Association between dairy intake and fracture in an Australian-based cohort of women: a prospective study

Objective Given the inconsistent evidence on dairy consumption and risk of fracture, we assessed the association between milk/total dairy consumption and major osteoporotic fracture (MOF) in women from the Geelong Osteoporosis Study (GOS). Methods Women aged &ge;50 years (n=833) were followed from baseline (1993-1997) to date of first fracture, death or 31 December 2017, whichever occurred first. Dairy consumption was assessed by self-report at baseline and the follow-up phases. MOFs (hip, forearm, clinical spine and proximal humerus) were confirmed radiologically. Multivariable-adjusted Cox proportional hazard models were used to determine associations between milk/total dairy (milk, cheese, yoghurt, ice cream) consumption and MOFs. Cross-sectional associations between milk/total dairy consumption and serum high-sensitivity C reactive protein (hsCRP), C-terminal telopeptide (CTx) and procollagen type 1 N-terminal propeptide (P1NP) at baseline were investigated using multivariable linear regression. Results During follow-up (11 507 person-years), 206 women had an MOF. Consuming &gt;500 mL/d of milk was not significantly associated with increased HR for MOF. Non-milk (1.56; 95% CI 0.99 to 2.46) drinkers and consumption of &ge;800 g/d total dairy (1.70; 95% CI 0.99 to 2.93) had marginally higher HR for MOF compared with consuming &lt;250 mL/d of milk and 200-399 g/d of total dairy, respectively. Milk consumption was inversely associated with serum hsCRP and CTx, but total dairy consumption was not associated with these serum markers. Conclusion Higher milk consumption did not increase the risk for MOF in older women. However, a trend for increased MOF was detected in zero milk and higher total dairy consuming women

Normative data for impact microindentation for Australian men: cross-sectional data from the geelong osteoporosis study

Impact microindentation (IMI) is a novel technique for assessing the bone material strength index (BMSi) in vivo. However, no studies have presented normative data for BMSi. The aim of this study was to develop such normative data using a population-based sample of men, randomly selected from electoral rolls for the Barwon Statistical Division in southeastern Australia to participate in the Geelong Osteoporosis Study. BMSi was measured on the tibial plateau using an OsteoProbe in 405 men (ages 33 to 96 years) during the period 2016 to 2019. Associations between BMSi, age, and anthropometry were examined using linear regression models. BMSi values ranged from 49.0 to 100.5. BMSi was negatively correlated with age (r = -0.152, p = 0.002), weight (r = -0.103, p = 0.039), and BMI (r = -0.187, p < 0.001), and positively correlated with height (r = +0.107, p = 0.032). Mean ± SD BMSi was 82.6 ± 7.0 for the whole group, and ranged from 85.6 ± 6.0 for ages 30 to 39 years to 79.8 ± 6.6 for ages 80+ years. This study provides normative data that can be used to calculate T- and Z-scores for BMSi. These data will be useful for identifying men with low BMSi. Further research is warranted to derive optimal cut points for BMSi that discriminate fracture risk. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research

Skeletal muscle health and cognitive function: a narrative review

Sarcopenia is the loss of skeletal muscle mass and function with advancing age. It involves both complex genetic and modifiable risk factors, such as lack of exercise, malnutrition and reduced neurological drive. Cognitive decline refers to diminished or impaired mental and/or intellectual functioning. Contracting skeletal muscle is a major source of neurotrophic factors, including brain-derived neurotrophic factor, which regulate synapses in the brain. Furthermore, skeletal muscle activity has important immune and redox effects that modify brain function and reduce muscle catabolism. The identification of common risk factors and underlying mechanisms for sarcopenia and cognition may allow the development of targeted interventions that slow or reverse sarcopenia and also certain forms of cognitive decline. However, the links between cognition and skeletal muscle have not been elucidated fully. This review provides a critical appraisal of the literature on the relationship between skeletal muscle health and cognition. The literature suggests that sarcopenia and cognitive decline share pathophysiological pathways. Ageing plays a role in both skeletal muscle deterioration and cognitive decline. Furthermore, lifestyle risk factors, such as physical inactivity, poor diet and smoking, are common to both disorders, so their potential role in the muscle&ndash;brain relationship warrants investigation

Feasibility and tolerability of bone impact microindentation testing: a cross-sectional, population-based study in Australia

OBJECTIVES: The OsteoProbe measures Bone Material Strength Index (BMSi) of cortical bone in living humans using impact microindentation (IMI). Research using this minimally invasive technique is expanding yet, to-date, there have been no reports about its feasibility in the research setting. In this study, we assessed the feasibility and tolerability of using the OsteoProbe in men enrolled in the Geelong Osteoporosis Study. DESIGN: Cross-sectional analysis of data collected in a population-based study. SETTING: Barwon Statistical Division, southeastern Australia, 2016-2018. METHODS: For 252 of 345 consecutive participants (ages 33-96 years), BMSi was measured using the OsteoProbe at the mid-tibia. Immediately following measurement, each participant used a Visual Analogue Scale (0-10) to rate the level of discomfort that was anticipated and experienced, their initial reluctance towards the measurement and their willingness to repeat measurement. RESULTS: Reasons for non-measurement in 92 men were needle phobia (n=8), discomfort after first indentation (n=5), skin infections (n=21), excessive soft tissues around the mid-tibia region (n=56), inability to provide informed consent (n=2). Among 252 men who had IMI measures, the expectation for pain during measurement was low (1.54±1.56), as was actual pain experienced (0.38±0.71). Reluctance to undergo measurement was low (0.34±0.93). All participants indicated a willingness to have the measurement performed again. Mean (±SD) BMSi was 83.0±6.4 (range 62.3-93.0). CONCLUSION: In this study, the procedure was well accepted by participants suggesting that IMI testing with the OsteoProbe is feasible in a research setting

Mean bone material strength index values for women are lower than those for men: Data from a single geographical location

Bone material strength index (BMSi) values are obtained using impact microindentation, which assesses the ability of bone to resist indentation. Differences in BMSi between men and women are unclear, and to date, BMSi sex differences have not been compared for individuals from the same population. Therefore, we compared BMSi values for men and women drawn from the same geographical location in Australia. Participants (n = 220) were from the Geelong Osteoporosis Study. BMSi was measured, following international published guidelines, using an OsteoProbe for participants at recent follow-up phases (women 2022-2023 and men 2016-2022). Women (n = 55) were age matched to men (n = 165) in a 1:3 ratio. A two-sample t test was used to determine the intergroup difference in mean BMSi. Linear regression was also performed, adjusting for weight and height. Median (IQR) ages for men and women were 67.0 (61.7-71.5) and 67.4 (62.0-71.2) years (p = 0.998). Men were heavier (81.0 ± 10.9 vs 71.0 ± 13.9 kg, p < 0.001) and taller (173.9 ± 6.4 vs 161.5 ± 7.5 cm, p < 0.001) than women. Mean (± SD) BMSi for women (75.7 ± 7.4) was lower than for men (82.8 ± 6.8) (p < 0.001). The difference persisted after adjustment for weight and height (mean ± SE: 76.5 ± 1.1 vs 82.5 ± 0.6, p < 0.001). Given the higher fracture risk observed for women, the higher mean BMSi values in men are consistent with cross sectional data suggesting this measure may be useful in fracture prediction