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

Associations Between Aldosterone-Renin-Ratio and Bone Parameters Derived from Peripheral Quantitative Computed Tomography and Impact Microindentation in Men

Components of the renin–angiotensin–aldosterone system (RAAS) are present on bone cells. One measure of RAAS activity, the aldosterone-renin-ratio (ARR), is used to screen for primary aldosteronism. Associations between ARR and bone mineral density are conflicting. This study investigated associations between ARR and peripheral quantitative computed tomography (pQCT) and impact microindentation (IMI). Male participants (n = 431) were from the Geelong Osteoporosis Study. “Likely” primary aldosteronism was defined as ARR ≥ 70 pmol/mIU. Another group, “possible” primary aldosteronism, was defined as either ARR ≥ 70 pmol/mIU or taking a medication that affects the RAAS, but not a beta blocker, and renin  0.05). There were no associations between ARR or aldosterone and pQCT-derived bone parameters. Men with likely primary aldosteronism had lower bone area, suggesting clinically high levels of ARR may have a negative impact on bone health

High alcohol intake in older men and the probability of osteoporotic fracture according to the FRAX algorithm

We aimed to determine the contribution of high alcohol intake to fracture probability, calculated using a fracture-risk assessment tool (FRAX). Participants were 262 men (ages 60–90 y) in the Geelong Osteoporosis Study. Alcohol consumption was documented via a food frequency questionnaire; 46 (17.6%) consumed three or more units per day, fulfilling the criterion for high alcohol intake. Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry. We determined FRAX probabilities (%) for major osteoporotic fracture (MOF) and hip fracture (HF), calculated with and without alcohol intake. Thresholds for high FRAX probabilities, calculated with or without BMD, were ≥20% for MOF and ≥3% for HF. Proportions of men with high HF-FRAX probabilities were consistently greater for drinkers compared with non-drinkers. For drinkers, paired differences showed that median MOF-FRAX(withoutBMD) probabilities calculated with and without alcohol changed by −2.3, HF-FRAX(withoutBMD) by −1.7, MOF-FRAX(withBMD) by −1.4, and HF-FRAX(withBMD) by −0.9 (all p < 0.001). We estimated that, should drinkers lower their alcohol consumption to <3 units/d, up to 66.7% of those at high risk for MOF and up to 41.0% at high risk for HF would reduce their FRAX probabilities to below the thresholds for high fracture risk. In the context of the Australian environment, these data describe the extent to which older men with high alcohol consumption are at increased risk for fracture

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

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

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

Pretiree lifestyles in relation to musculoskeletal health: cross-sectional data from the Geelong Osteoporosis Study

Background: What happens in the early-elderly ‘pretiree’ period potentially influences the divergent paths of healthy or unhealthy ageing. In this cross-sectional study, we aimed to profile musculoskeletal health and lifestyle behaviours for men and women in their late-fifties and sixties.Methods: For 482 participants from the Geelong Osteoporosis Study, we measured DXA-derived appendicular lean mass (rALM), bone mineral density (BMD) at the femoral neck and percentage body fat mass (%BF). Low-rALM and low-BMD referred to sex-specific T-scores&lt;-1.0. Associations between exposures and low-rALM and/or low-BMD were explored using multivariable logistic regression.Results: Three-quarters of participants had high %BF, 98(20.3%) had low-rALM, 202(41.9%) had low-BMD and 63(13.1%) had both low-rALM and low-BMD. Eight-two (17.0%) were very active and one-third participated in sports/recreational activities. Most [n=416(87.8%)] met the recommended daily intake (RDI) for protein; only 119(25.1%) met the RDI for calcium. Less than 10% smoked and one-third exceeded recommended alcohol intakes. Independent of age, weight and sex, greater %BF and sedentary behaviour increased the likelihood of low-rALM; high-alcohol consumption increased the likelihood of low-BMD; and greater %BF increased the likelihood of low-rALM and low-BMD combined.Conclusions: One-half of participants had rALM and BMD in the normal range. Only a few were involved in resistance-training or weight-bearing exercise, despite having the capacity to be physically active. As sedentary lifestyles, excessive adiposity and high alcohol use were associated with low-rALM and/or low-BMD, we propose that these adverse factors be potential targets among pretirees to minimise their risk of entering old age with poor musculoskeletal health. </jats:p

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

Dynapenia and Low Cognition: A Cross-Sectional Association in Postmenopausal Women

Dynapenia is a key contributor to physical frailty. Cognitive impairment and dementia accompany frailty, yet links between skeletal muscle and neurocognition are poorly understood. We examined the cross-sectional relationship between lower limb muscle strength and global cognitive function. Participants were 127 women aged 51&ndash;87 years, from the Geelong Osteoporosis Study. Peak eccentric strength of the hip-flexors and hip abductors was determined using a hand-held dynamometer, and dynapenia identified as muscle strength t-scores &lt; &minus;1. Cognition was assessed using the Mini-Mental State Examination (MMSE), and MMSE scores below the median were rated as low. Associations between dynapenia and low cognition were examined using logistic regression models. Hip-flexor dynapenia was detected in 38 (71.7%) women with low cognition and 36 (48.7%) with good cognition (p = 0.009); for hip abductor dynapenia, the pattern was similar (21 (39.6%) vs. 9 (12.2%); p &lt; 0.001). While the observed difference for hip-flexor strength was attenuated after adjusting for age and height (adjusted Odds Ratio (OR) 1.95, 95%CI 0.86&ndash;4.41), low cognition was nearly 4-fold more likely in association with hip abductor dynapenia (adjusted OR 3.76, 95%CI 1.44&ndash;9.83). No other confounders were identified. Our data suggest that low strength of the hip abductors and low cognition are associated and this could be a consequence of poor muscle function contributing to cognitive decline or vice versa. As muscle weakness is responsive to physical interventions, this warrants further investigation

Reference intervals for bone impact microindentation in healthy adults: a multi-centre international study

Impact microindentation (IMI) is a novel technique for assessing bone material strength index (BMSi) in vivo, by measuring the depth of a micron-sized, spherical tip into cortical bone that is then indexed to the depth of the tip into a reference material. The aim of this study was to define the reference intervals for men and women by evaluating healthy adults from the United States of America, Europe and Australia. Participants included community-based volunteers and participants drawn from clinical and population-based studies. BMSi was measured on the tibial diaphysis using an OsteoProbe in 479 healthy adults (197 male and 282 female, ages 25 to 98 years) across seven research centres, between 2011 and 2018. Associations between BMSi, age, sex and areal bone mineral density (BMD) were examined following an a posteriori method. Unitless BMSi values ranged from 48 to 101. The mean (± standard deviation) BMSi for men was 84.4 ± 6.9 and for women, 79.0 ± 9.1. Healthy reference intervals for BMSi were identified as 71.0 to 97.9 for men and 59.8 to 95.2 for women. This study provides healthy reference data that can be used to calculate T- and Z-scores for BMSi and assist in determining the utility of BMSi in fracture prediction. These data will be useful for positioning individuals within the population and for identifying those with BMSi at the extremes of the population