Associations between the VDR Gene rs731236 (TaqI) Polymorphism and Bone Mineral Density in Postmenopausal Women from the RAC-OST-POL.

BACKGROUND: Postmenopausal osteoporosis is not only related to hormonal factors but is also associated with environmental and genetic factors. One of the latter is the polymorphism of vitamin D receptor (VDR). The aim of the reported study was to comprehensively analyze the VDR gene polymorphic variants rs731236 (TaqI), rs1544410 (BsmI) and rs7975232 (ApaI) in the Polish population of postmenopausal women. METHODS: The study group consisted of 611 women after menopause (their median age was 65.82 ± 6.29 years). Each of them underwent bone densitometry (DXA) of the non-dominant femoral neck and total hip with a biochemical analysis of vitamin D3 serum concentration and genotyping of the above-mentioned single nucleotide polymorphisms (SNPs); the obtained results were analyzed in the aspect of waist circumference (WC), body mass index (BMI) and past medical history. RESULTS: The genotype prevalence rates of all SNPs were compatible with Hardy-Weinberg equilibrium (p > 0.050). Out of the studied polymorphisms, only rs731236 genotype variants affected DXA, with AG heterozygotes showing the worst bone parameters. Neither patient age nor vitamin D3 concentration, BMI, WC or comorbidities was associated with rs731236 genotype. CONCLUSIONS: Out of the polymorphisms studied, only rs731236 genotypes differed among the DXA results, while the AG heterozygotes were characterized by the lowest median bone mineral density.

Limited utility of salivary mineral content in prediction of fragility fractures among postmenopausal women.

BACKGROUND: Osteoporosis is a metabolic disease characterized by increased bone fragility. As it is characterized as a general skeletal disease, changes can also be seen in the stomatognathic system (edentulism, wrong fitting of dentures, etc.). The question is whether early changes in the salivary mineral content and acid-base balance may reflect skeletal status and risk of bone fracture. OBJECTIVES: The objective of the study was to evaluate whether minerals in the saliva were associated with skeletal fractures in a population of postmenopausal women. MATERIAL AND METHODS: In this observational study, dental examinations along with the collection of saliva were conducted in 117 randomly recruited women (mean age 64.6 ±5.9 years). The study group included 23 study participants with fractures, of which 10 had a history of osteoporotic fractures. Saliva samples for mineral content including copper (Cu), zinc (Zn), calcium (Ca), and phosphorus (P), as well as salivary pH were collected and analyzed to determine associations between salivary mineral content and fracture risk. RESULTS: As a result, the median pH value was 6.8, and the median levels for Cu (0.35 µmol/L), Zn (0.61 µmol/L), Ca (0.7 mmol/L), and P (6.64 mmol/L) were observed. No differences were noted in salivary mineral content and acid-basic balance between the fractured and non-fractured participants. CONCLUSIONS: The results of our study suggest that salivary mineral content has limited usability in predicting skeletal fragility in postmenopausal women when used alone.

OSTEOPOROSIS FROM YESTERDAY TO TODAY ­ A NARRATIVE REVIEW

Despite different lifestyles, humankind has suffered from osteoporosis for thousands of years. A literature review concerning the history of osteoporosis in the following databases: Index Medicus, Medline, PubMed, and PMC Citations was done. In the final analysis, 18 review articles and 31 original papers were included. The works were published during the period 1705-2020. Although there is evidence of the existence of osteoporosis for many centuries, it was first described as a disease at the beginning of the 18th century. It was first perceived as an unavoidable course of aging with no possibility to cure. This approach changed only in the 20th century thanks to sudden diagnostic and therapeutic progress. This paper presents the milestones and most important researchers in osteoporosis history. Rapid progress in diagnostic and therapeutic possibilities sheds new light on osteoporosis' nature. A comprehensive outlook on its history may help find answers for the still unsolved problems of this disease.

Relationship of vitamin D deficiency with cardiovascular disease and glycemic control in patients with type 2 diabetes mellitus: the Silesia Diabetes-Heart Project.

INTRODUCTION: Vitamin D (VD) has a pleiotropic effect on many health­related aspects, yet the results of studies regarding vitamin D deficiency (VDD) and both glycemic control and cardiovascular disease (CVD) are conflicting. OBJECTIVE: The aim of this work was to determine the prevalence of VDD and its associations with CVD and glycemic control among patients with type 2 diabetes mellitus (T2DM). PATIENTS AND METHODS: This was an observational study in T2DM patients recruited at the diabetology clinic in Zabrze, Poland (April-September 2019 and April-September 2020). The presence of CVD was determined based on medical records. Blood biochemical parameters, densitometry, and carotid artery ultrasound examination were performed. Control of diabetes was assessed based on glycated hemoglobin A1c (HbA1c) levels. A serum VD level below 20 ng/ml was considered as VDD. RESULTS: The prevalence of VDD in 197 patients was 36%. CVD was evident in 27% of the patients with VDD and in 33% of the patients with VD within the normal range (vitamin D sufficiency [VDS]) (P = 0.34). The difference between the groups regarding diabetes control was insignificant (P = 0.05), as for the VDD patients the median value (interquartile range) of HbA1c was 7.5% (6.93%-7.9%), and for VDS patients it was 7.5% (6.56%-7.5%). The VDD patients were more often treated with sodium­glucose cotransporter­2 inhibitors (SGLT­2is) (44% vs 25%; P = 0.01). CONCLUSIONS: About one­third of the patients showed VDD. The VDD and VDS groups did not differ in terms of CVD occurrence and the difference in glycemic control was insignificant. The patients with VDD were more often treated with SGLT­2is, which requires further investigation.

The Impact of Environmental and Genetic Factors on Bone Quality in Monozygotic and Dizygotic Twins.

The purpose of the research was to assess the genetic and environmental influences on bone properties. One hundred thirty-two pairs of twins (99/33 monozygotic/dizygotic) underwent anthropometric measurements and phalangeal quantitative ultrasound (DBM Sonic 1200, Igea, Italy) measuring the amplitude speed of sound (AD-SoS, m/s). The mean age was 16.78 ± 12.35 years for monozygotic twins and 14.30 ± 8 years for dizygotic. Interpair and intrapair correlations between twins were calculated. In the groups of monozygotic and dizygotic twins, Ad-SoS correlated significantly with age (r = 0.56−0.73, p < 0.05), weight (r = 0.73−0.78, p < 0.05), and height (r = 0.80−0.81, p < 0.05). The strongest intrapair correlation (r = 0.99−0.998) was noted in monozygotic females for Ad-SoS, weight, and height. There was a statistically significant correlation between the intrapair difference of Ad-SoS and age but only in the groups of monozygotic and dizygotic females (r = 0.281, r2 = 0.079, and p = 0.028; r = 0.544, r2 = 0.296, and p = 0.01, respectively). After age adjustment, it was estimated that 28.62% of Ad-SoS in women and 13.2% of Ad-SoS in men was explained by genetic influence, leading to the conclusion that Ad-SoS changed with age, weight, and height. The strongest correlation between pairs of twins was observed in monozygotic twins. The differences in bone values between female twins arose with age, which indicated the role of environmental factors.

Higher education and better knowledge of osteoporosis improve bone health in Polish postmenopausal women.

INTRODUCTION: The aim of the study was to establish the influence of knowledge of osteoporosis and educational level on bone health. MATERIAL AND METHODS: The study group consisted of 351 women, aged 50-88 years (mean 66.3 ± 8.6). None of them had had any previous personal experience with osteoporosis diagnosis and treatment. They filled in a questionnaire consisting of 10 questions assessing their knowledge about osteoporosis. All of them underwent femoral neck densitometry (GE Lunar, USA). RESULTS: The mean score in the knowledge questionnaire was 7.4 ± 1.6 points (range 2-10). The lowest percentage of correct answers was observed in the sentences regarding the possibility of successful cure of osteoporosis and the role of physical activity in osteoporosis treatment. The mean score in the osteoporosis questionnaire correlated negatively with the age of the participants (r = -0.2, p < 0.05) and was better among patients with higher educational degree (8.2 vs. 6.4 points, p < 0.001). Both the educational degree and the level of knowledge of osteoporosis correlated with bone mineral density (BMD) and T-score. CONCLUSIONS: Elderly and less educated women showed lower levels of knowledge about osteoporosis and its consequences. The study suggests that bone health in postmenopausal women may be indirectly improved by education concerning osteoporosis and its prevention.

Five-year fracture risk assessment in postmenopausal women, using both the POL-RISK calculator and the Garvan nomogram: the Silesia Osteo Active Study.

The study project was designed to assess the concordance of clinical results in the assessment of 5-year fracture risk of any fracture, carried out by two methods: the Garvan algorithm and the POL-RISK model. The study group included 389 postmenopausal women of Caucasian race. The concordance of results, obtained by those two models, turned out to be moderate, and the threshold for high fracture risk group was 11% in the POL-RISK model. PURPOSE: The goal of the study was to evaluate the concordance of results in fracture risk assessments between the Garvan Fracture Risk Calculator and POL-RISK, a new Polish algorithm, and to define an optimal threshold for intervention. METHODS: The study was a part of the Silesia Osteo Active Study. A group of 389 postmenopausal women, aged 65.2±6.9 years (mean ± SD), was randomly selected from the general population of Zabrze, Poland. All the participants had bone densitometry examination to assess the bone mineral density of the femoral neck. The mean femoral neck T-score was (-0.99) ± 1.05 SD. 6.4% of the women revealed osteoporosis. Five-year risk of any fracture was assessed, using the Garvan and POL-RISK calculators. The performance of each model was evaluated by the area under the receiver operating characteristic curve (AUC). RESULTS: The median 5-year risk of any fracture was 7% (range 1-54%) in the Garvan model and 8.8% (range 1.1-45.5%) in the POL-RISK algorithm. There was a significant correlation between the results obtained by both methods (r=0.6, p<0.005). For the thresholds, assumed at 8% and 13% (according to recommendation derived from Garvan tool), the rates of concordance of results between both calculators were 76% and 84%, respectively. In ROC analysis for the POL-RISK method, performed with reference to the Garvan method at two different cut-offs, assumed to be high fracture risk indicators (8% and 13%), the AUC values were 0.865 and 0.884, respectively. The optimal threshold for high fracture risk in the POL-RISK algorithm was ≥ 11%, which yielded a sensitivity of 0.94 and a specificity of 0.71. CONCLUSION: The obtained data demonstrate a moderate concordance of results between the POL-RISK algorithm and the Garvan model, illustrated by low and high fracture risk cut-offs, established in ROC analysis. In addition, the threshold of 11% in the POL-RISK method was the optimal level for "high risk".

Does Quantitative Ultrasound at the Calcaneus Predict an Osteoporosis Diagnosis in Postmenopausal Women from the Silesia Osteo Active Study?

The aims of the study were to assess the clinical conformity between quantitative ultrasound (QUS) and densitometry with use of the standard World Health Organization T-score thresholds to determine optimal diagnostic cutoff values for QUS T-scores in different age groups. Three hundred sixty-five postmenopausal Caucasian women were enrolled into the study and divided into two age groups (<65 y and ≥65 y). Skeletal status was assessed using QUS measurements at the calcaneus and bone densitometry at the spine and proximal femur (Hologic Explorer, Bedford, MA, USA). QUS measurement results expressed as the stiffness index (SI) correlated significantly with both femoral neck bone mineral density (r = 0.51, p < 0.0001) and lumbar spine bone mineral density (r = 0.52, p < 0.0001). On the basis of receiver operating characteristic curve analyses, the thresholds for correspondence between QUS T-score values and T-score -2.5SD in dual X-ray absorptiometry (DXA) were established. They ranged between -1.63SD and -1.70SD in relation to femoral neck DXA and between -1.22SD and -1.51SD in relation to lumbar spine DXA, depending on age category. In conclusion, the study described here confirmed that QUS measurements at the calcaneus may provide information comparable to DXA examinations at the femoral neck and lumbar spine in postmenopausal women.

Salivary Content Might be Associated With Skeletal Status in Postmenopausal Women: SilesiaOsteoActive Study Results.

AIM: The aim of the study was to investigate whether salivary mineral content may be associated with bone status in women after menopause. MATERIAL AND METHODS: The study group consisted of 125 postmenopausal women aged 64.3 ± 6.9 yr, derived from the epidemiological SilesiaOsteoActive Study. All participants underwent hip and spine bone densitometry using dual energy X-ray absorptiometry, dental examination, and saliva content analysis. Data for salivary pH, copper, calcium, phosphorus, and zinc concentrations were evaluated. RESULTS: Mean femoral neck bone mineral density (BMD) was 0.739 ± 0.118 g/cm2, total hip BMD 0.891 ± 0.14 g/cm2, and spine BMD 0.868 ± 0.14 g/cm2. Salivary pH was significantly lower in women with spinal osteoporosis defined as T-score below -2.5, compared to individuals with normal BMD (pH: 6.65 ± 0.67 vs 6.96 ± 0.58, p < 0.05). There was a significant though weak inverse correlation between Ca concentration in saliva and femoral neck BMD (r = -0.23, p < 0.05). CONCLUSIONS: High salivary calcium content and low salivary pH may be indicative of low hip and decreased spine BMD, respectively. These associations may reflect demineralization process (calcium redistribution) influencing bone, and a negative effect of acidity on mineral tissues, although causal pathway remains not clear.

Relevance of the semi-quantitative short Food Frequency Questionnaire in assessment of calcium consumption by female inhabitants of Zabrze over the age of 55 years (the Silesia Osteo Active Study).

In the study, we compare two methods used to assess the effects of nourishment on the bone status. Statistical analysis demonstrated a moderate conformity of both methods. Short Food Frequency Questionnaires can be used as short medical screening tool for calcium intake among women over 55 years of life. INTRODUCTION: Osteoporosis is a civilisation disease, the development of which is, among others, controlled and affected by diet. The factors which promote the health of bones include calcium, vitamin D, vitamin K, phosphorus, magnesium, and protein. A number of nutritional epidemiology methods can be applied to assess the effects of nourishment on the bone status, e.g. Food Frequency Questionnaire (FFQ) in its full or short (sFFQ) version or 3-day food record (3DFR). Both methods are known and widely used tools. METHODS: In the reported study, we attempted to compare and assess the sFFQ and 3DFR tools. Both methods were employed to examine 156 women, the majority of whom presented with an overweight-indicating BMI. An analysis of sFFQ data brought an observation that most of the studied patients (33.3%) consumed milk once a day. RESULTS: Based on 3DFR and sFFQ, we compared the measured volumes of consumed calcium which were 557.8 mg/day and 880.7 mg/day, respectively. The Cohen's kappa calculator was used for a diagnostic evaluation of both tools; the kappa index was 0.5047, demonstrating a moderate conformity of both methods. In addition, sensitivity and specificity indices were calculated, revealing the values of 97% and 12%, respectively. CONCLUSIONS: sFFQ can be used as a short medical screening. It is suggested to use both the 3DFR, conducted by the patient, and sFFQ, as a complementary method. It is necessary to continue this type of studies and to standardise the methods of nutritional status assessment with regard to selected groups.

Clinical Conformity Between Heel Ultrasound and Densitometry in Postmenopausal Women: A Systematic Review.

OBJECTIVES: To assess the conformity between heel ultrasound and densitometry, and the clinical application of densitometry T-score "gold standard" in quantitative ultrasound as a method of osteoporosis diagnosis in postmenopausal women. METHODS: The study is a systematic review of studies published in the last 17 years in PubMed, NLM Gateway, Medline, Embase, and Cochrane Library. Calcaneal quantitative ultrasound sensitivity and specificity were analyzed with regard to densitometry measurements in postmenopausal women. In addition, we summarized the values of ultrasound T-scores, for which their accuracy in osteoporosis diagnosis is the highest. RESULTS: The inclusion criteria met 15 research studies conducted on postmenopausal women. In 11 of them, the authors concluded that clinical conformity between heel ultrasound and densitometry is good. The recommended quantitative ultrasound T-score for osteoporosis diagnosis ranged between -1 and -3.65. CONCLUSIONS: Heel ultrasound should be considered to be as accurate as densitometry in diagnosing osteoporosis. Nevertheless, it needs to have separate T-score ranges determined, because those used in densitometry are not adequate.

Calcium supplementation from dairy products in the diet of women over the age of 55 from Zabrze (the Silesian Osteoactive Study - nutritional part).

OBJECTIVES: The primary goal of the study was to assess calcium intake among women over the age of 55. MATERIAL AND METHODS: The study participants were randomly selected from the female population of Zabrze, a town in the Upper Silesia Region in Poland, making use of the framework of the Silesia Osteoactive Study Project. The Semi-Quantitative Food Frequency Questionnaire (sFFQ) was used for nutritional assessment. A total of 388 women at the median age of 65.2 years responded to written and mailed invitations and decided to participate in the study. RESULTS: The mean calcium intake in the group of enrolled post-menopausal women was 886.9 ±615.1 mg/day. Only 32.9% of the participants met the daily calcium intake criterion of > 1000 g/day (the Estimated Average Requirement of 1000 mg according to the Nutrition Standards from 2017 for women in the age group of 51-65 years). Calcium supplementation, identified among women over the age of 55 years in Zabrze, was not sufficient and significantly differed from indicated nutrition standards. Fermented dairy products were the main source of calcium for the studied women. The quantity of calcium provided from yoghurts, kefirs and buttermilk was 338.3 mg/day. The level of consumption of fortified plant products, e.g., soy milk, was found to be very low. Some of the study participants (approximately 32%) reported the intake of calcium supplements or OTC medicinal products with calcium. CONCLUSIONS: Summing up, the studied women reported low calcium intake levels, which calls for appropriate adjustments, including either dietary modifications or proper supplementation programmes with calcium containing agents.

The role of physical activity in early adulthood and middle-age on bone health after menopause in epidemiological population from Silesia Osteo Active Study.

BACKGROUND: Osteoporosis is a growing problem in women after menopause. Among factors protecting from this disease is a physical activity (PA). AIM: The objective of the study was to evaluate the influence of PA in early adulthood and at middle-age on bone health after menopause. MATERIAL AND METHODS: The study group consisted of 362 randomly recruited postmenopausal women after menopause. Mean age was 65.2±6.9 years. Medical history was collected from all participants, and they completed questionnaires assessing PA in early adulthood and at middle-age. Physical capacity was estimated using the Duke scale. Bone status was measured with use of densitometry (DXA) for lumbar spine and hip and calcaneus quantitative ultrasound (QUS) measurements. RESULTS: Physical activity and healthy lifestyle activity in early adulthood did not correlate with bone health, but current PA did (for QUS parameters r=.11; P<.05). Physical capacity correlated with all QUS parameters (r=.2 to .22; P<.05) and femoral neck (FN) BMD and T-score (for both r=.16; P<.05). Current PA frequency at the level of several times a week has the highest positive impact on FN DXA results (P=.01). Bone mass in DXA and QUS variables is related to the type of exercises (P<.05). CONCLUSION: Physical activity, especially several times a week, at middle-age is a major factor influencing bone health in women after menopause. Further studies concerning the type of exercises are needed.