A study of the relationship between habitual recreational sporting activity and bone health in adolescents and young adults

<p>Osteoporosis is a major worldwide public health problem through its association with fragility fracture. Acquisition of peak bone mass (PBM) is an important contributor to later osteoporosis risk and may be modified by lifestyle factors, including habitual recreational sporting activity (HRSA). Previous studies that have considered the relationship between HRSA and bone health have focused on older people, elite sporting activity and used dual energy X-ray absorptiometry as a measure of bone density, rather than calcaneal quantitative ultrasound (cQUS), the outcome measure in this study. This research is important because it considers younger adults, to determine relationships between HRSA and bone health in adolescents and young adults, and the factors that affect their engagement with HRSA. In this thesis we consider the relationship between HRSA and bone health in three separate studies, reported as four manuscripts: (1) a systematic literature review of studies that considered relationships between non-elite sporting activity and bone health in adolescents and young adults as assessed by calcaneal heel ultrasound; (2) a quantitative study of 452 adolescents and young adults aged 16 to 35 years, who completed a questionnaire detailing sporting activity and relevant lifestyle confounders and underwent heel ultrasound measurements; and (3) nine focus groups of young adults to better understand their knowledge of bone health, the factors that impact it, and the barriers and facilitators to increasing HRSA. The results of the systematic literature review suggested that the available literature was scarce, with few studies focusing on relationships between HRSA and cQUS in adolescents and young adults. The studies available were too heterogeneous to perform a meta-analysis although, through a narrative synthesis, we reported that all six studies included in the systematic literature review reported significant benefits from weight-bearing HRSA on cQUS outcomes. In the quantitative study, selected bone cQUS parameters were positively associated with: BMI (SI- stiffness index, BUA-broadband ultrasound attenuation, and T-score); physical activity (SI, SOS-speed of sound, BUA, and T-score); and past HRSA score (SOS only), with weight-bearing sporting activity such as running (SI and SOS), soccer (SI and BUA) and rugby (T-score and Z-score) associated with better bone health. This study also reported that lifetime sport participation typically declined after individuals’ mid-teens. The qualitative study suggested that knowledge of PBM and risk of osteoporotic fracture were limited in the young adult age group. There was a general awareness of the positive and negative impacts of many lifestyle behaviours such as physical activity, diet, tobacco smoking and alcohol consumption on health in general, but not specifically how these impact PBM and good bone health in later life. Furthermore three main barriers to sports participation that emerged were: a) structural (disorientation in a new living environment, facilities, access to healthcare); b) social (financial and time constraints); and c) personal (social pressures and lack of an understanding of why sporting activity matters for bone health). On the other hand, enablers of sports participation included: a) supportive environments; b) access to health checks including support to avoid injury; and c) education to better understand the benefits of HRSA. In conclusion, HRSA that is of higher impact appears to be associated with more favourable bone health as assessed by heel ultrasound, but few studies have adequately considered these relationships. The quantitative study performed as part of this thesis provides further evidence that high impact HRSA is associated with more favourable bone health in adolescence and early adulthood, and while participation in sport in New Zealand is common until late teens, subsequently HRSA often decreases during the window of PBM acquisition. Knowledge of factors impacting bone health is poor, and barriers and facilitators to HRSA have been identified. Further work to consider how best to address these knowledge and evidence gaps is now warranted, including focus on young school to early adulthood populations to reduce their future fragility fracture risk.</p>

A study of the relationship between habitual recreational sporting activity and bone health in adolescents and young adults

<p>Osteoporosis is a major worldwide public health problem through its association with fragility fracture. Acquisition of peak bone mass (PBM) is an important contributor to later osteoporosis risk and may be modified by lifestyle factors, including habitual recreational sporting activity (HRSA). Previous studies that have considered the relationship between HRSA and bone health have focused on older people, elite sporting activity and used dual energy X-ray absorptiometry as a measure of bone density, rather than calcaneal quantitative ultrasound (cQUS), the outcome measure in this study. This research is important because it considers younger adults, to determine relationships between HRSA and bone health in adolescents and young adults, and the factors that affect their engagement with HRSA. In this thesis we consider the relationship between HRSA and bone health in three separate studies, reported as four manuscripts: (1) a systematic literature review of studies that considered relationships between non-elite sporting activity and bone health in adolescents and young adults as assessed by calcaneal heel ultrasound; (2) a quantitative study of 452 adolescents and young adults aged 16 to 35 years, who completed a questionnaire detailing sporting activity and relevant lifestyle confounders and underwent heel ultrasound measurements; and (3) nine focus groups of young adults to better understand their knowledge of bone health, the factors that impact it, and the barriers and facilitators to increasing HRSA. The results of the systematic literature review suggested that the available literature was scarce, with few studies focusing on relationships between HRSA and cQUS in adolescents and young adults. The studies available were too heterogeneous to perform a meta-analysis although, through a narrative synthesis, we reported that all six studies included in the systematic literature review reported significant benefits from weight-bearing HRSA on cQUS outcomes. In the quantitative study, selected bone cQUS parameters were positively associated with: BMI (SI- stiffness index, BUA-broadband ultrasound attenuation, and T-score); physical activity (SI, SOS-speed of sound, BUA, and T-score); and past HRSA score (SOS only), with weight-bearing sporting activity such as running (SI and SOS), soccer (SI and BUA) and rugby (T-score and Z-score) associated with better bone health. This study also reported that lifetime sport participation typically declined after individuals’ mid-teens. The qualitative study suggested that knowledge of PBM and risk of osteoporotic fracture were limited in the young adult age group. There was a general awareness of the positive and negative impacts of many lifestyle behaviours such as physical activity, diet, tobacco smoking and alcohol consumption on health in general, but not specifically how these impact PBM and good bone health in later life. Furthermore three main barriers to sports participation that emerged were: a) structural (disorientation in a new living environment, facilities, access to healthcare); b) social (financial and time constraints); and c) personal (social pressures and lack of an understanding of why sporting activity matters for bone health). On the other hand, enablers of sports participation included: a) supportive environments; b) access to health checks including support to avoid injury; and c) education to better understand the benefits of HRSA. In conclusion, HRSA that is of higher impact appears to be associated with more favourable bone health as assessed by heel ultrasound, but few studies have adequately considered these relationships. The quantitative study performed as part of this thesis provides further evidence that high impact HRSA is associated with more favourable bone health in adolescence and early adulthood, and while participation in sport in New Zealand is common until late teens, subsequently HRSA often decreases during the window of PBM acquisition. Knowledge of factors impacting bone health is poor, and barriers and facilitators to HRSA have been identified. Further work to consider how best to address these knowledge and evidence gaps is now warranted, including focus on young school to early adulthood populations to reduce their future fragility fracture risk.</p>

Anticonvulsant use and bone health in a population-based study of men and women: cross-sectional data from the Geelong Osteoporosis Study.

Background: Anticonvulsant use has been linked to bone deficits in specific patient populations. We studied the association between anticonvulsant use and bone health in a population-based sample of men and women.Methods: Data from 926 men (24-73yr) and 1070 women (21-94yr) participating in the Geelong Osteoporosis Study were included. Bone mineral density (BMD, g/cm2) of the PA-spine and total hip was measured using dual-energy X-ray absorptiometry (Lunar). Bone quality was determined using quantitative heel ultrasound (QUS). Anthropometry was conducted and socioeconomic status was determined. Medication and lifestyle information was obtained via questionnaire. Linear regression was used to test associations between anticonvulsant use and bone health before and after adjustment for potential confounders. Results: Seventeen (1.8%) men and 20 (1.9%) women reported anticonvulsant use. In men, anticonvulsant users had 9.1% lower adjusted mean BMD at the spine and hip compared to non-users. Body mass index was an effect modifier at the spine. Anticonvulsant users also had 1.8% lower speed of sound (SOS), 10.6% lower broadband ultrasound attenuation (BUA) and 13.7% lower stiffness index (SI) compared to non-users. In women, BMD tended to be lower at the hip compared to non-users as with the bone quality measure, BUA. No significant associations were observed at the spine or the other bone quality measures, SOS and SI. Conclusion: Our data suggest that bone quantity and quality, assessed using BMD and QUS, are lower for men and possibly women who use anticonvulsants. While further exploration into potential mechanisms is needed, our findings suggest that monitoring bone health among users of anticonvulsants is warranted.

Dietary Fiber, Genetic Variations of Gut Microbiota-derived Short-chain Fatty Acids, and Bone Health in UK Biobank

Context Dietary fiber intake may relate to bone health. Objective To investigate whether dietary fiber intake is associated with bone mineral density (BMD), and the modification effect of genetic variations related to gut microbiota-derived short-chain fatty acids (SCFAs). Design The associations of dietary fiber intake with estimated BMD derived from heel ultrasound and fractures were assessed in 224 630 and 384 134 participants from the UK Biobank. Setting UK Biobank. Main Outcome Measures Estimated BMD derived from heel ultrasound Results Higher dietary fiber intake (per standard deviation) was significantly associated with higher heel-BMD (β [standard error] = 0.0047 [0.0003], P = 1.10 × 10–54). Similarly significant associations were observed for all the fiber subtypes including cereal, fruit (dried and raw), and vegetable (cooked and raw) (all P &lt; .05). A positive association was found in both women and men but more marked among men except for dietary fiber in cooked vegetables (all Pinteraction &lt; .05). A protective association was found between dietary fiber intake and hip fracture (hazard ratio, 95% confidence interval: 0.94, 0.89-0.99; P = 3.0 × 10–2). In addition, the association between dietary fiber and heel BMD was modified by genetically determined SCFA propionate production (Pinteraction = 5.1 × 10–3). The protective association between dietary fiber and heel BMD was more pronounced among participants with lower genetically determined propionate production. Conclusions Our results indicate that greater intakes of total dietary fiber and subtypes from various food sources are associated with higher heel-BMD. Participants with lower genetically determined propionate production may benefit more from taking more dietary fiber.

Anticonvulsant Use and Bone Health in a Population-based Study of Men and Women: Cross-sectional Data from the Geelong Osteoporosis Study.

Background: Anticonvulsant use has been linked to bone deficits in specific patient populations. We studied the association between anticonvulsant use and bone health in a population-based sample of men and women.Methods: Data from 1996 people, 926 men (age:24-73y) and 1070 women (21-94y) participating in the Geelong Osteoporosis Study were included. Bone mineral density (BMD, g/cm2) of the PA-spine and total hip was measured using dual-energy X-ray absorptiometry (Lunar). Bone quality was determined using quantitative heel ultrasound (QUS). Anthropometry was conducted and socioeconomic status was determined. Medication and lifestyle information was obtained via questionnaire. Linear regression was used to test associations between anticonvulsant use and bone health before and after adjustment for potential confounders. Results: Seventeen (1.8%) men and 20 (1.9%) women reported anticonvulsant use. In men, anticonvulsant users had 9.1% lower adjusted mean BMD at the spine and hip compared to non-users. Body mass index (28.5 kg/m2) was an effect modifier at the spine. Anticonvulsant users also had 1.8% lower speed of sound (SOS), 10.6% lower broadband ultrasound attenuation (BUA) and 13.7% lower stiffness index (SI) compared to non-users. No significant association was observed between anticonvulsant use in women and spinal BMD, SOS, BUA or SI but BMD tended to be 5.8% lower at the hip compared to non-users. Conclusion: Our data suggest that bone quantity and quality, assessed using BMD and QUS, are lower for men and possibly women who use anticonvulsants. While further exploration into potential mechanisms is needed, our findings suggest that monitoring bone health among users of anticonvulsants is warranted.

Associations between Self-Reported Physical Activity, Heel Ultrasound Parameters and Bone Health Measures in Post-Menopausal Women

Physical activity plays an important role in the maintenance of bone health from childhood through adulthood. This study aimed to explore the associations between self-reported physical activity (PA), activity energy expenditure (AEE), heel ultrasound parameters and bone health measures among older adult women. The AEE was estimated from the responses of questionnaires for 125 older adult women aged 54–81 years. The bone parameters were measured by dual energy x-ray absorptiometry (DXA) and heel ultrasound parameters by the heel quantitative ultrasound (QUS). This study showed that AEE and the metabolic equivalent task (MET) were positively correlated with the bone and heel ultrasound parameters. However, fat mass (FM) and fat percentage were negatively correlated with AEE and MET. In addition, the regression analysis showed that higher AEE was a strong predictor of a higher spine T-score (β = 0.212, p = 0.015), QUS T-score (β = 0.239, p = 0.011) and stiffness index (β = 0.240, p = 0.010) after adjusting for age, fat mass, lean mass, height and calcium intake. These results contribute to our understanding of the importance of physical activity in postmenopausal women by reiterating the benefits of physical activity for older adult women. Physical activity is an important tool for the prevention and management of osteoporosis.

Heel ultrasound scan in detecting osteoporosis in low trauma fracture patients

Osteoporosis is the most common metabolic disease with significant impact on the morbidity and mortality of affected patients. Osteoporosis has a significant impact on the economy worldwide. The aim of this study was to find out whether heel ultrasound is as good as central bone densitometry scanning in diagnosing osteoporosis in patients who are at high risk of osteoporosis. This was a prospective study of patients comparing heel ultrasound to central bone densitometry scanning (dual X-ray absorptiometry, DEXA) in patients. The recruited patients attended for a DEXA scan of the left hip and lumbar spine. All subjects had an ultrasound of the left heel using the quantitative heel ultrasound machine. The results of DEXA scan were blinded from the results of ultrasound and vice versa. There were 59 patients who took part in the study, 12 men and 47 women. The mean age was 66 years (SD 11.9) and mean weight was 62.5 kg (SD 10.7). The sensitivity and specificity of the ultrasound heel test to predict osteoporosis were 53% (95%CI: 29-77) and 86% (95%CI: 75- 96) respectively. Specificity for predicting bone mineral density (BMD)-defined osteoporosis was high (86%), but sensitivity was low (53%). A heel ultrasound result in the osteoporotic range was highly predictive of BMD-defined osteoporosis. A positive ultrasound heel test in high risk patients is more useful in ruling in osteoporosis than a negative test to rule out osteoporosis.