Osteoporosis 2016 | Day-to-day levels of high impact physical activity are positively related to lower limb bone strength in older women: findings from a population based study using accelerometers to classify impact magnitude: Prof. Jon Tobias #osteo2016
Prof. Jon Tobias's presentation from Osteoporosis 2016: Day-to-day levels of high impact physical activity are positively related to lower limb bone strength in older women: findings from a population based study using accelerometers to classify impact magnitude.
Find out more at: https://nos.org.uk/conference
Kate Ward's presentation from Osteoporosis 2016: Relationships between muscle function and bone microarchitecture in the Hertfordshire cohort study.
Find out more at: https://nos.org.uk/conference
Kate Ward's presentation from Osteoporosis 2016: Relationships between muscle function and bone microarchitecture in the Hertfordshire cohort study.
Find out more at: https://nos.org.uk/conference
Dr Steve Cummings presentation from Osteoporosis 2016: Patients receiving bisphosphonates should not take holidays from treatment.
Find out more at: https://nos.org.uk/conference
Elizabeth Curtis's presentation from Osteoporosis 2016: Variation in UK fracture incidence by age, sex, geography, ethnicity, socioeconomic status, and time: results from the UK CPRD:
Find out more at: https://nos.org.uk/conference
Dr Trevor Cole's presentation from Osteoporosis 2016: From family history to epigenetics of osteoporosis.
Find out more at: https://nos.org.uk/conference
Sanni Ali's presentation from Osteoporosis 2016: Antidiabetic medication use and the risk of fracture amongst type 2 diabetic patients: a nested case-control study
Find out more at: https://nos.org.uk/conference
Prof. Richard Eastell's presentation from Osteoporosis 2016: Patients receiving bisphosphonates should take holidays from treatment. The case for holidays.
Find out more at: https://nos.org.uk/conference
Conservative Management of Knee osteoarthritisEsserHealth
Osteoarthritis is a major burden on personal health and international health care expenditures. Learn the basics of osteoarthritis and conservative management options for the physician.
Prof. Eugene McCloskey's presentation from Osteoporosis 2016: Assessment and intervention thresholds for FRAX probabilities in the UK- Impact on the need for BMD in older women with prior fracture
Find out more at: https://nos.org.uk/conference
Tenslotte zal Prof. Dr. Joop van den Bergh het fractuurrisico bij patiënten met DM type 1 en 2 bespreken: hoe relevant is het verhoogde fractuurrisico bij jonge patiënten met DM type 1? Zijn adipeuze patiënten met DM type 2 beschermd tegen osteoporose? Welke determinanten spelen een rol bij het fractuurrisico bij DM type 2?
Structural Targets for Prevention of Post Traumatic OAOARSI
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Chair, Musculoskeletal, Sydney Medical Program
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
Arti Gauvri Bhimjiyani's presentation from Osteoporosis 2016: The effect of social deprivation on hip fracture incidence has not changed over 10 years in England.
Find out more at: https://nos.org.uk/conference
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Dr Steve Cummings presentation from Osteoporosis 2016: Patients receiving bisphosphonates should not take holidays from treatment.
Find out more at: https://nos.org.uk/conference
Elizabeth Curtis's presentation from Osteoporosis 2016: Variation in UK fracture incidence by age, sex, geography, ethnicity, socioeconomic status, and time: results from the UK CPRD:
Find out more at: https://nos.org.uk/conference
Dr Trevor Cole's presentation from Osteoporosis 2016: From family history to epigenetics of osteoporosis.
Find out more at: https://nos.org.uk/conference
Sanni Ali's presentation from Osteoporosis 2016: Antidiabetic medication use and the risk of fracture amongst type 2 diabetic patients: a nested case-control study
Find out more at: https://nos.org.uk/conference
Prof. Richard Eastell's presentation from Osteoporosis 2016: Patients receiving bisphosphonates should take holidays from treatment. The case for holidays.
Find out more at: https://nos.org.uk/conference
Conservative Management of Knee osteoarthritisEsserHealth
Osteoarthritis is a major burden on personal health and international health care expenditures. Learn the basics of osteoarthritis and conservative management options for the physician.
Prof. Eugene McCloskey's presentation from Osteoporosis 2016: Assessment and intervention thresholds for FRAX probabilities in the UK- Impact on the need for BMD in older women with prior fracture
Find out more at: https://nos.org.uk/conference
Tenslotte zal Prof. Dr. Joop van den Bergh het fractuurrisico bij patiënten met DM type 1 en 2 bespreken: hoe relevant is het verhoogde fractuurrisico bij jonge patiënten met DM type 1? Zijn adipeuze patiënten met DM type 2 beschermd tegen osteoporose? Welke determinanten spelen een rol bij het fractuurrisico bij DM type 2?
Structural Targets for Prevention of Post Traumatic OAOARSI
David Hunter MBBS, PhD, FRACP
Florance and Cope Chair of Rheumatology, Professor of Medicine
University of Sydney and Royal North Shore Hospital
Chair, Institute of Bone and Joint Research
Chair, Musculoskeletal, Sydney Medical Program
Consultant Rheumatologist, North Sydney Orthopedic and Sports Medicine
Arti Gauvri Bhimjiyani's presentation from Osteoporosis 2016: The effect of social deprivation on hip fracture incidence has not changed over 10 years in England.
Find out more at: https://nos.org.uk/conference
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Arti Gauvri Bhimjiyani's presentation from Osteoporosis 2016: The effect of social deprivation on hip fracture incidence has not changed over 10 years in England.
Find out more at: https://nos.org.uk/conference
Prof. Nicholas Harvey's presentation from Osteoporosis 2016: Calcium, with or without vitamin D supplementation, is not associated with ischaemic heart disease or cardiac death: the UK Biobank cohort.
Find out more at: https://nos.org.uk/conference
Bo Abrahamsen's presentation from Osteoporosis 2016: Surgically treated osteonecrosis and osteomyelitis of the jaw and oral cavity in patients highly adherent to alendronate treatment.
Find out more at: https://nos.org.uk/conference
Frank de Vries's presentation from Osteoporosis 2016: The epidemiology of mortality after fragility fracture in England and Wales.
Find out more at: https://nos.org.uk/conference
Prof. Jon Tobias's presentation from Osteoporosis 2016: What are the properties of the perfect therapy?
Find out more at: https://nos.org.uk/conference
Prof. Richard Keen's presentation from Osteoporosis 2016: Teaching old dogs new tricks? Combination therapy in osteoporosis.
Find out more at: https://nos.org.uk/conference
Dr Jennifer Walsh's presentation from Osteoporosis 2016: Management of osteoporosis in the young adult.
Find out more at: https://nos.org.uk/conference
Dr Rachel Tattersall's presentation from Osteoporosis 2016: Successful transition from paediatric to adult services.
Find out more at: https://nos.org.uk/conference
Osteoporosis 2016 | The SCOOP study – Do we now have a rationale to screen fo...
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One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
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Osteoporosis 2016 | Day-to-day levels of high impact physical activity are positively related to lower limb bone strength in older women: findings from a population based study using accelerometers to classify impact magnitude: Prof. Jon Tobias #osteo2016
1. Professor Jon Tobias
Academic Rheumatology
Musculoskeletal Research Unit
University of Bristol
National Osteoporosis Society 2016
1
Day-to-day levels of higher impact physical activity are
positively related to lower limb bone strength in older women:
findings from a population based study using accelerometers to
classify impact magnitude
2. Background
2
• Exercise trials suggest that high impacts are beneficial for skeletal health in
postmenopausal women (1)
• Cross sectional studies using accelerometers suggest that day-to-day exposure to
high impacts is also positively related to hip bone mineral density (BMD) in
adolescents (2) and premenopausal women (3)
• Equivalent studies have not been performed in postmenopausal women, including
older individuals at risk of osteoporosis
1. M Martyn-St James, BJSM 2009, 43:898
2. K Deere et al JBMR 2012, 27:1887)
3. A Vainionpaa et al, OI 2006, 17:455
3. 1. To establish whether day-to-day exposure of older women to high vertical impacts,
assessed by seven day accelerometer recordings, is positively related to lower limb
bone strength
2. To determine whether any relationship with bone strength we find is explained by
relationships with BMD or bone size
3. To explore whether exposure to vertical impacts are related to bone turnover
markers, and whether these might also contribute to observed associations with
bone strength
3
Aims
4. 4
Bristol
Cohort for skeletal health in Bristol and Avon (COSHIBA): Unselected community-based study population
65-80 year old women recruited to
COSHIBA from GP practices (2007-09)
N= 3200
Invited to research clinic
(2015) N= 1064
Attended study clinic session
(2015) N= 463
7. 7
Seven day accelerometer recording
• Light weight (~55g) accelerometer worn in custom belt
for seven days, set to 50Hz sampling rate
8. 8
Seven day accelerometer recording
• Light weight (~55g) accelerometer worn in custom belt
for seven days, set to 50Hz sampling rate
• Seven day accelerometer trace was subsequently
down-loaded
9. 9
Seven day accelerometer recording
• Light weight (~55g) accelerometer worn in custom belt
for seven days, set to 50Hz sampling rate
• Seven day accelerometer trace was subsequently
down-loaded
• Y axis ‘peaks’ identified and categorised into low (0.5-
1.0g), medium (1.0-1.5g) and higher (>1.5g) impacts*
*K Deere et al, JAPA 2016 24:290
10. 10
Linear regression analysis
•Exposures
• Number of low, medium or higher impacts/week (log transformed)
•DXA outcomes
• Total hip BMD
• Femoral neck BMD
• Hip cross sectional moment of inertia (CSMI)
•Mid-tibial pQCT outcomes
• Periosteal circumference
• CSMI
•Adjustment
• Age, height, fat mass, lean mass, activity in other bands
11. 11
Characteristics of participants in final dataset (n=408)
Mean SD
Age (years) 76.8 3.0
Height (cm) 158.8 6.2
Weight (kg) 68.3 12.0
Accelerometer wear time (valid days) 5.4 1.5
Median 25th
Centile 75th
Centile
Low impacts (0.5-1.0g)/week 8809 4047 16882
Medium impacts (1.0-1.5)/week 345 99 764
Higher impacts (≥1.5g)/week 42 17 106
12. 12
Impacts vs Hip DXA
CSMI = cross sectional moment of inertia (mm4
)
Beta shows SD change in DXA outcome per doubling in number of impacts per week, adjusted for
age, height, fat mass, lean mass, activity in other bands
Low impacts Medium impacts Higher impacts
Beta lower CI upper CI p Beta lower CI upper CI p Beta lower CI upper CI p
Total hip BMD 0.087 -0.030 0.203 0.145 -0.055 -0.158 0.047 0.287 0.030 -0.042 0.101 0.417
Fem neck BMD 0.072 -0.048 0.192 0.237 -0.072 -0.177 0.033 0.180 0.033 -0.041 0.107 0.380
Hip CSMI 0.008 -0.099 0.115 0.882 -0.108 -0.202 -0.014 0.025 0.067 0.001 0.133 0.045
13. 13
Impacts vs tibia pQCT
CSMI = cross sectional moment of inertia (mm4
)
Beta shows SD change in pQCT outcome per doubling in number of impacts per week, adjusted for
age, height, fat mass, lean mass, activity in other bands
Low impacts Medium impacts Higher impacts
Beta lower CI upper CI p Beta lower CI upper CI p Beta lower CI upper CI p
Peri circ -0.002 -0.021 0.018 0.866 -0.007 -0.024 0.010 0.436 0.015 0.003 0.027 0.017
CSMI 0.016 -0.033 0.064 0.524 -0.031 -0.073 0.012 0.159 0.042 0.012 0.072 0.006
14. 14
Impacts vs Bone turnover markers
Low Impacts Medium Impacts Higher Impacts
Beta lower CI upper CI p Beta lower CI upper CI p Beta lower CI upper CI p
β-CTX ng/l -0.048 -0.206 0.111 0.556 0.027 -0.117 0.171 0.713 0.085 -0.017 0.187 0.103
P1NP ng/l -0.021 -0.172 0.129 0.780 -0.039 -0.174 0.097 0.577 0.127 0.031 0.224 0.010
Beta shows SD change in bone marker per doubling in number of impacts per week, adjusted for
age, height, fat mass, lean mass, activity in other bands
17. 17
Impacts vs tibia pQCT: additional confounder adjustment
Higher Impacts
Model Beta lower CI upper CI p
Periosteal
circumference Age, height, fat mass, other bands 0.012 0.000 0.025 0.056
+ Co-morbidities 0.012 0.000 0.025 0.055
+ Social class 0.012 0.000 0.025 0.055
+ Bone active medication 0.014 0.002 0.027 0.028
Cross sectional
moment of inertia Age, height, fat mass, other bands 0.037 0.006 0.069 0.020
+ Co-morbidities 0.038 0.006 0.069 0.020
+ Social class 0.037 0.006 0.069 0.021
+ Bone active medication 0.040 0.008 0.072 0.015
18. Limitations
• Difficulty in making causal inferences from cross sectional studies
• Seven day accelerometer recordings may not fully capture long term patterns of
physical activity
• Since effect sizes were relatively small, the clinical significance of relationships
between higher impacts and bone strength which we observed is unclear
• Participants are likely to represent a relatively healthy sub-population, limiting
generalisability of our observations
18
19. Conclusions
• Habitual levels of higher, but not medium or low, vertical impacts in older women are
positively associated with lower limb bone size and strength.
• Equivalent relationships are not observed for low or medium impacts.
• The benefit of day-to-day physical activity in older women for their skeletal health
appears to be explained by exposure to higher impacts, despite their rarity and the
relatively low g levels used to define these.
19
20. Acknowledgements
Kimberly Hannam1
Kevin Deere1
April Hartley1
Usama Al-Sari1
Emma Clark1
William Fraser2
1
Musculoskeletal Research Unit, University of Bristol School of Clinical Sciences
2
University of East Anglia
http://www.bristol.ac.uk/clinical-sciences/research/musculoskeletal/rheumatology/research/vibe/
20
Editor's Notes
Add that previous associations not affected by adjustment for bone turnover markers