Beschermt overgewicht tegen fracturen?


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Beschermt overgewicht tegen fracturen?, Presentatie van prof.dr J.C Netelenbos op 3 oktober 2012 voor de Stichting IWO.

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Beschermt overgewicht tegen fracturen?

  1. 1. Beschermt overgewicht tegen fracturen? IWO 3 Oktober 2012 te Utrecht J.C Netelenbos VUmc
  2. 2. Conflict of InterestI receive research grants, speaker’s and/or consulting feesfrom the following companies:•  Achmea•  Amgen•  E. Lilly•  GSK•  Novartis•  Nycomed•  Roche Diagnostics•  Sanofi-Aventis•  Will Farma•  J. Coen Netelenbos, MD
  3. 3. ITEMS- Obesitas, fracturen en gevolgen 4 slides- BMD en DXA meting bij obesitas 5 slides- Botstructuur en vetweefsel 2 slides- Effect vetzucht op botombouw 3 slides- Spier en vet 1 slide- Rol voor vitamine D? 3 slides- Geeft afvallen botverlies? 2 slides- Conclusies 1slide
  4. 4. More ankle and upper leg fractures and less hip,spine, wrist and rib fractures in obese older women Obese women with fracture differed from non-obese by: • early menopause • 2 or more falls past 2 years • use of arms to assist standing from sitting position They also experienced more astma, emphysema, and diabetes Compston JE et al . AJM 2011;124:1043-1050 (GLOW study)
  5. 5. Obesity and fracture Upper legModified after Shapses SA et al Annu Rev Nutr 2012;32:287-309 •  Mechanical instability ? •  Site-specific bone loss ?
  6. 6. Older diabetic women have especially fractures at humerus, femur and distal lower leg Representative HRpQCT of tibia in diabetic woman with fracture showing major cortical porosity Patsch JM et al. J Bone Miner Res. 2012 Sep 18 [Epub ahead of print]
  7. 7. Lower percentage of obese women who were on treatment with Anti Osteoporosis Medication before and after fractureCompston JE et al (GLOW study)
  8. 8. Vetzucht: BMD en DXA meting
  9. 9. Total body fat most consistent predictor of BMD isin cross-sectional study in normal postmenopausal women in 1992 Reid IR et al. J Clin Endocrinol Metab. 1992 Jul;75(1):45-51.
  10. 10. Most consistent predictor of BMD still is total body fat after 10 years of follow up Wu Fet al. Clin Endocrinol (Oxf). 2002 Jun;56(6):703-11
  11. 11. Obesity increases precision errors in DXA Percentage coefficient of variation (CV) of two duplicate DXA scans with repositioning in 100 women BMI<25 BMI 25-30 BMI>30 (n=48) (n=26) (n=26) LS BMD 0.99 1,30 1,68* FN BMD 1,32 1,37 2,00* Total Hip BMD 0,85 0,88 1,06 Total Body BMD 0,66 0,73 0,91* Caution with serial measurements in obesity Knapp KM et al. J Clin Densitometry 2012;(Sept)315-319
  12. 12. Simulated Increases in Body Fat and Errors in Bone Mineral Density Measurements by DXA and QCT YU EW et al. JBMR 2012;27:119–124
  13. 13. In obesity greater measurement error oflumbar spine DXA leading to overestimation •  excess abdominal fat, •  greater risk op spinal osteoarthritis and osteophytes •  addditional concern about difficulty of positioning when measuring TBBMD
  14. 14. Botstructuur en vetweefsel
  15. 15. HR-pQCT of distal radius in two obese 34-yrs old men both with BMI of 32kg/m2,with high (A) and low (B) visceral fat Subject A with lower trabecular and cortical density and area and also lower cortical thickness and impaired mechanical properties (decreased stiffness and failure load)By secretion of inflammatory cytokines as TNFα, IL-1 and IL-6 stimulating osteoclasts. Bredella MA et al. J Clin Endocrinol Metab, November 2012, 97(11):0000–0000
  16. 16. Lifetime changes in marrow fat content and lumbar spine BMD for male subjects in vivo proton (1H) MR spectroscopy of L3 BMD Males BMD marrow fat Females Griffith JF et al . J Magn Reson Imaging. 2012 Jul;36(1):225-30
  17. 17. Effect vetzucht op botombouw
  18. 18. Effect vetzucht op botombouw•  Cytokinen uit vetcel met direct effect op botcellen m.n. viscerale vetcel: inflammatie cytokinen als TNFα, IL-1, IL-6, resistin verhogen botresorptie of remmen botvorming•  Adipokines uit vetcel leptine, adiponectine die via hypothalamus en sympaticus effect hebben op botcellen:remmen osteoblast en stimuleren osteoclast differentiatie•  Paracriene en endocriene regulatie in beenmerg differentiatie mesenchymale stamcel in adipocyt of osteoblast o.a. PPARγ, E2,IGF-1
  19. 19. Schematic model of bone–fat connections Kawai M et al. J Intern Med. 2012 Oct;272(4):317-29
  20. 20. Schematic model of bone–fat connections Aging Lower E2 Elevated aromatase Less response to IGF1 Kawai M et al. J Intern Med. 2012 Oct;272(4):317-29
  21. 21. Irisin: A new potential hormonal target for the treatment of obesity The myocyte-adipocyte connectionKelly DP. Science 2012;336:42-43; Boström P et al. Nature. 2012 Jan 11;481(7382):463-8
  22. 22. Rol vitamine D?
  23. 23. Vitamine D spiegels van deelnemers aan deHoorn studie (538 mannen en vrouwen 60-87 jaar) zijn lager bij toename lichaamsvet RM van Dam et al. Am J Clin Nutr 2007;85:755–61
  24. 24. Adjusted relationship between 25(OH)D andprobabilities of metabolic syndrome at 5 years in Australian cohort (AusDiab) Contribution of 25(OH)D explained about 1% of the variance of risk metabolic syndrome Cagnon C et al. JCEM 2012;97:1953-1961
  25. 25. Calcium and vitamin D supplementation is associated with decreased visceral adipose tissue (VAT) in overweight and obese (2 RCT) During 16 weeks: 3x240 ml glass daily: Orange Juice (OJ) Regular or Light with or without 350mgCa+100 IUvitD Rosenblum JL et al. Am J Clin Nutr. 2012 Jan;95(1):101-8
  26. 26. Geeft afvallen botverlies?
  27. 27. Weight Loss in Obese Older Adults Increases Serum CTX and Decreases Hip BMD Both Are Prevented by Exercise TrainingArmamento-Villareal R et al.J Bone Miner Res.2011 Dec;26(12):2851-9 2012
  28. 28. A Losing Battle:Weight regain does not restore weight loss- induced bone loss in 0- 6 months postmenopausal women 6- 18 months Villalon KL et al. Obesity (Silver Spring). 2011 Dec;19(12):2345-50
  29. 29. Conclusie
  30. 30. Lifestyle-paradox: Vetzucht is risicofactor voorfractuur bij kind maar werkt beschermend tegen fractuur bij volwassene, maar niet bij ouderen Dimitri P et al. Bone. 2012 Feb;50(2):457-66
  31. 31. Dank voor uw aandacht Vragen?
  32. 32. Reserve dia’s
  33. 33. Diabetes and Fractures
  34. 34. Insuline regulates skeletal homeostasis OPG RANKL Bone resorption Modified JCN Kawai M et al. J Intern Med. 2012 Oct;272(4):317-29
  35. 35. Adjusted RRs for fracture among older women with diabetes, stratified by insulin use, compared with nondiabetic women (SOF study) Schwartz AV et al. Diabetes Care. 2002 Oct;25(10):1749-54
  36. 36. Cortical porosit andpathophysiology of fragility in type 2 diabetes
  37. 37. Changes in anthropometric measurements, bone mineral density and HbA1c in new diagnosed type 2 diabetes of postmenopausal women •  Bone markers did not change •  Lower adiponectin did not change and was inversely correlated with BMD Miazgwoski T et al. Diab.Med 2012;29:62-69
  38. 38. Review effect vitamin D supplementation on HbA1c, a marker of longer-term glycaemic control: no change inpatients with impaired glucose tolerance or type 2 diabetes P. S. George et al. Diabet Med. 2012 Aug;29(8):e142-50
  39. 39. Risk of fracture after bariatric surgery: population based, retrospective cohort study (UK) Lalmohamed A et al. BMJ. 2012 Aug 3;345:e5085. doi: 10.1136/bmj.e5085.