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      Association between the atherogenic index of plasma and bone mineral density among adult women: NHANES (2011–2018)

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          Abstract

          Background

          Studies on the relationship between the atherogenic index of plasma (AIP) and bone mineral density (BMD) among adult women in the United States are limited. The purpose of this study was to explore this association using a sizable, nationally representative sample.

          Methods

          Data from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES) were used in this observational study. The AIP was computed as log 10 (triglycerides/high-density lipoprotein cholesterol). Total BMD was measured via dual-energy X-ray densitometry. We constructed multiple linear regression models to evaluate the correlation between the AIP and BMD. The non-linear relationship was characterized by smooth curve fitting and generalized additive models. We also conducted subgroup and interaction analyses.

          Results

          In this study, we included 2,362 adult women with a mean age of 38.13 ± 12.42 years. The results of multiple linear regression analysis, the AIP and total BMD showed a negative association (β = −0.021, 95%CI: −0.037, −0.006). The curve fitting analysis and threshold effect analysis showed a non-linear relationship between the two variables, and the inflection point of the AIP was found to be -0.61. The total BMD decreased significantly when the AIP reached this value (β = −0.03, 95%CI: −0.04, −0.01). The results of the subgroup analysis showed that AIP and total BMD had a strong negative relationship in participants who were below 45 years old (β = -0.023; 95% CI: -0.041, -0.004), overweight (BMI ≥ 25 kg/m 2) (β = -0.022; 95% CI: -0.041, -0.002), had a higher education level (β = -0.025; 95% CI: -0.044, -0.006), and had no partners (β = -0.014; 95% CI: -0.06, -0.009).

          Conclusions

          We found a negative correlation between the AIP and total BMD. Clinicians should pay attention to patients with high AIP, which might indicate a low BMD and has reference significance in preventing osteoporosis.

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          Most cited references71

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          Osteoporosis

          Fractures resulting from osteoporosis become increasingly common in women after age 55 years and men after age 65 years, resulting in substantial bone-associated morbidities, and increased mortality and health-care costs. Research advances have led to a more accurate assessment of fracture risk and have increased the range of therapeutic options available to prevent fractures. Fracture risk algorithms that combine clinical risk factors and bone mineral density are now widely used in clinical practice to target high-risk individuals for treatment. The discovery of key pathways regulating bone resorption and formation has identified new approaches to treatment with distinctive mechanisms of action. Osteoporosis is a chronic condition and long-term, sometimes lifelong, management is required. In individuals at high risk of fracture, the benefit versus risk profile is likely to be favourable for up to 10 years of treatment with bisphosphonates or denosumab. In people at a very high or imminent risk of fracture, therapy with teriparatide or abaloparatide should be considered; however, since treatment duration with these drugs is restricted to 18-24 months, treatment should be continued with an antiresorptive drug. Individuals at high risk of fractures do not receive adequate treatment and strategies to address this treatment gap-eg, widespread implementation of Fracture Liaison Services and improvement of adherence to therapy-are important challenges for the future.
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            Clinical Practice. Postmenopausal Osteoporosis.

            Key Clinical Points Postmenopausal Osteoporosis Fractures and osteoporosis are common, particularly among older women, and hip fractures can be devastating. Treatment is generally recommended in postmenopausal women who have a bone mineral density T score of -2.5 or less, a history of spine or hip fracture, or a Fracture Risk Assessment Tool (FRAX) score indicating increased fracture risk. Bisphosphonates (generic) and denosumab reduce the risk of hip, nonvertebral, and vertebral fractures; bisphosphonates are commonly used as first-line treatment in women who do not have contraindications. Teriparatide reduces the risk of nonvertebral and vertebral fractures. Osteonecrosis of the jaw and atypical femur fractures have been reported with treatment but are rare. The benefit-to-risk ratio for osteoporosis treatment is strongly positive for most women with osteoporosis. Because benefits are retained after discontinuation of alendronate or zoledronic acid, drug holidays after 5 years of alendronate therapy or 3 years of zoledronic acid therapy may be considered for patients at lower risk for fracture.
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              Epidemiology, etiology, and diagnosis of osteoporosis.

              Osteoporosis, a major public health problem, is becoming increasingly prevalent with the aging of the world population. Osteoporosis is a skeletal disorder characterized by compromised bone strength, which predisposes the individual to an increased risk of fractures of the hip, spine, and other skeletal sites. The clinical consequences and economic burden of this disease call for measures to assess individuals who are at high risk to allow for appropriate intervention. Many risk factors are associated with osteoporotic fracture, including low peak bone mass, hormonal factors, the use of certain drugs (eg, glucocorticoids), cigarette smoking, low physical activity, low intake of calcium and vitamin D, race, small body size, and a personal or a family history of fracture. All of these factors should be taken into account when assessing the risk of fracture and determining whether further treatment is required. Because osteoporotic fracture risk is higher in older women than in older men, all postmenopausal women should be evaluated for signs of osteoporosis during routine physical examinations. Radiologic laboratory assessments of bone mineral density generally should be reserved for patients at highest risk, including all women over the age of 65, younger postmenopausal women with risk factors, and all postmenopausal women with a history of fractures. The evaluation of biochemical markers of bone turnover has been useful in clinical research. However, the predictive factor of these measurements is not defined clearly, and these findings should not be used as a replacement for bone density testing. Together, clinical assessment of osteoporotic risk factors and objective measures of bone mineral density can help to identify patients who will benefit from intervention and, thus, can potentially reduce the morbidity and mortality associated with osteoporosis-associated fractures in this population.
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                Author and article information

                Contributors
                URI : https://loop.frontiersin.org/people/2718327Role: Role: Role: Role: Role: Role: Role: Role: Role: Role: Role:
                URI : https://loop.frontiersin.org/people/775095Role: Role: Role: Role:
                Role:
                URI : https://loop.frontiersin.org/people/2618013Role: Role: Role: Role: Role:
                Journal
                Front Endocrinol (Lausanne)
                Front Endocrinol (Lausanne)
                Front. Endocrinol.
                Frontiers in Endocrinology
                Frontiers Media S.A.
                1664-2392
                21 May 2024
                2024
                : 15
                : 1363889
                Affiliations
                [1] 1 College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine , Wuhan, China
                [2] 2 Department of Orthopedics, Hubei University Affiliated Hospital of Hubei University of Chinese Medicine , Wuhan, China
                [3] 3 Department of Endocrinology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science , Xiangyang, China
                [4] 4 Center for Clinical Evidence-Based and Translational Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science , Xiangyang, China
                [5] 5 Department of Urology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science , Xiangyang, China
                Author notes

                Edited by: Katherine A. Staines, University of Brighton, United Kingdom

                Reviewed by: Hiroya Ohta, Hokkaido University of Science, Japan

                Orazio Valerio Giannico, Local Health Authority of Taranto, Italy

                *Correspondence: Zhiwen Zhang, zzwjjdd@ 123456163.com

                †These authors have contributed equally to this work

                Article
                10.3389/fendo.2024.1363889
                11148244
                38836228
                e01545ee-40df-400e-93a4-429adb8fd19e
                Copyright © 2024 He, Chen, Liang and Zhang

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 31 December 2023
                : 01 May 2024
                Page count
                Figures: 2, Tables: 4, Equations: 0, References: 73, Pages: 11, Words: 5650
                Funding
                The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Natural Science Foundation of Hubei Province of China (2022CFB406) and Wuhan Knowledge Innovation Special Project (2023020201010173).
                Categories
                Endocrinology
                Original Research
                Custom metadata
                Bone Research

                Endocrinology & Diabetes
                atherogenic index of plasma,bone mineral density,nhanes,cross-sectional study,women

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