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Context Bone mineral density (BMD) T-score reference may be updated when the peak BMD of the population is unclear and may need to be updated. Objective To update BMD T-score references using the peak BMD from the most recent National Health and Nutrition Examination Survey (NHANES) data. Design Cross-sectional study. Setting The NHANES 2005-2014. Participants Non-Hispanic white females between the ages 10-40 years (N=1549) were our target population to estimate peak BMD (SD). Individuals aged≥50 years (N=5523) were used to compare the percentages of osteoporosis and low bone mass based on existing and updated BMD T-score references. Main Outcome Measurements: BMD data within the age at attainment of peak BMD±5 years were used to calculate updated BMD T-score references. Results The updated average of BMD (SD) for diagnosing osteoporosis at the femoral neck and lumbar spine were 0.888 g/cm 2 (0.121 g/cm 2) and 1.065 g/cm 2 (0.122 g/cm 2), respectively. The percentages of individuals with osteoporosis at the femoral neck and low bone mass at the femoral neck and lumbar spine based on the updated BMD T-score references were higher than the percentages of people designated with these outcomes under the existing guidelines (P<0.001). However, we observed the opposite pattern for lumbar spine osteoporosis (P<0.001). Conclusions We calculated new BMD T-score references at the femoral neck and lumbar spine. We found significant differences in the percentages of individuals classified as having osteoporosis and low bone mass between the updated and existing BMD T-score references.

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BackgroundEvidence for a relationship between oxidative stress and osteoporotic fractures in humans is limited. Fluorescent oxidation products (FlOPs, excitation/emission wavelengths 320/420nm denoted FlOP_320; 360/420nm [FlOP_360]; and 400/475nm [FlOP_400]) are global biomarkers of oxidative stress, and reflect oxidative damage to proteins, phospholipids, and nucleic acids. We investigated the association between FlOPs and a recent osteoporotic fracture.MethodsWe conducted a case-control study in a Chinese population aged 50 years or older. A recent osteoporotic fracture in the cases was confirmed by x-ray. Cases were matched with community-based non-fracture controls (1:2 ratio) for age (± 4 years) and sex. In addition, we conducted a sensitivity unmatched case-control study which included all fracture cases and all eligible non-fracture controls prior to matching. Plasma FlOPs were measured with a fluorescent microplate reader. We used unconditional logistic regression to analyze the association between FlOPs (per 1-SD increase in logarithmic scale) and fracture; odds ratios (OR) and 95% confidence intervals (95% CI) were reported.ResultsForty-four cases and 88 matched controls (mean age: 68.2 years) were included. After covariate adjustment (i.e., body mass index, physical activity, and smoking), higher FlOP_360 (OR = 1.85; 95% CI = 1.03 – 3.34) and FlOP_400 (OR = 13.29; 95% CI = 3.48 – 50.69) levels, but not FlOP_320 (OR = 0.56; 95% CI = 0.27 – 1.15), were associated with increased fracture risk. Subgroup analyses by fracture site and unmatched case-control study found comparable associations of FlOP_360 and FlOP_400 with hip and non-hip fractures.ConclusionsHigher FlOP_360 and FlOP_400 levels were associated with increased risk of fracture, and this association was comparable for hip and non-hip fractures. Prospective studies are warranted to confirm this finding.