Association between total bilirubin and bone mineral density level in adolescents

Abstract

Background Increasing bone mass accumulation in adolescence and obtaining greater peak bone mass is one of the effective methods to prevent osteoporosis in the future. We aimed to examine the association between total bilirubin and bone mineral density (BMD) level in adolescents. Methods We used the data from 2005–2010 and 2013–2014 cycles of National Health and Nutrition Examination Survey (NHANES). The BMD levels in the region of lumbar spine and femoral regions, including total femur, femoral neck, trochanter, and intertrochanter were measured. Univariable and multivariable linear regression model were used to assess the relationship between total bilirubin concentration and BMD. Results A total of 3741 participants aged 12–19 years were ultimately included in the study. There were 1997 (53.38%) males and 1744 (46.62%) females. Univariate analysis results showed that age, sex, race, education, income, body mass index, dietary calcium intake, and diabetes were correlated with BMD levels. Compared with the lowest quartile of total bilirubin concentration, the highest quartile of total bilirubin concentration was positively associated with BMD levels in the regions of total femur (β = 0.036, 95% CI = 0.021 to 0.050, P < 0.001), femur neck (β = 0.030, 95% CI = 0.016 to 0.044, P < 0.001), trochanter (β = 0.033, 95% CI = 0.019 to 0.046, P < 0.001), intertrochanter (β = 0.040, 95% CI = 0.023 to 0.056, P < 0.001), and lumbar spine (β = 0.032, 95% CI = 0.018 to 0.045, P < 0.001). We also observe the same trend in sensitivity analysis (P for trend < 0.001). Conclusion Our study demonstrated that total bilirubin concentration was positively associated with BMD levels in adolescents in United States. Total bilirubin concentration might be a protective marker against bone loss in adolescents.

The role of total bilirubin in bone mineral density among patients with type 2 diabetes older than 50 years

“…Both studies excluded the effect of liver disease, but both had limited sample sizes and were restricted to the Korean population [15,16]. Another cross-sectional study based on the NHANES database indicated that TB was positively associated with BMD in the US adolescent population [17]. However, there are obvious methodological flaws in this study.…”

“…There are currently 3 published retrospective observational studies on the association of TB with BMD [15][16][17]. Two retrospective studies from South Korea showed that TB was positively associated with BMD in middle-aged men and postmenopausal women; in other words, TB appears to act as a protective factor to reduce the risk of osteoporosis.…”

“…Second, we maximized the exclusion of patients with liver disease and underlying hepatic metabolic abnormalities to more directly examine the effect of TB on BMD. Finally, in the only study involving a population of US adolescents, the investigators did not set specific exclusion criteria, which may greatly affect the accuracy of the conclusions [17]. In addition, confounding factors that may be associated with bone metabolism, such as alkaline phosphatase, serum calcium, serum phosphorus, and uric acid, were not fully controlled for in this study.…”

“…There are three articles in the current literature on the relationship between total bilirubin (TB) and BMD, all of which suggest that TB may act as a protective factor in reducing bone loss [15][16][17]. However, the role of TB in this elderly population with T2DM remains unknown and unclear.…”

A Mini Review on Osteoporosis: From Biology to Pharmacological Management of Bone Loss

“…Oxidative stress is generated when the antioxidant system is overwhelmed by these oxidants, leading to the pathogenesis of various diseases, including osteoporosis [ 36 ]. The circulating level of endogenous antioxidants, such as uric acid and bilirubin, has been associated with bone mineral density (BMD) in large epidemiological studies [ 37 , 38 ]. Similarly, dietary or circulating antioxidant levels, for example, vitamin E and vitamin C, have been linked positively with BMD in human studies [ 39 , 40 ].…”