Impact of Competing Risk of Mortality on Association of Cognitive Impairment With Risk of Hip Fracture in Older Women

Diem, Susan J.; Vo, Tien; Langsetmo, Lisa; Schousboe, John T.; Yaffe, Kristine; Ensrud, Kristine E.

doi:10.1002/jbmr.3462

Cited by 8 publications

(5 citation statements)

References 29 publications

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“…Osteoporotic fractures may cause morbidity and even mortality in the elderly [ 148 , 149 , 150 , 151 , 152 ]. Among osteoporotic fracture, hip fracture usually leads to hospitalization, disability, and even death [ 153 , 154 , 155 , 156 ]. Though there are considerable advances in the fracture risk assessment and the improvement of medication to decrease the risk of fragility fracture, many people with high fracture risk do not receive adequate investigation and treatment.…”

Section: Conclusion and Prospectivementioning

confidence: 99%

Osteoprotective Roles of Green Tea Catechins

et al. 2020

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Osteoporosis is the second most common disease only secondary to cardiovascular disease, with the risk of fracture increasing with age. Osteoporosis is caused by an imbalance between osteoblastogenesis and osteoclastogenesis processes. Osteoclastogenesis may be enhanced, osteoblastogenesis may be reduced, or both may be evident. Inflammation and high reactive oxygen enhance osteoclastogenesis while reducing osteoblastogenesis by inducing osteoblast apoptosis and suppressing osteoblastic proliferation and differentiation. Catechins, the main polyphenols found in green tea with potent anti-oxidant and anti-inflammatory properties, can counteract the deleterious effects of the imbalance of osteoblastogenesis and osteoclastogenesis caused by osteoporosis. Green tea catechins can attenuate osteoclastogenesis by enhancing apoptosis of osteoclasts, hampering osteoclastogenesis, and prohibiting bone resorption in vitro. Catechin effects can be directly exerted on pre-osteoclasts/osteoclasts or indirectly exerted via the modulation of mesenchymal stem cells (MSCs)/stromal cell regulation of pre-osteoclasts through activation of the nuclear factor kB (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) system. Catechins also can enhance osteoblastogenesis by enhancing osteogenic differentiation of MSCs and increasing osteoblastic survival, proliferation, differentiation, and mineralization. The in vitro effects of catechins on osteogenesis have been confirmed in several animal models, as well as in epidemiological observational studies on human subjects. Even though randomized control trials have not shown that catechins provide anti-fracture efficacy, safety data in the trials are promising. A large-scale, placebo-controlled, long-term randomized trial with a tea regimen intervention of optimal duration is required to determine anti-fracture efficacy.

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Section: Conclusion and Prospectivementioning

confidence: 99%

Osteoprotective Roles of Green Tea Catechins

et al. 2020

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“…Another 10‐year follow‐up prospective cohort study ( 47 ) demonstrated that for women aged 75 years or older poor cognitive status (MMSE ≤ 23) was significantly associated with fractures (relative ratio [RR] 1.80, 95% CI 1.30–2.40), while for women aged 65 to 74 years this was not significant (RR 0.90, 95% CI 0.70–1.20). Most prospective studies ( 48–51 ) evaluating the association between cognition and fracture risk did not include rigorous evaluation of cognitive status ( 10 ) or used different tools when evaluating cognition, making it difficult to compare with our findings. Further, participants in the CLSA tended to be socially advantaged and healthier because those with low levels of literacy in English or French (including recent immigrants), or with hearing or memory problems were less likely to participate or score well on cognitive measures.…”

Section: Discussionmentioning

confidence: 96%

“…In addition, given that all other cognitive measures evaluated in the current study were not associated with fractures, these results should be interpreted carefully and additional research is need to determine the association between cognition and fracture. The Study of Osteoporotic Fractures (SOF) Research Group ( 10 ) reported that women with mild cognitive impairment measured from comprehensive neuropsychological tests including Mini‐Mental State Examination (MMSE) had a 1.48‐fold higher risk of hip fracture (adjusted HR 1.48, 95% CI 0.98–2.28) but this was not statistically significant. Another 10‐year follow‐up prospective cohort study ( 47 ) demonstrated that for women aged 75 years or older poor cognitive status (MMSE ≤ 23) was significantly associated with fractures (relative ratio [RR] 1.80, 95% CI 1.30–2.40), while for women aged 65 to 74 years this was not significant (RR 0.90, 95% CI 0.70–1.20).…”

Section: Discussionmentioning

confidence: 99%

“…Women with mild cognitive impairment have been found to have a 1.59-fold higher risk of hip fracture compared to women without cognitive impairment when adjusting for fracture site, age, and race. (10) Cognitive decline has also been demonstrated to be an independent risk factor for falls. (11,12) For example, older adults with impaired executive function were three times more likely to fall during a 2-year follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Association Among Cognition, Frailty, and Falls and Self‐Reported Incident Fractures: Results From the Canadian Longitudinal Study on Aging (CLSA)

et al. 2022

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Cognition, frailty, and falls have been examined independently as potential correlates of fracture risk, but not simultaneously. Our objective was to explore the association between cognition, frailty, and falls and self-reported incident fractures to determine if these factors show significant independent associations or interactions. We included participants who completed the Canadian Longitudinal Study on Aging (CLSA) 2012-2015 baseline comprehensive assessment, did not experience any self-reported fractures in the year prior to cohort recruitment, and completed the follow-up questionnaire at year 3 (n = 26,982). We compared all baseline cognitive measures available in the CLSA, the Rockwood Frailty Index (FI), and presence of self-reported falls in the past 12 months in those with versus without self-reported incident fractures in year 3 of follow-up. We used multivariable logistic regression adjusted for covariates and examined two-way interactions between cognition, frailty, and prior falls. CLSA specified analytic weights were applied. The mean AE standard error (SE) age of participants was 59.5 AE 0.1 years and 52.2% were female. A total of 715 participants (2.7%) self-reported incident fractures at 3-year followup. Participants who experienced incident fractures had similar baseline cognition scores (mean AE SE; Rey Auditory Verbal Learning Test [RAVLT]: Immediate recall 6.1 AE 0.1 versus 5.9 AE 0.0; standardized difference [d] 0.124); higher FI scores (mean AE SE; FI 0.134 AE 0.005 versus 0.116 AE 0.001; d 0.193), and a greater percentage had fallen in the past 12 months (weighted n [%] 518 [7.2] versus 919 [3.5]; d 0.165). FI (each increment of 0.08) was associated with a significantly increased risk of self-reported incident fractures in participants of all ages and those aged 65 years or older (adjusted odd ratio [OR] 1.24, 95% confidence limit [CL] 1. adjusted OR 1.44, respectively). The adjusted odds for self-reported incident fractures in participants of all ages was also significantly associated with falls in the past 12 months prior to baseline (adjusted OR 1.83; 95% CL 1.13-2.97), but not in those aged 65 years or older. No interactions between cognition, frailty, and prior falls were found. However, considering the relatively young age of our cohort, it may be appropriate to make strong inferences in individuals older than 65 years of age.

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“…Our findings underscore a significant association between cognitive function and fracture risk, highlighting disparities across the axial and appendicular skeleton. This disparity points toward a multifaceted relationship between cognitive function, biomechanics, and bone quality [ 17 ]. Specifically, the axial skeleton, comprising regions such as the hip and spine, appears to derive greater benefits from cognitive processes.…”

Section: Discussionmentioning

confidence: 99%

Does enhanced cognitive performance reduce fracture risk? a Mendelian randomization study

Luo,

Deng,

Chen

et al. 2023

Aging

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Objective: While observational studies have suggested a link between cognitive performance and fracture risk, the causality and site-specific nature are unclear. We applied Mendelian randomization (MR) to elucidate these associations. Methods: 147 single-nucleotide polymorphisms (SNPs) tied strongly to cognitive performance ( p < 5e-8) were selected. We performed MR analysis to investigate the causal relationship between cognitive performance and fractures at specific sites, including the wrist, upper arm, shoulder, ribs, sternum, thoracic spine, lumbar spine, pelvis, femur, leg, and ankle. The primary estimate was determined using the inverse variance-weighted method. Additionally, we examined heterogeneity using the MR Pleiotropy RESidual Sum Outlier test and Cochran Q, and employed MR-Egger regression to identify horizontal pleiotropy. Results: MR analysis identified a causal association between cognitive performance and fractures at the lumbar-spine-pelvis (odds ratio [OR] = 0.727, 95% CI = 0.552–0.956, p = 0.023), and ribs-sternum-thoracic spine sites (OR = 0.774, 95% CI = 0.615–0.974, p = 0.029). However, no causal association was found for fractures at other sites. Conclusions: This study provided evidence of a causal connection between cognitive performance and fracture risk at certain locations. These findings underline the potential of cognitive enhancement strategies as innovative and effective methods for fracture prevention.

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Impact of Competing Risk of Mortality on Association of Cognitive Impairment With Risk of Hip Fracture in Older Women

Cited by 8 publications

References 29 publications

Osteoprotective Roles of Green Tea Catechins

Osteoprotective Roles of Green Tea Catechins

Association Among Cognition, Frailty, and Falls and Self‐Reported Incident Fractures: Results From the Canadian Longitudinal Study on Aging (CLSA)

Does enhanced cognitive performance reduce fracture risk? a Mendelian randomization study

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