[Frontiers in Bioscience E4, 2586-2606, June 1, 2012]

Role of obesity, alcohol and smoking on bone health

Fini Milena1, Salamanna Francesca1, Veronesi Francesca1,Torricelli Paola1,Nicolini Andrea2,Benedicenti Stefano3,Carpi Angelo4, Giavaresi Gianluca1

1Laboratory of Preclinical and Surgical Studies-Rizzoli Orthopaedic Institute, Bologna, Italy, 2Department of Internal Medicine, University of Pisa, Pisa, Italy, 3Department of Medical Science, Dentistry, and Biophysics, University of Genoa, Genoa, Italy, 4Department of Reproduction and Ageing, University of Pisa, Pisa, Italy

TABLES

Table 1. Main clinical studies on obesity effects on bone

Ref. Study

Design

Analysis

Sample Characteristics

Magnitude of Association

19

Population-based cohort study

Radius BMD associated with physical activity and nutritional and dietary factors

1222 women aged 70-73 y

     

BMI ≤ 25.1

RR=0.7 95% CI (0.3-1.4) for low daily physical exertion

RR=1.0 95% CI (0.7-1.4) for average daily current dietary calcium intake ≤ 654.0 mg

     

25.1<BMI<28.5

RR=0.4 95% CI (0.1-2.5) for low daily physical exertion

RR=1.8 95% CI (1.0-3.1) for average daily current dietary calcium intake ≤ 654.0 mg

     

BMI ≥ 28.5

RR=1.2 95% CI (0.3-4.1) for low daily physical exertion

RR=1.0 95% CI (0.3-3.1) for average daily current dietary calcium intake ≤ 654.0 mg

23

Cross-sectional population-based study

Effects of sex and age on the impact of FM on femoral neck BMD.

Men 47-50 y

FM <1 5 Kg OR=2.22 95% CI (1.15-4.28)

FM 16-10 Kg OR=2.41 95% CI (1.25-4.64)

FM 21-24 Kg OR=1.90 95% CI (0.96-3.73)

FM 25-30 Kg OR=1.38 95% CI (0.65-2.95)

FM ≥30 Kg OR=1

     

Women 47-50 y

FM <1 5 Kg OR=2.95 95% CI (1.79-4.86)

FM 16-10 Kg OR=2.60 95% CI (1.63-4.16)

FM 21-24 Kg OR=2.25 95% CI (1.42-3.57)

FM 25-30 Kg OR=1.48 95% CI (0.88-2.48)

FM ≥30 Kg OR=1

     

Men 71-75 y

FM <1 5 Kg OR=1.44 95% CI (0.74-2.80)

FM 16-10 Kg OR=1.37 95% CI (0.71-2.65)

FM 21-24 Kg OR=1.02 95% CI (0.52-1.99)

FM 25-30 Kg OR=0.99 95% CI (0.47-2.08)

FM ≥30 Kg OR=1

     

Men 71-75 y

FM <1 5 Kg OR=8.43 95% CI (4.46-15.93)

FM 16-10 Kg OR=2.46 95% CI (1.38-4.38)

FM 21-24 Kg OR=2.13 95% CI (1.23-3.69)

FM 25-30 Kg OR=3.20 95% CI (1.89-5.42)

FM ≥30 Kg OR=1

195

Population-based study

A study of persistent high BMD in a multivariate logistic regression analysis

Women 53.5 y old (48.0-59.6)

BMI 25-30 kg/m2 OR=2.84 95% CI (1.83-4.42)

BMI > 30 kg/m2 OR=5.94 95% CI (3.47-10.16)

Menopause OR=0.57 95% CI (0.38-0.85)

Age OR=0.94 95% CI (0.87-1.01)

Daily Ca intake >1.500 mg OR=1.44 95% CI (0.52-3.97)

Physical activity OR=0.86 95% CI (0.59-1.33)

16

Population-based study

Evaluate the relationship between obesity and osteoporosis (Pearson correlations FM-weight-adjusted bone area, p< 0.01)

Chinese premenopausal women and men (27.24.5 y old),

r=-0.25 lumbar spine

r=-0.16 femoral neck

r=-0.22 total body bone area

     

Caucasian females and males (47.816.2 y old)

r=-0.17 lumbar spine,

r=-0.12 femoral neck

r=-0.15 total body bone area

24

Cross-sectional study

Relationship between BMD and age, BMI, FM and LM

Postmenopausal women (50-85 y old)

BMD-age and BMI: R2= 0.30, 0.37, 0.35 for lumbar spine, femoral neck and whole body respectively.

BMD- age, LM and FM: R2=0.33, 0.38, 0.39 for lumbar spine, femoral neck and whole body respectively.

Table 2. Main clinical studies on alcohol effects on bone

Study

Design

Units of Analysis of Alcohol

Sample Characteristics

Magnitude of Association

40

metanalysis

drinkers compared with abstainers

(1 drink= 14g/day)

≤ 0.5 drinks/day

both

RR = 0.84 95% CI (0.70-1.01) hip fracture

   

0.5 - 1.0 drinks/day

 

RR = 0.80 95% CI (0.71-0.91) hip fracture

   

> 2 drinks/day (28g/day)

 

RR = 1.39 95% CI (1.08-1.79) hip fracture

41

metanalysis

> 2 units/day (16g/day) (1 unit = 8g)

16971 men and women

RR = 1.23 95% CI (1.06-1.43) any fracture

       

RR = 1.38 95% CI (1.16-1.65) osteoporotic fracture

       

RR = 1.68 95% CI (1.19-2.36) hip fracture

48

population-based case-control study

aged > 50y

≥ 2 units/day

725 women

RR = 2.9 95% CI (1.0-8.6) hip fracture

     

451 men

RR = 1.9 95% CI (1.1-3.2) hip fracture

44

cross-sectional and prospective study

aged > 65y

< 12 drinks/y

5974 men

 
   

≥ 12 drinks/y - < 2 drinks/day

 

RR = 0.77 95% CI (0.65-0.92) incident falls

   

≥ 2 drinks/day

 

RR = 0.83 95% CI (0.63-1.10) incident falls

59

population-based case-control study

50-81 y

<3 g/day

4589 women

ORadj = 0.78 95% CI (0.64-0.95) hip fracture

   

3-6 g/day

BMI = 18.9-29.4 kg/cm

ORadj = 0.80 95% CI (0.65-0.99) hip fracture

   

> 6 g/day

 

ORadj = 0.84 95% CI (0.66-1.08) hip fracture

42

prospective cohort study

aged > 65y

≤ 2 drinks/day

5888 men and women

HRadj = 0.78 95% CI (0.61-1.00) hip fracture

   

> 2 drinks/day

BMI 21.8-32.4 kg/cm

HRadj = 1.18 95% CI (0.77-1.81) hip fracture

120

cross-sectional study

68.6 7.1 y

~0.5 - 1.0 drinks/day

136 women

Radj = 53.3 total BMD

     

BMI = 26.0 3.8

Radj = 56.1 lumbar spine BMD

63

cross-sectional study

48.44 12.59 y

non-drinkers

1697 women

β = 1.06 Ad-SoS* vs beer intake

   

light drinkers < 15.7g/day

BMI = 19-32 kg/cm

β = -3.86 Ad-SoS* vs BMI

   

moderate drinkers 15.7-40g/day

   

65

prospective cohort study

36.87 7.95 y

< 3.4 g /day

400 men

β = 0.19 femoral BMD

   

3.4 - 7.3 g/day

   
   

7.4 - 15 g/day

BMI = 23.8 2.4 kg/cm

 

13

population-based cohort study

45-92 y

< 0.43 drinks/days (referent)

507 men

OR = 0.68 95% CI (0.46 - 0.99) femoral BMD

   

≥ 0.43 drinks/wk

BMI = 24-28 kg/cm

 

Table 3. Main clinical studies on cigarette smoking effects on bone

Study

Design

Analysis

Sample Characteristics

Magnitude of Association

116

meta-analysis

current, previous and never smokers

40753 men and women

 

104

meta-analysis

current, previous and never smokers

512399 men and women

RR (current smokers)=1.26 all fracture types

41

meta-analysis

current or past smoking

59232 men and women

RR (smoker vs. non smokers)=1.25 any fracture

149

systematic review

factors associated with osteoporosis

Women>65y

 

148

systematic review

effects of smoking on bone health

Pre and postmenopausal women and man

 

102

systematic review

Risk factors for low BMD

Men age≥50 y

 
         

129

cohort study

risk of low bone status at the lumbar spine of ever-smokers

789 premenopausal women aged 20-40 years

OR=2.03;
OR=1.55 in those with < 3 pack-years of tobacco use;

OR= 2.55 in those with ≥ 3 pack-years of tobacco use

13

prospective cohort study

predictors of bone loss

507 ambulatory community-dwelling men aged 45 to 92 years

Total hip:

OR Never smokers=1.0

OR Former smokers=0.93

OR Current smokers=1.42

Femoral Neck:

OR Never smokers=1.0

OR Former smokers=1.02

OR Current smokers=2.09 Lumbar spine:

OR Never smokers=1.0

OR Former smokers=1.11

OR Current smokers=1.39

105

case-control study

risk factors for hip fracture in men

7495 men aged 46-56 years

HR in never smokers=1.00

HR in ex-smokers=1.06

HR in smokers=1.58

98

case-control study

risk factors for hip fracture

40,279 long-stay (>60 days) home care clients aged 65

RR in smokers=1.41

RR in smokers with osteoporosis=1.59