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Erschienen in: Archives of Osteoporosis 1/2021

01.12.2021 | Original Article

Oxidative balance score and risk of osteoporosis among postmenopausal Iranian women

verfasst von: Zahra Shahriarpour, Bita Nasrabadi, Sudiyeh Hejri-Zarifi, Seyedeh-Elaheh Shariati-Bafghi, Mahboobe Yousefian-Sanny, Mohsen Karamati, Bahram Rashidkhani

Erschienen in: Archives of Osteoporosis | Ausgabe 1/2021

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Abstract

Summary

To our knowledge, this is the first study to examine the association of oxidative balance score (OBS) and risk of osteoporosis. Findings suggest that a predominance of anti- over pro-oxidant exposures, as reflected by a higher OBS, is associated with lower risk of lumbar spine osteoporosis among postmenopausal Iranian women.

Purpose

The oxidative balance score (OBS) is a combined measure of pro- and anti-oxidant exposure status, with a higher OBS indicating a predominance of anti- over pro-oxidant exposures. We aimed to examine the potential association of OBS and risk of osteoporosis among postmenopausal Iranian women, hypothesizing that a higher OBS is associated with lower risk of postmenopausal osteoporosis.

Methods

This cross-sectional study was conducted among 151 postmenopausal Iranian women aged 50–85 y. Bone mineral density (BMD) at lumbar spine and femoral neck was measured by dual-energy X-ray absorptiometry, and osteoporosis was defined using the WHO criteria as a BMD T-score of ≤ − 2.5 standard deviations. The OBS was calculated by combining information from 17 a-priori selected pro- and anti-oxidant components classified in the following four categories: non-dietary pro-oxidants (i.e., obesity and smoking); non-dietary anti-oxidants (i.e., physical activity); dietary pro-oxidants (i.e., saturated fatty acid, poly-unsaturated fatty acid, and iron); and dietary anti-oxidants (i.e., fiber, vitamin E, folate, vitamin C, alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein/zeaxanthin, lycopene, zinc, and selenium).

Results

After controlling for several potential covariates in the multivariable-adjusted binary logistic regression analysis, subjects in the highest tertile of OBS had a lower risk of lumbar spine osteoporosis than those in the lowest tertile (odds ratio = 0.14; 95% confidence interval, 0.04–0.45; p = 0.001). The OBS was not associated with risk of femoral neck osteoporosis.

Conclusion

Findings suggest that a predominance of anti- over pro-oxidant exposures, as indicated by a higher OBS, is associated with lower risk of lumbar spine osteoporosis among postmenopausal Iranian women.
Literatur
1.
Zurück zum Zitat Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381PubMedPubMedCentralCrossRef Cosman F, de Beur SJ, LeBoff MS, Lewiecki EM, Tanner B, Randall S, Lindsay R (2014) Clinician’s guide to prevention and treatment of osteoporosis. Osteoporos Int 25:2359–2381PubMedPubMedCentralCrossRef
2.
Zurück zum Zitat Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ III, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42:467–475PubMedCrossRef Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ III, Khaltaev N (2008) A reference standard for the description of osteoporosis. Bone 42:467–475PubMedCrossRef
3.
Zurück zum Zitat Black DM, Rosen CJ (2016) Clinical practice. Postmenopausal osteoporosis. N Engl J Med 374:254–262PubMedCrossRef Black DM, Rosen CJ (2016) Clinical practice. Postmenopausal osteoporosis. N Engl J Med 374:254–262PubMedCrossRef
4.
Zurück zum Zitat Dempster DW (2011) Osteoporosis and the burden of osteoporosis-related fractures. Am J Manag Care 17(Suppl 6):S164–S169PubMed Dempster DW (2011) Osteoporosis and the burden of osteoporosis-related fractures. Am J Manag Care 17(Suppl 6):S164–S169PubMed
8.
Zurück zum Zitat Kanis JA, Cooper C, Rizzoli R, Reginster JY (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30:3–44PubMedCrossRef Kanis JA, Cooper C, Rizzoli R, Reginster JY (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30:3–44PubMedCrossRef
9.
Zurück zum Zitat Hemmati F, Sarokhani D, Sayehmiri K, Motadayen M (2018) Prevalence of osteoporosis in postmenopausal women in Iran: a systematic review and meta-analysis. Iranian Journal of Obstetrics, Gynecology and Infertility 21:90–102 Hemmati F, Sarokhani D, Sayehmiri K, Motadayen M (2018) Prevalence of osteoporosis in postmenopausal women in Iran: a systematic review and meta-analysis. Iranian Journal of Obstetrics, Gynecology and Infertility 21:90–102
10.
Zurück zum Zitat Bonaccorsi G, Piva I, Greco P, Cervellati C (2018) Oxidative stress as a possible pathogenic cofactor of post-menopausal osteoporosis: existing evidence in support of the axis oestrogen deficiency-redox imbalance-bone loss. Indian J Med Res 147:341–351PubMedPubMedCentralCrossRef Bonaccorsi G, Piva I, Greco P, Cervellati C (2018) Oxidative stress as a possible pathogenic cofactor of post-menopausal osteoporosis: existing evidence in support of the axis oestrogen deficiency-redox imbalance-bone loss. Indian J Med Res 147:341–351PubMedPubMedCentralCrossRef
12.
Zurück zum Zitat Qiao D, Li Y, Liu X, Zhang X, Qian X, Zhang H, Zhang G, Wang C (2020) Association of obesity with bone mineral density and osteoporosis in adults: a systematic review and meta-analysis. Public Health 180:22–28PubMedCrossRef Qiao D, Li Y, Liu X, Zhang X, Qian X, Zhang H, Zhang G, Wang C (2020) Association of obesity with bone mineral density and osteoporosis in adults: a systematic review and meta-analysis. Public Health 180:22–28PubMedCrossRef
13.
Zurück zum Zitat Lee T, Suh HS (2019) Associations between dietary fiber intake and bone mineral density in adult Korean population: analysis of National Health and Nutrition Examination Survey in 2011. J Bone Metab 26:151–160PubMedPubMedCentralCrossRef Lee T, Suh HS (2019) Associations between dietary fiber intake and bone mineral density in adult Korean population: analysis of National Health and Nutrition Examination Survey in 2011. J Bone Metab 26:151–160PubMedPubMedCentralCrossRef
15.
Zurück zum Zitat Zheng J, Mao X, Ling J, He Q, Quan J (2014) Low serum levels of zinc, copper, and iron as risk factors for osteoporosis: a meta-analysis. Biol Trace Elem Res 160:15–23PubMedCrossRef Zheng J, Mao X, Ling J, He Q, Quan J (2014) Low serum levels of zinc, copper, and iron as risk factors for osteoporosis: a meta-analysis. Biol Trace Elem Res 160:15–23PubMedCrossRef
16.
Zurück zum Zitat Mohammad Rahimi GR, Smart NA, Liang MTC, Bijeh N, Albanaqi AL, Fathi M, Niyazi A, Mohammad Rahimi N (2020) The impact of different modes of exercise training on bone mineral density in older postmenopausal women: a systematic review and meta-analysis research. Calcif Tissue Int 106:577–590PubMedCrossRef Mohammad Rahimi GR, Smart NA, Liang MTC, Bijeh N, Albanaqi AL, Fathi M, Niyazi A, Mohammad Rahimi N (2020) The impact of different modes of exercise training on bone mineral density in older postmenopausal women: a systematic review and meta-analysis research. Calcif Tissue Int 106:577–590PubMedCrossRef
17.
Zurück zum Zitat Chen Z, Stini WA, Marshall JR, Martínez ME, Guillén-Rodríguez JM, Roe D, Alberts DS (2004) Wheat bran fiber supplementation and bone loss among older people. Nutrition 20:747–751PubMedCrossRef Chen Z, Stini WA, Marshall JR, Martínez ME, Guillén-Rodríguez JM, Roe D, Alberts DS (2004) Wheat bran fiber supplementation and bone loss among older people. Nutrition 20:747–751PubMedCrossRef
18.
Zurück zum Zitat Enneman AW, Swart KM, van Wijngaarden JP, van Dijk SC, Ham AC, Brouwer-Brolsma EM, van der Zwaluw NL, Dhonukshe-Rutten RA, van der Cammen TJ, de Groot LC, van Meurs J, Lips P, Uitterlinden AG, Zillikens MC, van Schoor NM, van der Velde N (2015) Effect of vitamin B12 and folic acid supplementation on bone mineral density and quantitative ultrasound parameters in older people with an elevated plasma homocysteine level: B-PROOF, a randomized controlled trial. Calcif Tissue Int 96:401–409PubMedPubMedCentralCrossRef Enneman AW, Swart KM, van Wijngaarden JP, van Dijk SC, Ham AC, Brouwer-Brolsma EM, van der Zwaluw NL, Dhonukshe-Rutten RA, van der Cammen TJ, de Groot LC, van Meurs J, Lips P, Uitterlinden AG, Zillikens MC, van Schoor NM, van der Velde N (2015) Effect of vitamin B12 and folic acid supplementation on bone mineral density and quantitative ultrasound parameters in older people with an elevated plasma homocysteine level: B-PROOF, a randomized controlled trial. Calcif Tissue Int 96:401–409PubMedPubMedCentralCrossRef
19.
Zurück zum Zitat Talaulikar VS, Chambers T, Manyonda I (2012) Exploiting the antioxidant potential of a common vitamin: could vitamin C prevent postmenopausal osteoporosis? J Obstet Gynaecol Res 38:253–257PubMedCrossRef Talaulikar VS, Chambers T, Manyonda I (2012) Exploiting the antioxidant potential of a common vitamin: could vitamin C prevent postmenopausal osteoporosis? J Obstet Gynaecol Res 38:253–257PubMedCrossRef
20.
Zurück zum Zitat Nielsen FH, Milne DB (2004) A moderately high intake compared to a low intake of zinc depresses magnesium balance and alters indices of bone turnover in postmenopausal women. Eur J Clin Nutr 58:703–710PubMedCrossRef Nielsen FH, Milne DB (2004) A moderately high intake compared to a low intake of zinc depresses magnesium balance and alters indices of bone turnover in postmenopausal women. Eur J Clin Nutr 58:703–710PubMedCrossRef
21.
Zurück zum Zitat Rondanelli M, Opizzi A, Perna S, Faliva MA (2013) Update on nutrients involved in maintaining healthy bone. Endocrinol Nutr 60:197–210PubMedCrossRef Rondanelli M, Opizzi A, Perna S, Faliva MA (2013) Update on nutrients involved in maintaining healthy bone. Endocrinol Nutr 60:197–210PubMedCrossRef
22.
Zurück zum Zitat Goodman M, Bostick RM, Dash C, Flanders WD, Mandel JS (2007) Hypothesis: oxidative stress score as a combined measure of pro-oxidant and antioxidant exposures. Ann Epidemiol 17:394–399PubMedCrossRef Goodman M, Bostick RM, Dash C, Flanders WD, Mandel JS (2007) Hypothesis: oxidative stress score as a combined measure of pro-oxidant and antioxidant exposures. Ann Epidemiol 17:394–399PubMedCrossRef
23.
Zurück zum Zitat Ilori TO, Wang X, Huang M, Gutierrez OM, Narayan KM, Goodman M, McClellan W, Plantinga L, Ojo AO (2017) Oxidative balance score and the risk of end-stage renal disease and cardiovascular disease. Am J Nephrol 45:338–345PubMedCrossRef Ilori TO, Wang X, Huang M, Gutierrez OM, Narayan KM, Goodman M, McClellan W, Plantinga L, Ojo AO (2017) Oxidative balance score and the risk of end-stage renal disease and cardiovascular disease. Am J Nephrol 45:338–345PubMedCrossRef
24.
Zurück zum Zitat Slattery ML, John EM, Torres-Mejia G, Lundgreen A, Lewinger JP, Stern MC, Hines L, Baumgartner KB, Giuliano AR, Wolff RK (2014) Angiogenesis genes, dietary oxidative balance and breast cancer risk and progression: the Breast Cancer Health Disparities Study. Int J Cancer 134:629–644PubMedCrossRef Slattery ML, John EM, Torres-Mejia G, Lundgreen A, Lewinger JP, Stern MC, Hines L, Baumgartner KB, Giuliano AR, Wolff RK (2014) Angiogenesis genes, dietary oxidative balance and breast cancer risk and progression: the Breast Cancer Health Disparities Study. Int J Cancer 134:629–644PubMedCrossRef
25.
Zurück zum Zitat Slattery ML, Lundgreen A, Torres-Mejia G, Wolff RK, Hines L, Baumgartner K, John EM (2014) Diet and lifestyle factors modify immune/inflammation response genes to alter breast cancer risk and prognosis: the Breast Cancer Health Disparities Study. Mutat Res 770:19–28PubMedPubMedCentralCrossRef Slattery ML, Lundgreen A, Torres-Mejia G, Wolff RK, Hines L, Baumgartner K, John EM (2014) Diet and lifestyle factors modify immune/inflammation response genes to alter breast cancer risk and prognosis: the Breast Cancer Health Disparities Study. Mutat Res 770:19–28PubMedPubMedCentralCrossRef
26.
Zurück zum Zitat Goodman M, Bostick RM, Dash C, Terry P, Flanders WD, Mandel J (2008) A summary measure of pro- and anti-oxidant exposures and risk of incident, sporadic, colorectal adenomas. Cancer Causes Control 19:1051–1064PubMedCrossRef Goodman M, Bostick RM, Dash C, Terry P, Flanders WD, Mandel J (2008) A summary measure of pro- and anti-oxidant exposures and risk of incident, sporadic, colorectal adenomas. Cancer Causes Control 19:1051–1064PubMedCrossRef
27.
Zurück zum Zitat Dash C, Bostick RM, Goodman M, Flanders WD, Patel R, Shah R, Campbell PT, McCullough ML (2015) Oxidative balance scores and risk of incident colorectal cancer in a US prospective cohort study. Am J Epidemiol 181:584–594PubMedCrossRef Dash C, Bostick RM, Goodman M, Flanders WD, Patel R, Shah R, Campbell PT, McCullough ML (2015) Oxidative balance scores and risk of incident colorectal cancer in a US prospective cohort study. Am J Epidemiol 181:584–594PubMedCrossRef
28.
Zurück zum Zitat Lakkur S, Goodman M, Bostick RM, Citronberg J, McClellan W, Flanders WD, Judd S, Stevens VL (2014) Oxidative balance score and risk for incident prostate cancer in a prospective U.S. cohort study. Ann Epidemiol 24:475–478 e474PubMedPubMedCentralCrossRef Lakkur S, Goodman M, Bostick RM, Citronberg J, McClellan W, Flanders WD, Judd S, Stevens VL (2014) Oxidative balance score and risk for incident prostate cancer in a prospective U.S. cohort study. Ann Epidemiol 24:475–478 e474PubMedPubMedCentralCrossRef
31.
Zurück zum Zitat Mirmiran P, Esfahani FH, Mehrabi Y, Hedayati M, Azizi F (2010) Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study. Public Health Nutr 13:654–662PubMedCrossRef Mirmiran P, Esfahani FH, Mehrabi Y, Hedayati M, Azizi F (2010) Reliability and relative validity of an FFQ for nutrients in the Tehran lipid and glucose study. Public Health Nutr 13:654–662PubMedCrossRef
32.
Zurück zum Zitat Esfahani FH, Asghari G, Mirmiran P, Azizi F (2010) Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol 20:150–158PubMedCrossRef Esfahani FH, Asghari G, Mirmiran P, Azizi F (2010) Reproducibility and relative validity of food group intake in a food frequency questionnaire developed for the Tehran Lipid and Glucose Study. J Epidemiol 20:150–158PubMedCrossRef
33.
Zurück zum Zitat Ghaffarpour M, Houshiar-Rad A, Kianfar H (1999) The manual for household measures, cooking yields factors, and edible portion of foods. Agriculture Sciences Press, Tehran Ghaffarpour M, Houshiar-Rad A, Kianfar H (1999) The manual for household measures, cooking yields factors, and edible portion of foods. Agriculture Sciences Press, Tehran
34.
Zurück zum Zitat Azar M, Sarkisian E (1980) Food composition table of Iran. National Nutrition and Food Research Institute, Tehran Azar M, Sarkisian E (1980) Food composition table of Iran. National Nutrition and Food Research Institute, Tehran
35.
Zurück zum Zitat Holden JM, Eldridge AL, Beecher GR, Buzzard IM, Bhagwat S, Davis CS, Douglass LW, Gebhardt S, Haytowitz D, Schakel S (1999) Carotenoid content of US foods: an update of the database. J Food Compos Anal 12:169–196CrossRef Holden JM, Eldridge AL, Beecher GR, Buzzard IM, Bhagwat S, Davis CS, Douglass LW, Gebhardt S, Haytowitz D, Schakel S (1999) Carotenoid content of US foods: an update of the database. J Food Compos Anal 12:169–196CrossRef
36.
Zurück zum Zitat Willett W, Stampfer MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124:17–27PubMedCrossRef Willett W, Stampfer MJ (1986) Total energy intake: implications for epidemiologic analyses. Am J Epidemiol 124:17–27PubMedCrossRef
37.
Zurück zum Zitat Kelishadi R, Rabiee K, Khosravi A, Famouri F, Sadeghi M, Roohafza H, Sh S (2001) Assessment of physical activity in adolescents of Isfahan. J Shahrekord Univ Med Sci 3:55–66 Kelishadi R, Rabiee K, Khosravi A, Famouri F, Sadeghi M, Roohafza H, Sh S (2001) Assessment of physical activity in adolescents of Isfahan. J Shahrekord Univ Med Sci 3:55–66
38.
Zurück zum Zitat Aadahl M, Jorgensen T (2003) Validation of a new self-report instrument for measuring physical activity. Med Sci Sports Exerc 35:1196–1202PubMedCrossRef Aadahl M, Jorgensen T (2003) Validation of a new self-report instrument for measuring physical activity. Med Sci Sports Exerc 35:1196–1202PubMedCrossRef
39.
Zurück zum Zitat Centers for Disease Control and Prevention (2007) National Health and Nutrition Examination Survey (NHANES) Anthropometry Procedures Manual. CDC, Atlanta Centers for Disease Control and Prevention (2007) National Health and Nutrition Examination Survey (NHANES) Anthropometry Procedures Manual. CDC, Atlanta
40.
Zurück zum Zitat Lakkur S, Bostick RM, Roblin D, Ndirangu M, Okosun I, Annor F, Judd S, Dana Flanders W, Stevens VL, Goodman M (2014) Oxidative balance score and oxidative stress biomarkers in a study of Whites, African Americans, and African immigrants. Biomarkers 19:471–480PubMedPubMedCentralCrossRef Lakkur S, Bostick RM, Roblin D, Ndirangu M, Okosun I, Annor F, Judd S, Dana Flanders W, Stevens VL, Goodman M (2014) Oxidative balance score and oxidative stress biomarkers in a study of Whites, African Americans, and African immigrants. Biomarkers 19:471–480PubMedPubMedCentralCrossRef
41.
Zurück zum Zitat Cho AR, Kwon YJ, Lim HJ, Lee HS, Kim S, Shim JY, Lee HR, Lee YJ (2018) Oxidative balance score and serum gamma-glutamyltransferase level among Korean adults: a nationwide population-based study. Eur J Nutr 57:1237–1244PubMedCrossRef Cho AR, Kwon YJ, Lim HJ, Lee HS, Kim S, Shim JY, Lee HR, Lee YJ (2018) Oxidative balance score and serum gamma-glutamyltransferase level among Korean adults: a nationwide population-based study. Eur J Nutr 57:1237–1244PubMedCrossRef
42.
Zurück zum Zitat Ott SM (2018) Cortical or trabecular bone: what’s the difference? Am J Nephrol 47:373–375PubMedCrossRef Ott SM (2018) Cortical or trabecular bone: what’s the difference? Am J Nephrol 47:373–375PubMedCrossRef
43.
Zurück zum Zitat New SA, Bolton-Smith C, Grubb DA, Reid DM (1997) Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr 65:1831–1839PubMedCrossRef New SA, Bolton-Smith C, Grubb DA, Reid DM (1997) Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women. Am J Clin Nutr 65:1831–1839PubMedCrossRef
44.
Zurück zum Zitat Karamati M, Yousefian-Sanni M, Shariati-Bafghi SE, Rashidkhani B (2014) Major nutrient patterns and bone mineral density among postmenopausal Iranian women. Calcif Tissue Int 94:648–658PubMedCrossRef Karamati M, Yousefian-Sanni M, Shariati-Bafghi SE, Rashidkhani B (2014) Major nutrient patterns and bone mineral density among postmenopausal Iranian women. Calcif Tissue Int 94:648–658PubMedCrossRef
45.
Zurück zum Zitat Domazetovic V, Marcucci G, Iantomasi T, Brandi ML, Vincenzini MT (2017) Oxidative stress in bone remodeling: role of antioxidants. Clin Cases Miner Bone Metab 14:209–216PubMedPubMedCentralCrossRef Domazetovic V, Marcucci G, Iantomasi T, Brandi ML, Vincenzini MT (2017) Oxidative stress in bone remodeling: role of antioxidants. Clin Cases Miner Bone Metab 14:209–216PubMedPubMedCentralCrossRef
46.
Zurück zum Zitat Munoz-Garach A, Garcia-Fontana B, Munoz-Torres M (2020) Nutrients and dietary patterns related to osteoporosis. Nutrients 12:1986PubMedCentralCrossRef Munoz-Garach A, Garcia-Fontana B, Munoz-Torres M (2020) Nutrients and dietary patterns related to osteoporosis. Nutrients 12:1986PubMedCentralCrossRef
47.
49.
Zurück zum Zitat Yang M, Wang Y, Davis CG, Lee SG, Fernandez ML, Koo SI, Cho E, Song WO, Chun OK (2014) Validation of an FFQ to assess short-term antioxidant intake against 30 d food records and plasma biomarkers. Public Health Nutr 17:297–306PubMedCrossRef Yang M, Wang Y, Davis CG, Lee SG, Fernandez ML, Koo SI, Cho E, Song WO, Chun OK (2014) Validation of an FFQ to assess short-term antioxidant intake against 30 d food records and plasma biomarkers. Public Health Nutr 17:297–306PubMedCrossRef
50.
Zurück zum Zitat Yang M, Wang Y, Davis CG, Lee SG, Fernandez ML, Koo SI, Cho E, Chun OK (2014) Validation of an FFQ to assess antioxidant intake in overweight postmenopausal women. Public Health Nutr 17:1467–1475PubMedCrossRef Yang M, Wang Y, Davis CG, Lee SG, Fernandez ML, Koo SI, Cho E, Chun OK (2014) Validation of an FFQ to assess antioxidant intake in overweight postmenopausal women. Public Health Nutr 17:1467–1475PubMedCrossRef
Metadaten
Titel
Oxidative balance score and risk of osteoporosis among postmenopausal Iranian women
verfasst von
Zahra Shahriarpour
Bita Nasrabadi
Sudiyeh Hejri-Zarifi
Seyedeh-Elaheh Shariati-Bafghi
Mahboobe Yousefian-Sanny
Mohsen Karamati
Bahram Rashidkhani
Publikationsdatum
01.12.2021
Verlag
Springer London
Erschienen in
Archives of Osteoporosis / Ausgabe 1/2021
Print ISSN: 1862-3522
Elektronische ISSN: 1862-3514
DOI
https://doi.org/10.1007/s11657-021-00886-w

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