Osteoporosis and Cognitive impairment: a bibliometrics study and visualization analysis via CiteSpace

doi:10.21203/rs.3.rs-3607461/v1

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Osteoporosis and Cognitive impairment: a bibliometrics study and visualization analysis via CiteSpace

https://doi.org/10.21203/rs.3.rs-3607461/v1

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The purpose of this study is to evaluate the research hotspots and trends in comorbidity studies of osteoporosis and cognitive impairment through literature visualization analysis and provide valuable insights for further applications and research in this field.

Methods: Using the Web of Science database, relevant literature on co-morbidity studies of osteoporosis and cognitive impairment published until October 20, 2023, was retrieved. CiteSpace was employed to analyze the publication trends, countries, institutions, author collaborations, co-occurring keywords, and burst keywords in this research area.

Results: A total of 917 relevant publications on co-morbidity studies of osteoporosis and cognitive impairment were included in the analysis. The research in this area is primarily concentrated in countries such as the United States, Italy, China, the United Kingdom, and Australia. High-impact authors include Julie A. Pasco and Sophia X. Sui. Cluster analysis revealed key topics such as hip fractures, bone density, cognitive impairment, breast cancer, and randomized trials. The top three burst keywords, ranked by burst strength, were quality of life, postmenopausal women, and hormone replacement therapy.

Conclusion: The number of co-morbidity studies on osteoporosis and cognitive impairment has been steadily increasing in recent years. However, based on the results from CiteSpace, we recommend more active collaboration among countries, institutions, and authors to facilitate clinical and basic research. Current research focuses on exploring the correlation and epidemiological characteristics of osteoporosis and cognitive impairment. Developing simple, reliable early screening methods and effective early interventions may become the research hotspots for the management of co-morbidity between osteoporosis and cognitive impairment.

Health sciences/Diseases/Endocrine system and metabolic diseases

Health sciences/Diseases/Neurological disorders

Osteoporosis

Cognitive Impairment

Co-Morbidity Management

CiteSpace

Visualization

Osteoporosis (OS) and cognitive impairment (CI) are common diseases among the elderly population (1). In the context of global aging, the harm caused by these two diseases has become a worldwide public health issue (2). The prevalence of osteoporosis in people aged 60 and above is 37.7%, among them, 60.8% also have cognitive impairment (3). Studies have shown that OS and CI share common pathogenic mechanisms and both can be prevented and controlled (4–5), and guidelines suggest that comorbidity management of OS and CI should be conducted (6).

There are various interactions between osteoporosis and cognitive impairment. A meta-analysis of 136,222 patients shows that the risk of cognitive impairment is significantly higher in patients with osteoporosis compared to those without osteoporosis (OR = 2.01, 95% CI 1.63–2.48) (7). Patients with cognitive impairment have a higher risk of developing osteoporosis in the spine (OR = 1.42, 95% CI 1.04–1.92) and hip (OR = 1.50, 95% CI 1.09–2.05) (8). Special attention should be paid to that when osteoporosis and cognitive impairment coexist, it is evident that they will aggravate each other's potential risks and injury severity.

According to the World Health Organization's predictions, the global population aged 65 and above will reach 1.6 billion by 2050 (9). The medical practice ahead of us will be extremely challenging. Currently, the medical community in various countries has not managed osteoporosis and cognitive impairment as comorbidities. Therefore, this study uses bibliometric methods and CiteSpace software to construct a knowledge map of relevant literature from the Web of Science. It aims to understand the research hotspots and trends in comorbidity studies of osteoporosis and cognitive impairment, providing a scientific basis for scholars worldwide to conduct related research and comorbidity management.

2.1 Data Source and Search Strategies

The Web of Science is the most comprehensive academic database in the world, widely used for bibliometric analysis (10–11). For this study, data were sourced from the Web of Science Core Collection using advanced search techniques. The search query was as follows: TS=("Osteoporosis") and TS= ("Cognitive impairment"). The search was conducted from the establishment of the database until October 20, 2023.

Inclusion criteria: Literature related to comorbidity studies of osteoporosis and cognitive impairment was included in the analysis. Exclusion criteria: Non-academic documents such as news reports, patents, conference proceedings. Literature that was in the form of books or inaccessible in full text. Duplicate publications.

2.2 Visualization Analysis Software

In this study, we utilized CiteSpace version 6.2.R2 to transform and visualize the included literature, generating knowledge maps with a time slice unit of 1 year. Node types encompassed authors, institutions, and keywords, selected based on research requirements. The threshold for the highest annual citation frequency was set at 50. The pruning methods included Pathfinder and Pruning sliced networks, and other settings were kept at their default configurations.

3.1 Publication Trend

Based on the search results, a total of 917 articles were included for analysis. The results indicated an overall increasing trend in the number of publications since 1988. Research on the comorbidity of OS (Osteosarcoma) and CI (Chronic Illnesses) started relatively early internationally. There was a sudden sharp increase in publications in 2016, reaching its peak in 2022 with over 80 articles, as shown in Fig. 1.

3.2 Bibliometric analysis of countries and institutions.

The research on the comorbidity of osteoporosis and cognitive impairment has been studied by 3,349 institutions across 78 countries or regions. The total number of papers published by these top 10 countries is 816, which accounts for 88.99% of the total publications. Additionally, the top 5 institutions contributed 68 papers, making up 7.42% of the total publications in this field as shown in Table 1. The cooperation relationships between countries or regions can be seen in Fig. 2, and the cooperation relationships between institutions can be seen in Fig. 3.

Table 1

The top 10 countries and top 5 institutions with most publications.
Rank	Country	N(%)	Institution	N(%)
1	USA	258	Chinese University of Hong Kong	18
2	Italy	100	University of Melbourne	15
3	China	91	Monash University	13
4	England	73	Deakin University	12
5	Australia	68	Harvard University	10
6	Germany	51
7	The Netherlands	46
8	Spain	44
9	Canada	44
10	Japan	41

3.3 Author Cooperation Network Analysis

The top 10 authors based on publication volume are as follows: Pasco, Julie A (11 papers); Sui, Sophia X (9 papers); Kwok, Timothy; Cameron Lan D; Woo, Jean; Willams, Lana J (7 papers); Chen, Jian Sheng; Di Monaco, Marco (6 papers); Cumming, Robert G; Seibel, Markus J (5 papers). Several author collaboration groups have been formed, but these collaborations primarily involve scholars within the same institution. Cooperation among authors from different institutions is not extensive.

3.4 Keyword Visualization Analysis

3.4.1 Keyword Co-occurrence Analysis

The keyword co-occurrence network effectively reflects the research hotspots in this field. We obtained a total of 460 keyword nodes, and their interconnections can be found in Fig. 5. The top 10 keywords with the highest frequencies, along with their centrality, counts, and year of first appearance, are detailed in Table 2.

Table 2

Top 10 keywords in terms of centrality, frequency, and first appearance year
Rank	Keyword	Centrality	Count	Year of the first aeticle
1	bone mineral density	0.17	155	1993
2	risk	0.14	132	1996
3	alzheimers disease	0.13	110	1997
4	cognitive impairment	0.04	96	2006
5	osteoporosis	0.06	92	1999
6	hip fracture	0.08	91	1997
7	postmenopausal women	0.13	86	2003
8	mortality	0.07	83	2000
9	cognitive function	0.05	80	2007
10	quality of life	0.09	76	1999

3.4.2 Keyword cluster analysis

Building upon the foundation of keyword co-occurrence analysis, the cluster analysis conducted reflects the research focal points in this field. A total of nine clusters have been identified: #0 hip fractures, #1 bone density, #2 cognitive impairment, #3 breast cancer, #4 randomized trials, #5 Alzheimer's disease, #6 protection, #7 hormone therapy, #8 quality of life, as illustrated in Fig. 6.

3.4.3 Keyword burst analysis

Keyword bursts reflect the developmental trends and frontiers of the research field. In this study, a total of 24 keyword bursts were identified. The top three bursts in terms of intensity were quality of life (strength = 12.23), postmenopausal women (strength = 12.12), and hormone replacement therapy (strength = 9.37). Keywords that have experienced bursts include association, incidence rate, cognitive impairment, injury, and elderly population, as shown in Fig. 7.

4.1 General information

In the field of comorbidity research between osteoporosis and cognitive impairment, there is a rising trend in the number of research publications, and researchers' attention to this area continues to increase. The research hotpots exhibit diverse characteristics. This can be attributed to two main reasons. Firstly, in the context of global aging, osteoporosis and cognitive impairment are common diseases among the elderly (12–14). Scholars easily recognize the potential correlation between osteoporosis and cognitive impairment, epidemiological investigations and laboratory studies are employed to explore the comorbidity rates and mechanisms of osteoporosis and cognitive impairment (15–17). Secondly, interventional studies indicate that comorbidity management of osteoporosis and cognitive impairment can yield economic and social benefits, such as reducing medical expenses, promoting interdisciplinary collaboration, raising public awareness of health, and driving the formulation of relevant policies (18–20). However, in the academic community, a unified management strategy has not yet been established. Consequently, an increasing number of scholars are eager to explore more effective approaches in this regard.

4.2 Research Focus and Frontier

4.2.1 Bone Mineral Density

Bone Mineral Density (BMD) serves as a crucial outcome indicator in research related to the comorbidity of osteoporosis and cognitive function (21). Studies have clearly identified measures to improve bone density, including pharmaceutical treatments such as alendronate sodium, zoledronic acid, and denosumab (22–25). Additionally, calcium supplementation and vitamin D can be achieved through medication, consuming calcium-rich foods, or sun exposure to facilitate the synthesis of vitamin D (26). Protein supplementation is also essential, as it promotes bone growth, insufficient protein intake can lead to decreased bone density and quality in the elderly (27). Furthermore, engaging in regular physical exercise can increase bone density, enhance physical activity, and protect the skeletal, joint, and muscular systems (28). In summary, improving bone density requires considering various factors, including diet, exercise, and lifestyle habits. Although the effectiveness of these habits in enhancing bone density is well established, integrating these health practices into everyday life remains challenging for both diseased and non-diseased populations (29). Therefore, we hope to raise public awareness of health and early screening for osteoporosis and cognitive impairment.

4.2.2 Elderly Population

The elderly population has become a prominent research hotpot in the comorbidity management of osteoporosis and cognitive impairment due to the high prevalence of these two diseases in older adults and their mutual influence (30). Osteoporosis and cognitive impairment are common ailments among the elderly, significantly affecting their quality of life (31). And there is a reciprocal relationship between osteoporosis and cognitive impairment, when both conditions coexist, the outcomes tend to worsen (32). Osteoporosis can lead to fractures, necessitating bed rest, which may exacerbate cognitive impairment symptoms, such as brain atrophy and cognitive decline, due to prolonged immobility (33). On the other hand, individuals with cognitive impairment may be unable to protect themselves effectively due to decreased memory and concentration, resulting in a higher risk of falls (34).

4.2.3 Postmenopausal Women

After menopause, women experience a decline in estrogen levels, leading to reduced bone mass and cognitive function (35). Estrogen plays a protective role in both the skeletal and nervous systems (36). Consequently, postmenopausal women are more prone to osteoporosis and cognitive impairment (37), requiring increased attention and research efforts. Comorbidity management of osteoporosis and cognitive impairment in postmenopausal women can enhance their physical condition and cognitive abilities, improve their quality of life, and reduce healthcare costs and societal burdens (38). Therefore, postmenopausal women have become a key research hotpot in the comorbidity management of osteoporosis and cognitive impairment. Researchers should explore more effective management and treatment methods, providing better healthcare services for this population.

4.2.4 Breast Cancer

The comorbidity research concerning osteoporosis and cognitive impairment in breast cancer patients has garnered significant attention (39). Breast cancer patients undergo treatments such as chemotherapy and radiotherapy, which can impact the skeletal and nervous systems, increasing the risk of osteoporosis and cognitive impairment (40). Additionally, surgical procedures and radiotherapy may lead to decreased physical condition and malnutrition, further exacerbating the occurrence of osteoporosis and cognitive impairment (41). Finally, osteoporosis and cognitive impairment have a significant impact on the quality of life and prognosis of breast cancer patients. Osteoporosis may result in complications such as fractures, affecting daily life abilities and quality of life. Cognitive impairment may hinder patients from receiving proper breast cancer treatment and rehabilitation training, affecting their prognosis and survival period. Therefore, comorbidity management of osteoporosis and cognitive impairment in breast cancer patients is expected to improve their quality of life and prognosis.

4.2.5 Mortality Rate

Clearly, for any elderly individual, acquiring an additional disease will undoubtedly increase the risk of mortality (42). However, when osteoporosis and cognitive impairment coexist, the harm caused is greater than the sum of its parts (43). From the perspective of disease progression, osteoporosis increases the risk of cognitive impairment in the elderly because of the connection between skeletal health and brain health (44). Conversely, cognitive impairment further exacerbates the progression of osteoporosis due to the higher risk of fractures and accidents among patients with cognitive impairment (45). In terms of the consequences of diseases, osteoporotic fractures, such as hip fractures, in elderly individuals may lead to severe health issues such as pain, loss of mobility, and decreased independence (46). Cognitive impairment may cause memory loss, confusion, weakened judgment, which could affect the elderly's daily life abilities, making them more susceptible to accidents or fractures (47). For elderly individuals with both osteoporosis and cognitive impairment, a single accident often becomes the last fall in their lives.

4.2.6 Hormone Replacement Therapy

For postmenopausal women with osteoporosis, hormone replacement therapy, by supplementing estrogen or testosterone, can increase bone density and reduce the risk of fractures (48). Similarly, hormone replacement therapy for male osteoporotic patients, through testosterone supplementation, can increase bone density and alleviate symptoms such as pain (49). Hormone replacement therapy can also improve symptoms of cognitive impairment (50). Study suggest that hormone replacement therapy can enhance cognitive function in elderly women, including memory, attention, and executive functions (51). These improvements might be related to the protective effects of hormone replacement therapy on brain neurons (52). Hormone replacement therapy has become a research hotpot in the comorbidity management of osteoporosis and cognitive impairment due to its effectiveness in alleviating symptoms of both conditions, improving patients' quality of life, and reducing the risk of fractures.

4.2.7 Quality of Life

Quality of life is the ultimate destination of all medical research, and both osteoporosis and cognitive impairment lead to a decline in patients' quality of life (53). Osteoporosis can cause pain, fractures, and other health issues, affecting patients' daily life and mobility (54). Cognitive impairment may result in memory loss, slow thinking, and other neuropsychiatric symptoms, affecting patients' social skills, self-management, and quality of life (55). Comorbidity management of osteoporosis and cognitive impairment holds crucial significance in improving patients' quality of life. Lastly, evaluating the quality of life serves as a vital indicator for assessing the effectiveness of treatments and we can understand the effectiveness of interventions and patients' satisfaction, providing references for further optimizing treatment plans (56).

4.3 Strengths and Limitations

To the best of our knowledge, this is the first study utilizing CiteSpace for bibliometric analysis and visualization, presenting the hotspots, frontiers, as well as cooperation between authors, institutions, and countries in research related to the comorbidity of osteoporosis and cognitive impairment. However, there are still some limitations. We only analyzed English literature from WoS, potentially leading to the risk of not comprehensively incorporating all relevant studies. Additionally, there might be overlaps between clusters due to synonymous terms in the keywords.

Based on the results from CiteSpace, we recommend more active collaboration among countries, institutions, and authors for clinical and basic research. The ongoing research focus lies in understanding the correlation and epidemiological characteristics of osteoporosis and cognitive impairment, investigating their impact on the quality of life in the elderly. Early screening methods and interventions might become future research hotspots in the comorbidity management of osteoporosis and cognitive impairment.Data availability statement

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding authors.

Author contributions

W-ZS designed and analyzed the data. W-ZS and JJ drafted the manuscript and edited the manuscript. W-ZS and X-JJ analyzed the data. X-JJ, C-XH and W-WY contributed to revising the manuscript. All authors contributed to the article and approved the submitted version.

Funding

The Youth Science and Technology Project of Changzhou Health Commission (QN202216); Young Talent Development Plan of Changzhou Health Commission (CZQM2020057)

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

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No competing interests reported.

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Osteoporosis and Cognitive impairment: a bibliometrics study and visualization analysis via CiteSpace

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Abstract

Figures

1 Background

2 Methods

2.1 Data Source and Search Strategies

2.2 Visualization Analysis Software

3 Results

3.1 Publication Trend

3.2 Bibliometric analysis of countries and institutions.

3.3 Author Cooperation Network Analysis

3.4.1 Keyword Co-occurrence Analysis

3.4.2 Keyword cluster analysis

3.4.3 Keyword burst analysis

4 Discussion

4.1 General information

4.2 Research Focus and Frontier

4.2.1 Bone Mineral Density

4.2.2 Elderly Population

4.2.3 Postmenopausal Women

4.2.4 Breast Cancer

4.2.5 Mortality Rate

4.2.6 Hormone Replacement Therapy

4.2.7 Quality of Life

4.3 Strengths and Limitations

5 Conclusion

Declarations

References

Additional Declarations

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