J Clin Endocrinol Metab. 2006 Jun 27; Epub ahead of print

Bonds DE, Larson JC, Schwartz AV, Strotmeyer ES, Robbins J, Rodriguez BL, Johnson KC, Margolis KL.

Context: Some but not all studies have shown higher rates of fracture in individuals with type 2 diabetes. Objective: To determine the risk of fracture in postmenopausal women with type 2 diabetes and to determine if risk varies by fracture site, ethnicity, and baseline bone density. Design, Setting, and Participants: Women with clinically diagnosed type 2 diabetes at baseline in the Women's Health Initiative Observational Cohort, a prospective study of postmenopausal women (n = 93,676), were compared with women without diagnosed diabetes and risk of fracture overall and at specific sites determined. Main Outcome Measures: All fractures and specific sites separately (hip/pelvis/upper leg; lower leg/ankle/knee; foot; upper arm/shoulder/elbow; lower arm/wrist/hand; spine/tailbone). Bone mineral density in a subset. Results: The overall risk of fracture after 7 yr of follow-up was higher in women with diabetes at baseline after controlling for multiple risk factors including frequency of falls (adjusted RR 1.20, 95% CI 1.11-1.30). In a sub-sample of women with baseline bone mineral density (BMD) scores, women with diabetes had greater hip and spine BMD. The elevated fracture risk was found at multiple sites (hip/pelvis/upper leg; foot; spine/tailbone), among black women (RR 1.33, 95% CI 1.00-1.75), and in women with increased baseline bone density (RR 1.26, 95% CI 0.96-1.66). Conclusion: Women with type 2 diabetes are at increased risk for fractures. This risk is also seen among black and non-Hispanic white women after adjustment for multiple risk factors including frequent falls and increased BMD (in a subset).

Diabetes Care. 2006 Jul;29(7):1573-8

Janghorbani M, Feskanich D, Willett WC, Hu F.

OBJECTIVE: The purpose of this study was to determine whether women with type 1 and type 2 diabetes are at higher risk of hip fractures. RESEARCH DESIGN AND METHODS: A total of 109,983 women aged 34-59 years in 1980 were followed through 2002 for the occurrence of hip fracture. At baseline and through biennial follow-up, women were asked about their history and treatment of diabetes and other potential risk factors for hip fracture. RESULTS: During 2.22 million person-years of follow-up, 1,398 women had a hip fracture. Compared with women without diabetes, the age-adjusted relative risk (RRs) of hip fracture was 7.1 (95% CI 4.4-11.4) for women with type 1 diabetes and 1.7 (1.4-2.0) for those with type 2 diabetes. After further adjustment for BMI, smoking, physical activity, menopausal status, daily intake of calcium, vitamin D, protein, and postmenopausal hormone use, the multivariate RR of incident hip fracture in individuals with type 1 diabetes compared with individuals without diabetes was 6.4 (3.9-10.3) and with type 2 diabetes was 2.2 (1.8-2.7). The RRs increased with longer duration of type 2 diabetes (3.1 [2.3-4.0] for >/=12 years compared with no diabetes, P for trend < 0.001) and ever use of insulin. CONCLUSIONS: These data indicate that both type 1 and type 2 diabetes are associated with an increased risk of hip fracture. The results of this study highlight the need for fracture-prevention strategies in women with diabetes.

J Bone Miner Res. 2006 Jun;21(6):817-28

Effects of conjugated equine estrogen on risk of fractures and BMD in postmenopausal women with hysterectomy: results from the women's health initiative randomized trial.

Jackson RD, Wactawski-Wende J, LaCroix AZ, Pettinger M, Yood RA, Watts NB, Robbins JA, Lewis CE, Beresford SA, Ko MG, Naughton MJ, Satterfield S, Bassford T; Women's Health Initiative Investigators.

Further analyses from the Women's Health Initiative estrogen trial shows that CEE reduced fracture risk. The fracture reduction at the hip did not differ appreciably among risk strata. These data do not support overall benefit over risk, even in women at highest risk for fracture. INTRODUCTION: The Women's Health Initiative provided evidence that conjugated equine estrogen (CEE) can significantly reduce fracture risk in postmenopausal women. Additional analysis of the effects of CEE on BMD and fracture are presented. MATERIALS AND METHODS: Postmenopausal women 50-79 years of age with hysterectomy were randomized to CEE 0.625 mg daily (n = 5310) or placebo (n = 5429) and followed for an average 7.1 years. Fracture incidence was assessed by semiannual questionnaire and verified by adjudication of radiology reports. BMD was measured in a subset of women (N = 938) at baseline and years 1, 3, and 6. A global index was used to examine whether the balance of risks and benefits differed by baseline fracture risk. RESULTS: CEE reduced the risk of hip (hazard ratio [HR], 0.65; 95% CI, 0.45-0.94), clinical vertebral (HR, 0.64; 95% CI, 0.44-0.93), wrist/lower arm (HR, 0.58; 95% CI, 0.47-0.72), and total fracture (HR, 0.71; 95% CI, 0.64-0.80). This effect did not differ among strata according to age, oophorectomy status, past hormone use, race/ethnicity, fall frequency, physical activity, or fracture history. Total fracture reduction was less in women at the lowest predicted fracture risk in both absolute and relative terms (HR, 0.86; 95% CI, 0.68-1.08). CEE also provided modest but consistent positive effects on BMD. The HRs of the global index for CEE were relatively balanced across tertiles of summary fracture risk (lowest risk: HR, 0.81; 95% CI, 0.62-1.05; mid risk: HR, 1.09; 95% CI, 0.92-1.30; highest risk: HR, 1.04; 95% CI, 0.88-1.23; interaction, p = 0.42). CONCLUSIONS: CEE reduces the risk of fracture and increases BMD in hysterectomized postmenopausal women. Even among the women with the highest risk for fractures, when considering the effects of estrogen on other important health outcomes, a summary of the burden of monitored effects does not indicate a significant net benefit.

J Gen Intern Med. 2006 Jun;21(6):630-5

Cass AR, Shepherd AJ, Carlson CA.

BACKGROUND: Dual energy x-ray absorptiometry (DXA), coupled with early treatment, may reduce morbidity and mortality associated with osteoporosis. Clinical tools to enhance selection of women for DXA screening have not been developed or validated in an ethnically diverse population. OBJECTIVE: To compare the performance of the osteoporosis risk assessment instrument (ORAI) and the simple calculated osteoporosis risk estimation (SCORE) instrument across 3 racial/ethnic groups to identify women who would benefit from DXA scans. DESIGN: Blinded comparison of the instruments in a cross-sectional sample. PARTICIPANTS: Two-hundred twenty-six postmenopausal women were recruited from a university-based family medicine clinic. Women with a prior diagnosis of osteoporosis or those taking bone active medications were excluded. MEASUREMENTS: Participants completed a questionnaire that contained the ORAI and the SCORE questions; 203 completed a DXA scan. RESULTS: The sensitivity and specificity for the ORAI (0.68, [0.49 to 0.88, 95% CI]; 0.66, [0.59 to 0.73, 95% CI]) and the SCORE instrument (0.54, [0.34 to 0.75, 95% CI]; 0.72, [0.65 to 0.78, 95% CI]) differed significantly from previous reports. Overall, the accuracy of the ORAI (66.5%) and SCORE instrument (70.0%) were similar (McNemar's test P value = .37). The accuracy between instruments differed significantly in African-American women (McNemar's test, P value <.001). In African Americans, the SCORE instrument correctly identified more women without osteoporosis, but missed 70% of those with osteoporosis. CONCLUSIONS: The performance of the ORAI and SCORE instrument differed significantly from previous reports. Although both can reduce the use of DXA scans for screening for osteoporosis, lower sensitivities resulted in underrecognition of osteoporosis and may limit their clinical usefulness in an ethnically diverse population.

Maturitas. 2006 Jun 26; [Epub ahead of print

Zalloua PA, Hsu YH, Terwedow H, Zang T, Wu D, Tang G, Li Z, Hong X, Azar ST, Wang B, Bouxsein ML, Brain J, Cummings SR, Rosen CJ, Xu X.

OBJECTIVES: Over the past decade, dietary choices and nutrition have proven to be major modulators of bone mineral density (BMD) in men and women. We investigated environmental determinants, specifically dietary habits, of BMD by using multiple regression models in a rural Chinese population. METHODS: BMDs were measured at the hip and total body in 5848 men and 6207 women, aged 25-64. Dietary and supplemental intakes were assessed by a simple, one-page questionnaire tailored to collect nutritional information from large rural populations. Another questionnaire was used to collect information on the subjects' age, disease history, smoking, alcohol consumption, physical activity as well as women's menstrual status and reproductive history. Multiple regression models were used to assess the relationships among dietary variables and BMD, after adjusting for age, BMI (body mass index), weight, occupation, smoking status, and alcohol consumption. RESULTS: Increasing seafood consumption was significantly associated with greater BMD in women (p<0.001), especially those consuming more than 250g per week of seafood. One thousand and three hundred and twenty-four men and 1479 women consumed >250g of fruit per week. Higher fruit intake was found to be significantly associated with higher BMD in both sexes (p<0.05). High vegetable consumption, however, did not positively impact BMD. CONCLUSIONS: This study with its large population size has identified preventive measures, as well as some risk factors, involved in bone loss and osteoporosis. Our results highlight the importance of several dietary variables as significant determinants of BMD. It also emphasizes the role of dietary intake in general and shows that specific foods, such as fruits and seafood, can positively impact BMD.

Menopause. 2006 May 25; [Epub ahead of print]

Zoli A, Lizzio MM, Capuano A, Massafra U, Barini A, Ferraccioli G.

OBJECTIVE:: Osteoarthritis and osteoporosis are two major health problems affecting postmenopausal women. Epidemiological observations seem to demonstrate a possible inverse relationship between osteoarthritis and osteoporosis. Erosive osteoarthritis (EOA) of the hand is a destructive form of primary osteoarthritis. This study evaluated bone mineral density and bone metabolism changes in erosive and nonerosive hand osteoarthritis women. DESIGN:: Fifty-five women (mean age, 59 years; body mass index, 23 +/- 1.4 kg/m) who had been postmenopausal for an average of 9 years and who presented with hand osteoarthritis according to American College of Rheumatology criteria were enrolled in the study; 15 women showed clinical and radiological evidence of hand EOA. Twenty women matched for age, age at menopause, and body mass index formed the control group. Bone mineral density (g/cm) was measured at the hip and lumbar spine using dual-energy x-ray absorptiometry. Serum and urinary calcium and phosphate, serum 25-hydroxyvitamin D, parathyroid hormone, osteocalcin, and urinary breakdown products of bone matrix (CrossLaps) were analyzed. RESULTS:: Women with hand EOA had a statistically significant lower T- and Z-score L2-L4 value than non-hand EOA women and controls (P < 0.01). Moreover, postmenopausal women with hand EOA had higher significant percentage of osteoporosis at lumbar spine when compared with non-hand EOA postmenopausal women and controls. Any statistically significant difference in osteocalcin and CrossLaps serum levels was noted among women with hand EOA, hand osteoarthritis, and controls. CONCLUSION:: Our data suggest that postmenopausal women with clinical and radiological EOA are at risk for development of osteoporosis.

Vnitr Lek. 2002 Oct;48(10):943-7

Masaryk P, Stancikova M, Letkovska A, Rovensky J.

Alendronate is an aminobisphosphonate, a selective inhibitor of osteoclast-mediated bone resorption. Due to its influence a decline of markers of bone turnover occurs. The latter react much sooner than it is possible to detect significant changes of bone density. In the submitted trial the authors investigated changes of selected markers: total alkaline phosphatase (ALP), osteocalcin (OC), N-terminal telopeptide fragment of collagen type I (NTx) after 3 months' treatment with alendronate, the influence on bone density after one year's treatment in 50 postmenopausal women with densitometrically verified osteoporosis. After one-year treatment in the whole group a significant increase of bone density occurred in the area L2-L4 by 4.52% (SD = 3.9), neck of the femur by 2.24% (SD = 3.6), trochanter by 2.81% (SD = 3.0) and total by 1.89% (SD = 2.7). Total ALP and OC in serum, similarly as NTx in urine declined significantly already after 3 months treatment and the decline persisted also after one year of treatment. With the change of bone density after one year correlated significantly only NTx. A decline of NTx after 3 months by more than 30% as compared with the baseline value was recorded in 81% patients and this change predicted a significant rise of the bone density in the area of the neck of the femur, on average by 30.Urinary NTx is a promising predictor of the effect of alendronate treatment. Its drop by more than 30% after 3 months justifies the assumption that bone density increased after one year's treatment.

Osteoporos Int. 2006 Jun 1; [Epub ahead of print]

Martyn-St James M, Carroll S.

INTRODUCTION: Conflicting evidence exists regarding the optimum exercise for postmenopausal bone loss. A systematic review and meta-analysis was undertaken to evaluate the effects of randomised controlled trials (RCTs) of progressive, high-intensity resistance training on bone mineral density (BMD) amongst postmenopausal women. METHODS: Structured electronic searching of multiple databases and hand-searching of key journals and reference lists was undertaken to locate relevant studies up to December 2004. Study quality and possible publication bias were assessed using recognised methods. Primary outcomes were absolute changes in BMD at the lumbar spine (LS), femoral neck (FN) and total hip (TH). A priori defined subgroup analyses included concurrent hormonal or antiresorptive therapy or calcium supplementation during the intervention. The weighted mean difference method (WMD) was used for combining study group estimates. Random or fixed effect models were applied according to study heterogeneity observed from the I (2) statistic. RESULTS: At the LS, 14 RCT study groups were homogenous (I (2)=25.2%) in demonstrating a significant increase (P=0.006) in BMD of 0.006 g/cm(2) (fixed effect; 95% CI 0.002-0.011) following high-intensity resistance training. In contrast, marked heterogeneity (I (2)=88.2%) was apparent within 11 RCT study groups evaluating FN. For this comparison, a random effects model showed a positive change in FN BMD of 0.010 g/cm(2) (95% CI -0.002 to 0.021; P = 0.11). Subgroup analyses showed more anatomical variability of BMD responses to resistance training according to participants' hormone therapy use. Treatment effects for study groups increasing all participants' calcium intake showed significant positive BMD changes at TH (P=0.007). Methodological quality of all included studies was low, and a reporting bias towards studies with positive BMD outcomes was evident. CONCLUSIONS: These findings are relevant to the nonpharmacological treatment of postmenopausal bone loss.

Eur J Appl Physiol. 2006 May 23; [Epub ahead of print]

Rikkonen T, Tuppurainen M, Kroger H, Jurvelin J, Honkanen R.

.

Kuopio osteoporosis risk factor and prevention (OSTPRE) study is a population-based study from Eastern Finland. At baseline in 1989-91, bone densitometry of lumbar spine and femoral neck as assessed by DXA was carried out on women aged 48-58 (n = 3,222). In 1993, menarcheal age and health habits during adolescence were inquired from a postal inquiry. In 1996, a random sample of 254 women who had been premenopausal at baseline was interviewed over phone. They were asked how many kilometers per day they had walked to school and back, in each grade of primary school. The study sample (N = 185) was formed by excluding women with menarcheal age of >14 or <11 years. Women with any reported HRT history were also excluded. The mean age of the study sample was 50.7 (1.63) years, weight 70.8 (13.1) kg, height 161.5 (5.0) cm, and mean walking distance to and fro from the school at ages from 9 to 11 years was 2.7 (1.7) km. In regression analysis, the walking distance was associated with femoral BMD (r = 0.18, P = 0.015). After adjusting for baseline age, weight and height, this association persisted (P = 0.025). When walking distance was categorized as I = 0-0.549 km, II = 0.55-1.99 km, III = 2.0-4.99 and IV = 5.0 km and more, the respective means for femoral BMDs were 0.92, 0.97, 0.98 and 1.01 g/cm(2). Statistical significance persisted after adjusting for height, weight, age, grip strength, calcium intake, smoking, place of residence, use of contraceptive pills, physical load of work and baseline physical activity (P = 0.032). A 10 year follow-up revealed no changes in bone loss rate between the groups and femoral BMD benefits persisted (repeated measures analysis = NS). Walking distance was not associated with spinal bone density. Even though walking is a low impact activity, walking before menarche may have a moderate but long-lasting positive effect on femoral peak bone density. Lack of walking and similar low impact physical activities during peak growth years may have a negative effect on peak bone mass formation.

Rheumatol Int. 2006 May 20; [Epub ahead of print]

Hayirlioglu A, Gokaslan H, Andac N.

The objective of this study is to investigate the effect of bilateral oophorectomy with total abdominal hysterectomy on bone loss, comparing the cases having surgery before and after the menopause. Bone mineral density (BMD) measurements were obtained from the lumbar spine and femoral neck of totally 127 cases. Out of 127, 105 had surgery before menopause and 22 cases were operated on postmenopausally. The results were compared with the USA normal values. The average age of surgical menopause (SM) cases was 48.45 years with a mean duration of menopause of 5.77 years. The average height and weight were 157.67 cm and 68.19 kg, respectively. The average age of cases having surgery after menopause (SAM) was 62.45 years with a mean duration of 5.59 years after the surgery (duration after menopause is 13.23 years). The average height and weight were 157.45 cm and 73.55 kg, respectively. The average of BMD measurements of lumbar spines L2-L4 was 1.04 gr/cm(2) (BMD = 85.65% and T score = -0.96) in the cases with SM. On the contrary, the average of the BMD measurements of lumbar spines L2-L4 was 1.05 gr/cm(2) (BMD = 101.14% and T score = 0.24) in the cases with SAM. The average of the BMD measurements of femoral neck was 0.85 gr/cm(2) (BMD = 91.39% and T score = -0.64) in the cases with SM. On the contrary, the average of the BMD measurements of femoral neck was 0.82 gr/cm(2) (BMD = 96.69% and T score = -0.31) in the cases with SAM. The bilateral oophorectomy as a surgical procedure is not a statistically significant factor for the acceleration of the bone loss. The main points are the age and the duration of menopause of the patient affecting the bone loss if the surgery is performed before menopause.

Metabolism. 2006 Jun;55(6):741-7

Tseng LN, Sheu WH, Ho ES, Lan HH, Hu CC, Kao CH.

To evaluate the effect of alendronate combined with hormone replacement therapy (HRT) on postmenopausal osteoporotic Chinese women living in Taiwan, we treated 151 women (age range, 47-70 years; mean, 61 years) with conjugated equine estrogen (0.625 mg), medroxyprogesterone 5 mg, and elemental calcium 500 mg daily with either alendronate 10 mg (n = 79) or placebo (n = 72), and measured their bone mineral density (BMD) at the lumbar spine and hip every 6 months for 3 years. Urine N-telopeptide of type I collagen corrected by concentration of urine creatinine (NTx/Cr) and serum osteocalcin (OC) concentration was also measured at weeks 2, 4, and every 3 months from month 3 for 2 years. Significantly higher percentage increases in BMD at the lumbar spine (P < .0001, 2-way analysis of variance) throughout the 36-month treatment period were found in the alendronate plus HRT group than in the HRT-only group. However, there was no difference in BMD at the femoral neck and trochanter between these 2 groups. Treatment with alendronate plus HRT resulted in a 10.1% increase at the L-spine BMD and a 7.7% increase at the trochanter BMD at the end of the 3-year study period (P < .01, compared with baseline at both sites). A significant decline in urine NTx/Cr was observed at week 4 in the alendronate plus HRT group, whereas in the HRT-only group, a significant decline in urine NTx/Cr occurred at month 9. By the end of 24 months, urine NTx/Cr decreased by 49.7% in the alendronate plus HRT group (P = .001 compared with a 20.4% increase in the HRT group). A significant decline in serum OC level occurred at month 3 in the alendronate plus HRT group, whereas a similar decline was observed at month 6 in the HRT-only group. By the end of 24 months, serum OC decreased by 52.2% in the alendronate plus HRT group (P < .001 compared with a 1.5% increase in the HRT-only group). Subjects treated with alendronate plus HRT had a significantly greater percentage decrease in urine NTx/Cr (P = .0001) and serum OC (P = .0007) than subjects treated with HRT only throughout the 24-month treatment period by 2-way analysis of variance comparison. There was no difference in upper gastrointestinal or drug-related side effects between groups. In conclusion, our data suggest that the use of alendronate combined with HRT for 3 years was well tolerated and it significantly increased BMD at the L-spine and hip in postmenopausal Chinese women with osteoporosis. This regimen is safe and can be used in subjects who have no satisfactory response to a single agent or who have very low BMD with multiple risks. However, this study does not indicate whether HRT plus alendronate has any greater effect on BMD than alendronate alone.

BMC Public Health. 2006 May 19;6(1):135 [Epub ahead of print]

Allali F, Aichaoui S, Saoud B, Maaroufi H, Abouqal R, Hajjaj-Hassouni N.

ABSTRACT: BACKGROUND: The clothing style is an important factor that influences vitamin D production and thus bone mineral density. We performed a case-control study in order to evaluate the effect of veil wearing (concealing clothing) on bone mineral density in Moroccan post menopausal women. METHODS: The cases were osteoporotic women whose disease was assessed by bone mineral density measurement. Each patient was matched with a non osteoporotic woman for age, and body mass index. All our patients were without secondary causes or medications that might affect bone density. The veil was defined as a concealing clothing which covered most of the body including the arms, the legs and the head. This definition is this of the usual Moroccan traditional clothing style. RESULTS: 178 post menopausal osteoporotic patients and 178 controls were studied. The mean age of the cases and the controls was 63.2 years (SD 7) and the mean body mass index was 32.1 (SD 8). The results of crude Odds Ratios analyses indicated that wearing a veil was associated with a high risk of osteoporosis: OR 2.29 (95% CI, 1.38-3.82). Multiparity or a history of familial peripheral osteoporotic fractures had also a significant effect on increasing the osteoporosis risk (ORs: 1.87 (95% CI, 1.05-3.49) and 2.01 (95% CI, 1.20-3.38)). After a multiple regression analysis, wearing the veil and a history of familial osteoporotic fractures remained the both independent factors that increased the osteoporosis risk (ORs: 2.20 (95% CI, 1.22-3.9) and 2.19 (95% CI, 1.12-4.29) respectively). CONCLUSION: our study suggested that in Moroccan post menopausal women, wearing a traditional concealing clothing covering arms, legs and head increased the risk of osteoporosis. Further studies are required to evaluate the clinical impact of the above findings and to clarify the status of vitamin D among veiled women in Morocco.

Scott Med J. 2006 May;51(2):27-31

Burleigh E, Potter J.

Vitamin D deficiency is common in older people and increases risk of falls, osteoporosis and fracture. This may be reduced with supplements. Recent Scottish guidelines recommend routine use of vitamin D and calcium for all older housebound, sunlight deprived or institutionalised people. Whilst many outpatients will undoubtedly meet these criteria, others who would benefit may not. We have determined the extent of vitamin D deficiency in older outpatients in our geographical area, to clarify further whether those found to be deficient, would receive supplementation under current guidelines. METHODOLOGY: 102 new patient referrals to outpatient clinics and day hospital were questioned over their social circumstances and activity levels, and had serum 25-Hydroxy Vitamin D (25(OH)D) levels measured in wintertime. RESULTS: Mean age was 79.6 (SD 7.3), 31.4% were housebound and 51.0% exposed their skin to sunlight. 72.6% had insufficient vitamin D levels [25(OH)D < 50 nmol/l], 27.5% of whom levels were frankly deficient [25(OH)D < 25 nmol/l]. Deficiency was significantly more common in females (p = 0.002), those attending the falls clinic or day hospital (p = 0.021), the housebound (p = 0.012) or patients who never exposed their skin to sunlight (p = 0.007). However, even in those patients who were outdoors frequently or who did expose their skin to the sun, the mean vitamin D levels remained insufficient [mean 25(OH)D = 45.6 (SD 26.2) nmol/l and 47.9 (SD 26.3) nmol/l respectively]. CONCLUSIONS: The prevalence of vitamin D deficiency is high in older outpatients in this geographical area. These patients may benefit from routine vitamin D and calcium, but currently many would not be targeted in recent Scottish Executive recommendations because they are not housebound and sunlight deprived.

Clin Rheumatol. 2006 May 11; [Epub ahead of print]

Rajeswaran C, Spencer J, Barth JH, Orme SM.

The ageing population is expected to increase the burden of osteoporosis on the health care system. Secondary causes of osteoporosis are found in a proportion of patients. There is much controversy regarding the best work-up for patients who have been diagnosed as having osteoporosis based on bone mineral density. It is difficult to decide where interventions should be targeted both from a patient's perspective and for cost effectiveness. We evaluated the utility of a standard panel (full blood count, plasma viscosity, plasma protein, electrophoresis, urine Bence Jones protein, thyroid function test, bone profile, fasting lipids and liver function test) of biochemical investigations in 327 consecutive patients (287 females, 40 males) referred to the new patient osteoporosis clinic from April 1999 to March 2000. Patients were characterised after measurement of spinal/femoral neck bone mineral density after a dual energy X-ray absorptiometry (DEXA) scan. There were 88 patients with osteoporosis, 91 with osteopenia, 130 had normal bone mineral density and 20 who did not have a bone scan. No case of multiple myeloma was found in this cohort of patients. There was no difference in the mean plasma viscosity of patients with and without osteoporosis (P=0.182). There was no significant difference in the abnormal urine calcium/creatinine (Ca/Cr ratio) in patients with osteoporosis and those without osteoporosis (P=0.316). There was no significant difference in the prevalence of hypothyroidism (P=0.213) or thyrotoxicosis (P=0.138) in patients with and without osteoporosis. There was no strong correlation between cholesterol concentrations and osteoporosis (r=0.069). We found no utility in performing a myeloma screen. A small proportion of patients had abnormalities of calcium homeostasis or thyroid disease. We recommend that a screening biochemical evaluation should be restricted to calcium/bone profile and thyroid function tests in patients with a presumptive diagnosis of osteoporosis.

Zhonghua Yi Xue Za Zhi. 2006 Feb 14;86(6):366-70

Qin YJ, Zhang ZL, Huang QR, He JW, Hu YQ, Li M, Liu YJ.

OBJECTIVE: To determine whether premenopausal daughters of women with postmenopausal osteoporosis have lower peak bone mass than the daughters of normal women the same age, and to analyze the related risk factors affecting bone mass variation. METHODS: 126 pairs of mother with postmenopausal osteoporosis and her premenopausal daughter, and 136 pairs of normal postmenopausal mother and her premenopausal daughter selected for 410 core families including one healthy premenopausal daughter aged 20 - 40, all of Han ethnicity living in Shanghai recruited by advertisement and lectures. A questionnaire survey was conducted to investigate their dietary custom, Dual-energy X-ray absorptionmetry at lumber spine 1 - 4 (L(1 - 4)) and proximal femur was conducted to measure the values of bone mineral density (BMD). RESULTS: The BMD values in L(1 - 4), femoral neck, and greater trochanter of the daughters of mothers with osteoporosis were 0.68 g/cm(2) +/- 0.07 g/cm(2), 0.59 g/cm(2) +/- 0.08 g/cm(2), and 0.47 g/cm(2) +/- 0.07 g/cm(2) respectively, all significantly lower than those of the daughters of normal mothers (0.86 g/cm(2) +/- 0.14 g/cm(2), 0.70 g/cm(2) +/- 0.11 g/cm(2), and 0.57 g/cm(2) +/- 0.10 g/cm(2) respectively, all P < 0.001). The average body weight of the daughters of mothers with osteoporosis was lighter then that of the daughters of normal mothers by 4.8% (P < 0.05). Multivariate regression analysis showed that age, body height, age of menarche, and milk intake were not influencing factors of BMD value, however, body weight was most significantly associated with BMD of the premenopausal daughters, contributing to the BMD variation at L(1 - 4), femoral neck, and greater trochanter by 9.4%, 16.5%, and 16.6% respectively. When body weight was excluded in the model, lower BMD of mother became the most important factors affecting the BMD variation, contributing to the BMD variation at L(1 - 4), femoral neck, and greater trochanter by 5.1%, 5.3%, and 4.2% respectively. CONCLUSION: The daughters of mothers with osteoporosis have reduced peak bone mass. It is likely due to the lower body weight of the daughter and the lower bone mass of the mother.

Osteoporos Int. 2006 Apr 12; [Epub ahead of print]

Lo JC, Pressman AR, Omar MA, Ettinger B.

INTRODUCTION: Although clinical trials indicate that oral bisphosphonates reduce osteoporotic fracture risk, compliance with bisphosphonate therapy in practice is suboptimal, with 1-year discontinuation rates exceeding 50%. METHODS: We conducted a retrospective cohort study among female members of a large integrated health care delivery system (Kaiser Permanente of Northern California), age 45 years and older, to determine their persistence with weekly alendronate (defined as continuous use, allowing for a refill gap of 60 days), predictors of discontinuation, and subsequent osteoporosis therapy. We also examined the effect of varying the refill gap from 30 to 120 days on the discontinuation rate. From 2002 through 2003, we identified 13,455 women (age 68.8+/-10.4 years) who initiated weekly oral alendronate therapy. RESULTS: Using a 60-day refill gap, the 1-year discontinuation rate was 49.6% [95% confidence interval (CI) 48.8-50.4%]; this increased to 58.0% (CI 57.2-58.8%) with a 30-day gap and decreased to 42.2% (CI 41.1-43.0%) with a 120-day gap. Among those who discontinued therapy, about one-third restarted alendronate or another osteoporosis drug within 6 months. Baseline factors associated with alendronate discontinuation included prior bone mineral density testing [adjusted odds ratio (OR) 0.64, CI 0.60-0.69], prior postmenopausal hormone therapy (OR 0.78, CI 0.73-0.84), prior high-dose oral glucocorticoid therapy (OR 1.26, CI 1.05-1.51), prior gastrointestinal diagnoses (OR 1.21, CI 1.09-1.36), and high number of therapeutic classes of prescriptions filled in the prior year (OR 1.21, CI 1.10-1.32), although the final model had limited explanatory power. CONCLUSIONS: We conclude that apparent discontinuation rates are high within 1 year after treatment initiation, although a subset of women appears to restart bisphosphonate or other osteoporosis therapy. Because intermittent use and/or poor adherence is common, discontinuation rates based on data from administrative databases are sensitive to the refill gap length. In addition, we identified no clinical factors highly predictive of discontinuation.

Orv Hetil. 2006 Mar 19;147(11):495-9

Meszaros S, Ferencz V, Deli M, Csupor E, Toth E, Horvath C.

INTRODUCTION: Smoking is a risk factor for osteoporosis. In a previous study, the authors showed lower bone density among smokers in a group of postmenopausal women. AIMS: After this finding, the primary goal of current research was to investigate how smoking could influence bone quality. METHODS: Forty-five (age range: 25-72 ys) smoker women were compared with 45 nonsmoker women adjusted for age and antropometric parameters. Quantitative ultrasound method was used to determine the speed of ultrasound and the ultrasound attenuation transmitting the left heel (Achilles In Sight, GE Lunar). Dual photon absorptiometry method was applied to investigate the bone mineral density of lumbar spine and left femoral neck (Prodigy, GE Lunar) and single photon absorptiometry was used to determine the bone mineral content of radius at the non dominant side (NK-364, Gamma). RESULTS: No difference was found between smokers and non-smokers among the premenopausal group, however, postmenopausal smoker women had slightly lower speed of ultrasound and ultrasound attenuation values than non-smoker women. Postmenopausal smoker women suffering from bone fracture had significantly lower speed of ultrasound than postmenopausal non-smoker women (1508.9 vs. 1525.3 m/s, respectively), despite their bone density did not differ from each other. CONCLUSION: These data augment the knowledge about the injurious effect of smoking. The increased risk for bone fracture among smokers could be explained not only with the decrease of bone mass, which was previously described, but also with a decreased bone elasticity.

J Nutr. 2006 May;136(5):1323-8

Ikeda Y, Iki M, Morita A, Kajita E, Kagamimori S, Kagawa Y, Yoneshima H.

Japanese fermented soybeans (natto in Japanese), which contain a large amount of menaquinone-7, may help prevent the development of osteoporosis. We assessed the possibility of an association between habitual natto intake and bone mineral density (BMD) and BMD change over time in healthy Japanese women who participated in a large representative cohort study (Japanese Population-based Osteoporosis Study: JPOS study). The BMD was measured at the spine, hip, and forearm in 944 women (20-79 y old) at baseline and at a follow-up conducted 3 y later. Dietary natto intake was assessed by a FFQ on both occasions. Additional covariates including age, height, weight, lifestyle factors, dietary calcium intake, and the intake of other soybean products, were also measured. The total hip BMD at baseline increased (P for trend = 0.0034) with increasing habitual natto intake in the postmenopausal women, although this was not the case at other skeletal sites. There were significant positive associations between natto intake and the rates of changes in BMD at the femoral neck (P < 0.0001) and at the distal third of the radius (P = 0.0002) in the postmenopausal women. The association in the femoral neck persisted even after adjusting for covariates. No significant association was observed between the intake of tofu or other soybean products and the rate of BMD change in the postmenopausal women. Natto intake may help prevent postmenopausal bone loss through the effects of menaquinone 7 or bioavailable isoflavones, which are more abundant in natto than in other soybean products

Hum Reprod. 2005 Dec 22; [Epub ahead of print]

Bahamondes L, Espejo-Arce X, Hidalgo MM, Hidalgo-Regina C, Teatin-Juliato C, Petta CA.

BACKGROUND: There are concerns about the effect of hormonal contraceptives on bone mineral density (BMD), but there is currently no information available on the effect of the levonorgestrel-releasing intrauterine system (LNG-IUS) on BMD. The objective of this study was to compare the BMD of LNG-IUS users with that of controls using the TCu380A intrauterine device (IUD). MATERIALS AND METHODS: A cross-sectional study paired 53 women, aged 25-51 years, who had been using the LNG-IUS for 7 years, with 53 IUD users, according to age (+/-1 year) and body mass index (BMI; kg/m(2)) (+/-1). BMD was evaluated at the midshaft of the ulna and the distal radius of the nondominant forearm using double X-ray absorptiometry. RESULTS: Mean age of women was 34 years. BMI was slightly over 25 in both groups. Estradiol was normal. Mean BMD was 0.469 +/- 0.008 and 0.467 +/- 0.009 and 0.409 +/- 0.009 and 0.411 +/- 0.009 at the midshaft of the ulna and distal radius in LNG-IUS and IUD users, respectively, without significant differences. CONCLUSIONS: Women aged 25-51 years, using the LNG-IUS for 7 years, had a mean BMD similar to that of the control group of TCu380A IUD users.