Julio de 2007
Dr. Juan Enrique Blümel.
Departamento Medicina Sur. Universidad de Chile
Cochrane Database Syst Rev. 2007 Jul
18;(3):CD004526.
WITHDRAWN: Calcium
supplementation on bone loss in postmenopausal women.
Shea B, Wells G, Cranney A, Zytaruk N, Robinson V, Griffith L, Hamel C, Ortiz Z, Peterson J, Adachi J, Tugwell P, Guyatt G; the Osteoporosis Methodology
Group; and the Osteoporosis Research
Advisory Group.
BACKGROUND: Although calcium is one the simplest and least expensive
strategies for preventing osteoporotic fractures calcium supplementation is
nevertheless not without controversy (Kanis 1989; Nordin 1990). The Food and
Drug Administration in the US has permitted a bone health claim for
calcium-rich foods, and the NIH in its Consensus Development Process approved a
statement that high calcium intake reduces the risk of osteoporosis.
OBJECTIVES: To assess the effects of calcium on bone density and fractures in
postmenopausal women. SEARCH STRATEGY: We searched Cochrane Controlled
Register, MEDLINE and EMBASE up to 2001, and examined citations of relevant
articles and proceedings of international meetings. SELECTION CRITERIA: Trials
that randomized postmenopausal women to calcium supplementation or usual
calcium intake in the diet and reported bone mineral density of the total body,
vertebral spine, hip, or forearm or recorded the number of fractures, and
followed patients for at least one year were considered for inclusion. DATA
COLLECTION AND ANALYSIS: Three independent reviewers assessed the methodologic
quality and extracted data for each trial. For each bone density site (lumbar
spine, total body, combined hip and combined forearm), we calculated the
weighted mean difference in bone density between treatment and control groups
using the percentage change from baseline. We constructed regression models in
which the independent variables were year and dose, and the dependent variable
was the effect size. This regression was used to determine the years across
which pooling was appropriate. Heterogeneity was asssesed. For each fracture
analysis we calculated a risk ratio. MAIN RESULTS: Fifteen trials, representing
1806 participants, were included. Calcium was more effective than placebo in
reducing rates of bone loss after two or more years of treatment. The pooled
difference in percentage change from baseline was 2.05% (95% CI 0.24 to 3.86)
for total body bone density, 1.66% (95% CI 0.92 to 2.39) for the lumbar spine
at 2 years, 1.60% (95% CI 0.78 to 2.41) for the hip, and 1.91% (95% CI 0.33 to
3.50) for the distal radius. The relative risk of fractures of the vertebrae
was 0.79 (95% CI 0.54 to 1.09); the relative risk for non-vertebral fractures
was 0.86 (95% CI 0.43 to 1.72). AUTHORS' CONCLUSIONS: Calcium supplementation
alone has a small positive effect on bone density. The data show a trend toward
reduction in vertebral fractures, but it is unclear if calcium reduces the
incidence of non vertebral fractures.
Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004523.
WITHDRAWN:
Risedronate for the prevention and treatment of postmenopausal osteoporosis.
Cranney A, Adachi J, Guyatt G, Papaioannou A, Robinson V, Shea B, Tugwell P, Waldegger L, Weaver B, Wells G, Zytaruk N.
BACKGROUND: Postmenopausal osteoporosis results in an increased
susceptibility to low-trauma fractures due to reduced bone volume and
microarchitectural deterioration. Risedronate, a third generation
bisphosphonate, has been shown in multiple clinical trials to reduce fracture
risk and improve bone mineral density in postmenopausal women with
osteoporosis. First and second generation bisphosphonates are known to have
gastrointestinal side-effects and risedronate may be better tolerated.
OBJECTIVES: To systematically review the efficacy of risedronate on bone
density, and fracture reduction in postmenopausal women. SEARCH STRATEGY: The
Cochrane Controlled Trials Registry Medline, and Current Contents were searched
from 1990 - 2001. The electronic search was supplemented by handsearching four
osteoporosis journals and their conference proceedings, as well as contacting
content experts and industry sources for unpublished data. SELECTION CRITERIA:
We included eight trials that randomised women to risedronate or an alternative
(placebo or calcium and /or vitamin D) and measured bone mineral density for at
least one year. DATA COLLECTION AND ANALYSIS: For each trial three independent
reviewers assessed the methodological quality and abstracted data. Data was
extracted for outcomes of fracture, bone mineral density and adverse events.
The more conservative random effects model was used to pool data. The quality
of trials was assessed according to the Jadad five-point scale. MAIN RESULTS:
Both vertebral and non-vertebral fractures were statistically and clinically
reduced with risedronate. Eleven out of one hundred women who received
risedronate had a vertebral fracture compared to 17 out of one hundred of those
who received calcium and vitamin D (pooled relative risk for vertebral
fractures of 0.64 (95% CI 0.52 - 0.77). Three percent of participants who
received risedronate had a non-vertebral fracture compared to 4.6% of those who
received calcium and vitamin D (pooled relative risk for nonvertebral fractures
of 0.73 (95% CI 0.61 - 0.87). The weighted mean difference for the percent
change from baseline for bone mineral density with 5 mg daily for lumbar spine,
femoral neck and trochanter was 4.54% (95%CI 4.12 - 4.97), p<0.01; 2.75% (95%
CI 2.32 - 3.17), p<0.01; and 4.38% (95% CI 3.51 - 5.25), p<0.01
respectively. AUTHORS' CONCLUSIONS: There is good evidence for the efficacy of
risedronate in the reduction of both vertebral and non-vertebral fractures. In
addition, there is evidence from randomized trials that risedronate is able to
achieve this without increasing risk for overall withdrawals due to adverse
effects.
Obesity (Silver Spring). 2007 Jul;15(7):1827-1840.
Morbidity and
Mortality Risk Associated With an Overweight BMI in Older Men and Women.
School of Kinesiology and Health Studies, Queen’s University,
Background: There is controversy as to whether older adults with a BMI
in the overweight range (25 to 29.9 kg/m(2)) are at increased health risk and
whether they should be encouraged to lose weight. The purpose of this study was
to determine whether older adults with a BMI in the overweight range are at
increased morbidity and mortality risk. Methods: Participants consisted of 4968
older (>/=65 years) men and women from the Cardiovascular Health Study
limited access dataset. Based on BMI (kg/m(2)), participants were grouped into
normal-weight (20 to 24.9 kg/m(2)), overweight (25 to 29.9 kg/m(2)), and obese
(>/=30 kg/m(2)) categories. Participants were followed for up to 9 years to
determine if they developed 10 weight-related health outcomes that are
pertinent to older adults. Cox proportional hazards models were used to
estimate the hazards ratios of morbidity and mortality after adjusting for age,
sex, income, smoking, and physical activity. RESULTS: Compared with the
normal-weight group, the risks of myocardial infarction, stroke, sleep apnea,
urinary incontinence, cancer, and osteoporosis were not different in the
overweight group (p > 0.05). The risks for arthritis and physical disability
were modestly increased in the overweight group (p < 0.05), whereas the risk
for type 2 diabetes was increased by 78% in the overweight group (p < 0.01).
After adjusting for all relevant covariates, all-cause mortality risk was 11%
lower in the overweight group (p < 0.05). Conclusions: A BMI in the
overweight range was associated with some modest disease risks but a slightly
lower overall mortality rate. These findings suggest that a BMI cut-off point
of 25 kg/m(2) may be overly restrictive for the elderly.
Curr Med Res Opin. 2007 Jul 12; [Epub
ahead of print]
Prevalence of
vitamin D inadequacy in European postmenopausal women.
OBJECTIVE: Inadequate vitamin D level is associated with secondary
hyperparathyroidism and increased bone turnover and bone loss, which in turn
increases fracture risk. The objective of this study is to assess the
prevalence of inadequate serum vitamin D levels in postmenopausal European
women. There are no clear international agreements on what constitutes a level
of vitamin D inadequacy, but recent publications suggest that the circulating
level of vitamin D should be over 80 nmol/L or at least between 50 and 80
nmol/L.MATERIAL AND METHODS: Assessment of 25-hydroxyvitamin D [25(OH)D] was
performed in 8532 European postmenopausal women with osteoporosis or
osteopenia. European countries included
Osteoporos Int. 2007 Jul 19; [Epub
ahead of print]
Effectiveness of
antiresorptive agents in the prevention of recurrent hip fractures.
Morin S, Rahme E, Behlouli H, Tenenhouse A, Goltzman D, Pilote L.
Division of Internal Medicine, McGill University Health Center (MUHC),
1650 Cedar Ave, Room B2-118, Montreal, QC, H3G 1A4, Canada.
Hip fracture is associated with recurrent fractures and increased
mortality. The results of our retrospective cohort study support the use of
antiresorptive agents to prevent recurrent hip fractures in this population.
INTRODUCTION: Hip fracture, the most serious consequence of osteoporosis, is
associated with recurrent fractures and increased mortality. Antiresorptive
therapy has proven efficacy in the prevention of fractures after vertebral
fractures. It is unknown if it can prevent recurrent fractures after a hip
fracture. METHODS: We designed a population based, retrospective cohort study,
using administrative databases and identified patients hospitalized for a hip
fracture between 1996 and 2002. The exposure was defined as being dispensed a
prescription for an antiresorptive agent at any time following discharge.
Multivariate Cox regression models were used to estimate the hazard ratio of
recurrent hip fracture. Subgroup and propensity score analyses were performed.
RESULTS: A total of 20,644 patients were identified; 6,779 filled a
prescription for antiresorptive agents. There were 992 recurrent hip fractures.
Patients exposed to antiresorptives had a 26% reduction in the rate of recurrent
fractures (adjusted hazard ratio 0.74; 95% CI, 0.64-0.86) compared to patients
who were not. All subgroups experienced a reduction in recurrent fracture,
except the very elderly. Propensity score analyses were consistent with the
main analysis. CONCLUSIONS: Antiresorptive therapy reduces the risk of
recurrent hip fractures in elderly patients. These results provide evidence
that this therapy should be considered for secondary prevention of hip
fractures.
Endocr J. 2007 Jul 20; [Epub ahead of print]
Subclinical
Hypothyroidism is Related to Lower Heel QUS in Postmenopausal Women.
Nagata M, Suzuki A, Sekiguchi S, Ono Y, Nishiwaki-Yasuda K, Itoi T, Yamamoto S, Imamura S, Katoh T, Hayakawa N, Oda N, Hashimoto S, Itoh M.
Division of Endocrinology and Metabolism, Department of Internal
Medicine,
Recent findings suggest that thyroid stimulating hormone (TSH) is a
negative regulator of skeletal remodeling by reducing both differentiation of
osteoblasts and formation of osteoclasts. In addition, increased fracture risk
in untreated hypothyroid patients has been reported to begin up to 8 years
before diagnosis. The aim of the present study was to evaluate the effect of
subclinical hypothyroidism on bone structure by using the heel QUS. Subjects were
outpatients without any past or present history of thyroid disease. Among 210
postmenopausal women, 22 of 33 patients (Hypo), who had elevated serum TSH
concentration (TSH >/=4 muU/ml) with normal serum free thyroxine (FT(4))
concentration, agreed to join to this study. We also randomly selected 24
control subjects (Cont) from 176 postmenopausal women with normal thyroid
status. Calcaneus osteo sono assessment indices (OSI) of right feet were
measured using the ultrasound bone densitometry AOS-100. Serum TSH
concentrations in Hypo patients (5.31 +/- 1.3 muU/ml) were higher than those in
Cont patients (2.05 +/- 1.1 muU/ml), and there was significant difference of
FT(4) concentrations (Cont 1.33 +/- 0.15 ng/dl; Hypo 1.19 +/- 0.17 ng/dl). OSI
and its Z-score in Hypo subjects (OSI, 2.138 +/- 0.152; Z-Score -0.322 +/-
0.504 SD, Mean +/- SD) were significantly lower than those in Cont subjects
(OSI, 2.347 +/- 0.243; Z-Score 0.322 +/- 0.91 SD, Mean +/- SD). Simple
regression statistical analysis showed that OSI decreased according to the
increase of serum TSH concentration (n = 47, P<0.037). In addition, multiple
regression analysis showed that the elevation of serum TSH concentration was
associated with the decrease of OSI. These results suggest that the elevation
of serum TSH concentration in subclinical hypothyroidism affects not bone
turnover but bone structure as assessed by QUS.
Nutr Cancer. 2007;58(2):136-45.
Lifestyle and
Dietary Correlates of Plasma Insulin-Like Growth Factor Binding Protein-1
(IGFBP-1), Leptin, and C-Peptide: The Multiethnic Cohort.
Henderson KD, Rinaldi S, Kaaks R, Kolonel L, Henderson B, Le Marchand L.
Circulating insulin-like growth factor binding protein 1 (IGFBP-1),
leptin, and insulin are 3 proteins modified by obesity and have been associated
with cancer at several sites in past studies. We conducted a cross-sectional
study to describe the correlation of these proteins with gender,
race/ethnicity, anthropometric indexes, and dietary and lifestyle factors. We
measured fasting plasma levels of IGFBP-1, leptin, and C-peptide, used here as
a stable measure of insulin secretion, in a random sample of 450 male and 352
postmenopausal female Hawaii and Los Angeles Multiethnic Cohort Study (MEC)
participants (age range 47-82 yr at blood draw). Through a series of multiple
linear regressions, we found that the most parsimonious model for plasma
IGFBP-1 included inverse associations with age, body mass index (BMI), and
regular soda intake. A term for interaction between age and BMI was positively
associated with plasma IGFBP-1. Adjusted mean plasma leptins were highest among
Whites and African Americans and lowest among Hawaiians and Japanese Leptin was
also inversely associated with age and positively associated with the
interaction between age and race/ethnicity, female gender, and BMI. A model
with only race/ethnicity and BMI (positive association) was best for plasma
C-peptide. Adjusted means for C-peptide were highest for Japanese and Whites
and lowest for African Americans. The overall percent of variance in protein
levels explained by these models was low for IGFBP-1(R2=0.17) and C-peptide
(R(3)=0.11) and higher for leptin (R(2)=0.57). We saw no clear correlation
between racial/ethnic trends in protein levels with those of colorectal,
breast, or prostate cancer incidence rates in the MEC. Research to clarify
factors associated with determination of these proteins and their relationship
with cancer etiology is warranted.
Nutr Cancer. 2007;58(2):127-35.
Dietary fiber
intake and endogenous serum hormone levels in naturally postmenopausal mexican
american women: the multiethnic cohort study.
Monroe KR, Murphy SP, Henderson BE, Kolonel LN, Stanczyk FZ, Adlercreutz H, Pike MC.
Department of Preventive Medicine,
This study investigated dietary fiber intake in association with serum
estrogen levels in naturally postmenopausal
Endocr Relat Cancer. 2007
Jun;14(2):169-87.
Critical assessment
of new risk factors for breast cancer: considerations for development of an
improved risk prediction model.
Santen RJ, Boyd NF, Chlebowski RT, Cummings S, Cuzick J, Dowsett M, Easton D, Forbes JF, Key T, Hankinson SE, Howell A, Ingle J.
Internal Medicine/Endocrinology,
The majority of candidates for breast cancer prevention have not
accepted tamoxifen because of the perception of an unfavorable risk/benefit
ratio and the acceptance of raloxifene remains to be determined. One means of
improving this ratio is to identify women at very high risk of breast cancer.
Family history, age, atypia in a benign biopsy, and reproductive factors are
the main parameters currently used to determine risk. The most powerful risk
factor, mammographic density, is not presently employed routinely. Other
potentially important factors are plasma estrogen and androgen levels, bone
density, weight gain, age of menopause, and fracture history, which are also
not currently used in a comprehensive risk prediction model because of lack of
prospective validation. The Breast Cancer Prevention Collaborative Group
(BCPCG) met to critically examine and prioritize risk factors that might be
selected for further testing by multivariate analysis using existing clinical
material. The BCPCG reached a consensus that quantitative breast density, state
of the art plasma estrogen and androgen measurements, history of fracture and
height loss, BMI, and waist-hip ratio had sufficient priority for further
testing. As a practical approach, these parameters could be added to the
existing Tyrer-Cuzick model which encompasses factors included in both the
Claus and Gail models. The BCPCG analyzed potentially available clinical
material from previous prospective studies and determined that a large
case/control study to evaluate these new factors might be feasible at this
time.
Cancer Causes Control. 2007 Jul 19; [Epub
ahead of print]
Breast density in
relation to risk of ductal carcinoma in situ of the breast in women undergoing
screening mammography.
Mackenzie TA, Titus-Ernstoff L, Vacek PM, Geller B, Weiss JE, Goodrich ME, Carney PA.
Department of Community & Family Medicine, Dartmouth Medical School,
Norris Cotton Cancer Center, Hanover, NH, USA.
OBJECTIVE: To examine the association between breast density and risk of
breast ductal carcinoma in situ (DCIS). METHODS: We assessed breast density in
relation to DCIS risk using combined data from statewide mammography registries
in NH and VT. The prospective analyses were based on 572 DCIS cases arising in
154,936 women (58,496 premenopausal and 96,440 postmenopausal). Women in the
study were followed on average 4.1 years. Breast density was scored by
community radiologists using BIRADS categories (fatty, scattered density,
heterogeneous density, extreme density). RESULTS: In premenopausal women, based
on 157 cases, the RR for DCIS risk were 0.29 (95% CI: 0.0.04, 2.24) for fatty
breasts, 2.06 (95% CI: 1.39, 3.05) for heterogeneous density, and 2.40 (95% CI:
1.47, 3.91) for extreme density, relative to scattered density. In
postmenopausal women, based on 369 cases, the RR for DCIS risk were 0.58 (95%
CI: 0.37, 0.93) for fatty breasts, 1.41 (95% CI: 1.12, 1.78) for heterogeneous
density, and 1.49 (95% CI: 0.93, 2.37) for extreme density, relative to
scattered density. The possible interaction between breast density and
menopausal status in relation to DCIS risk was not statistically significant.
CONCLUSIONS: We observed an association between breast density and DCIS risk.
Although the association seemed stronger in premenopausal women, there was no
evidence of an interaction involving breast density and menopausal status.
BMJ. 2007 Jul
11; [Epub ahead of print
Main morbidities
recorded in the women's international study of long duration oestrogen after
menopause (WISDOM): a randomised controlled trial of hormone replacement
therapy in postmenopausal women.
Vickers MR, Maclennan AH, Lawton B, Ford D, Martin J, Meredith SK, Destavola BL, Rose S, Dowell A, Wilkes HC, Darbyshire JH, Meade TW.
MRC General Practice Research Framework, Stephenson House,
OBJECTIVE: To assess the long term risks and benefits of hormone
replacement therapy (combined hormone therapy versus placebo, and oestrogen alone
versus combined hormone therapy). DESIGN: Multicentre, randomised, placebo
controlled, double blind trial. SETTING: General practices in
J Sex Med. 2007
Jul;4(4i):1001-1008
Evaluation of the
Clinical Relevance of Benefits Associated with Transdermal Testosterone
Treatment in Postmenopausal Women with Hypoactive Sexual Desire Disorder.
Kingsberg S, Shifren J, Wekselman K, Rodenberg C, Koochaki P, Derogatis L.
University Hospitals of Cleveland,
Introduction. Postmenopausal women with hypoactive sexual desire
disorder (HSDD) experienced statistically significant improvements in the
frequency of satisfying sexual activity, sexual desire, and distress with
testosterone treatment in phase III trials, but it was not known whether the
magnitude of these effects was clinically meaningful. The clinical relevance
study was designed to answer this question. Aim. To evaluate the clinical
relevance of the treatment benefits. Methods. This study involved a
representative sample of 132 surgically postmenopausal women with HSDD who were
enrolled in two randomized, placebo-controlled trials (N = 1094) assessing the
efficacy and safety of transdermal testosterone treatment (300 mcg/day) for 6
months. At the end of the studies, prior to unblinding, a sample of women (12%)
was interviewed concerning their experiences with the treatment. Main Outcome
Measures. Women were asked "Overall, would you say that you experienced a
meaningful benefit from the study patches?" Changes in the efficacy end
points in the double-blind studies were compared for the women who did and did
not experience an overall meaningful benefit. Results. Overall, 33 of 64 women
(52%) who received testosterone reported experiencing a meaningful treatment
benefit, compared with 21 of 68 women (31%) who received placebo (P = 0.025).
Among the women who identified themselves as experiencing a meaningful benefit,
the mean (SE) change from baseline in 4-week frequency of satisfying sexual
activity was 4.4 (0.76), in desire score was 21.0 (2.78), moving from
"seldom" to "sometimes" feeling sexual desire, and in
distress score was -36.5 (3.96), moving from "often" to "seldom"
being distressed. Among the women who identified themselves as not experiencing
a meaningful benefit, the mean (SE) change from baseline in 4-week frequency of
satisfying sexual activity was 0.5 (0.31), in desire score was 2.9 (1.42), and
in distress score was -8.8 (2.23). Conclusions. Surgically menopausal women
with HSDD in these studies received clinically meaningful benefits, including
improvements in satisfying sexual activity, sexual desire, and personal
distress.
J Sex Med. 2007
Jul;4(4i):1056-1069
The Burden of
Testosterone Deficiency Syndrome in Adult Men: Economic and Quality-of-Life
Impact.
Maggi M, Schulman C, Quinton R, Langham S, Uhl-Hochgraeber K.
Andrology Unit, Department of Clinical Physiopathology,
Introduction. Testosterone deficiency syndrome (TDS) causes a wide range
of symptoms that can lead to significant morbidity. Preliminary evidence has
also linked TDS with premature mortality and with a number of comorbid diseases
including diabetes and metabolic syndrome. Such associations can lead to
substantial economic and quality- of-life implications, the magnitude of which
remains largely unknown. Aim. To review the economic and quality-of-life
consequences of a largely untreated condition and to consider the likely health
economic benefits of testosterone treatment. Methods. A systematic review of
four main areas: epidemiological evidence of the magnitude of TDS, estimates of
cost of illness, impact on quality-of-life, and cost-effectiveness of
testosterone treatment. Main Outcome Measure. Review of peer-reviewed
literature. Results. The lack of clear universally accepted diagnostic criteria
and the uncertainty surrounding the link between TDS and some of its
consequences complicate the estimation of the burden of illness of TDS.
Consequences of TDS that potentially lead to increased economic burden include
depression, sexual dysfunction, mild cognitive impairment, osteoporosis,
cardiovascular disease, and mortality. However, although good evidence exists
demonstrating an association between TDS and sexual dysfunction and cognitive
impairment, evidence is less strong for depression, the incidence of fractures
and mortality, and highly controversial for cardiovascular disease. The
consequences that are likely to impact on patients' quality of life include
sexual function, energy levels, body composition, mood, and cognitive function.
Conclusion. Understanding the burden is only the first step decision makers
need to take to decide whether to allocate scarce resources to treat the
condition. To make informed decisions on when and who to treat information is
also needed on the cost-effectiveness of available treatments. Such data would
highlight the benefits of treatment of TDS to physicians, patients, and to
society as a whole.
Aust N Z J Obstet Gynaecol. 2007 Aug;47(4):329-34
A quantitative
analysis of the menopause experience of Indian women living in
School of Public Health and Community Medicine, Faculty of Medicine, The
University of New South Wales, Sydney, New South Wales, Australia.
Aims: To examine the experience of menopause in Indian women (aged 45-65
years) in
Menopause. 2007 Jul
6; [Epub ahead of print
Association of
general and abdominal obesities and metabolic syndrome with subclinical
atherosclerosis in asymptomatic Chinese postmenopausal women.
Yu RH, Ho SC, Ho SS, Woo JL, Ahuja AT.
From the 1Department of Community and Family Medicine, Chinese
University of Hong Kong, School of Public Health; 2Department of Diagnostic
Radiology and Organ Imaging, the Chinese University of Hong Kong, The Sir
Yue-kong Pao Centre for Cancer, and the Lady Pao Children's Cancer Centre; and
3Department of Medicine and Therapeutics, Chinese University of Hong Kong,
Prince of Wales Hospital, Shatin, N.T., Hong Kong, SAR.
OBJECTIVE:: This study aimed to investigate the relationships between
obesity, especially abdominal obesity, andmetabolic syndrome (MS) with carotid
intima-media thickness (IMT) and plaque, markers of subclinical
atherosclerosis, in asymptomatic Chinese postmenopausal women in
J Musculoskelet Neuronal Interact. 2007 Apr-Jun;7(2):144-8.
Common
musculoskeletal adverse effects of oral treatment with once weekly alendronate
and risedronate in patients with osteoporosis and ways for their prevention.
Bock O, Boerst H, Thomasius FE, Degner C, Stephan-Oelkers M, Valentine SM, Felsenberg D.
Centre for Muscle and Bone Research, Charite - University Medicine
Objective: To examine in a major cohort of patients whether or not
musculoskeletal adverse effects (MAEs), similar to those seen in intravenous
bisphosphonates (BP), might occur also in high dosage oral treatment regimens
with alendronate (ALN) and risedronate (RSN). Patients and methods: 612
consecutive patients treated in the osteoporosis outpatient clinic at Charite,
Campus Benjamin Franklin, between July 2002 and October 2003 with oral ALN or
RSN (mean age 68.2+/-9.7 years; 527 females, 85 males), were examined and
followed up for MAEs. Results: The overall frequency of any severe MAEs in our
patients was low (5.6%). All severe MAEs occurred in primarily once weekly
treated patients: 27 in ALN 70 mg once weekly (27/134=20.1%) and 7 in RSN 35 mg
once weekly (7/28=25.0%), with no significant difference between those groups.
The most frequently reported MAE was acute arthralgia in 12.6%, followed by
acute back pain in 9.1% of all primarily once weekly treated cases. None of the
302 patients initially treated with daily BP reported any MAEs when later
switching to once weekly administration (218 patients to ALN 70 mg once weekly
and 84 patients to RSN 35 mg once weekly). With reference to recently published
data, the phenomenon is probably related to dose dependent gammadelta T cell
activation by accumulation of isopentenyl pyrophosphate (IPP) due to inhibition
of the mevalonate pathway by nitrogen containing bisphosphonates (nBP). Conclusions:
MAEs in oral BP are, in general, less common and severe than in intravenous BP.
They are observed exclusively in patients starting ALN or RSN treatment with
once weekly dosage regimens. In order to avoid this phenomenon, it is suggested
to start ALN or RSN treatment with the lower daily dosages of ALN 10 mg daily
or RSN 5 mg daily for about two weeks before switching to the overall, more
convenient, once weekly dose regimen.
Cancer Epidemiol Biomarkers Prev. 2007 Jul;16(7):1443-8. Epub 2007 Jul
Dietary patterns
and breast cancer risk in the shanghai breast cancer study.
Cui X, Dai Q, Tseng M, Shu XO, Gao YT, Zheng W.
The association of breast cancer with dietary patterns such as a western
diet has not been studied in Asian women. We examined this among Shanghai
Breast Cancer Study participants. Cases were of ages 25 to 64 years, diagnosed
08/1996-03/1998, and identified through a rapid case ascertainment system
supplemented by the Shanghai Cancer Registry. Controls, selected from the
general population of urban
BMC Public Health. 2007 Jul 9;7(1):150
[Epub ahead of print
Changes in body
mass index in Canadians over a five-year period: Results of a prospective,
population-based study.
Hopman WM, Leroux C, Berger C, Joseph L, Barr SI, Prior JC, Harrison M, Poliquin S, Towheed T, Anastassiades T, Goltzman D, Research Group C.
ABSTRACT: Background The initiation of the Canadian Multicentre
Osteoporosis Study in 1996, and subsequent follow-up of the cohort 5 years
later, provided longitudinal body mass index (BMI) data for a random sample of
Canadians. Methods Height and weight were measured at baseline and 5 years and
used to calculate BMI and assign one of six weight categories. Multiple
imputation was used to adjust for missing weight at year 5. Data were
stratified by age and gender. The proportion of participants moving between
categories was generated, and multivariable linear regression was used to
identify factors associated with weight change. Results Baseline data were
available for 8548 participants, year 5 data for 6721, and year 5 weight was
imputed for 1827 (17.6%). Mean BMI for every age and gender group exceeded
healthy weight guidelines. Most remained within their BMI classification over 5
years, but when change occurred, BMI category was more likely to increase than
decrease. Several sociodemographic, lifestyle and clinical characteristics were
associated with change. Conclusions Mean baseline BMI tended to be higher than
recommended. Moreover, on average, men under age 45 and women under age 55 were
gaining approximately 0.45 kilograms (one pound) per year, which leveled off with
increased age and reversed in the oldest age groups. These findings underscore
the need for public health efforts aimed at combating obesity.
BMC Public Health. 2007 Jul 7;7(1):149 [Epub ahead of
print
Early menopause,
association with tobacco smoking, coffee consumption and other lifestyle
factors: a cross-sectional study.
Mikkelsen TF, Graff-Iversen S, Sundby J, Bjertness E.
ABSTRACT: BACKGROUND: Early onset of menopause is a risk factor for
several health problems. The objective was primarily to investigate the
association between early menopause and current, past active and passive
smoking. A second aim was to investigate the association between coffee and alcohol
consumption and early menopause. METHODS: The present population-based
cross-sectional study included a sub-sample of 2123 postmenopausal women born
in 1940-41 who participated in the Oslo Health Study. Early menopause was
defined as menopause occurring at an age of less than 45 years. We applied
logistic regression analyses (crude and adjusted odds ratio (OR)) to examine
the association between early menopause and selected lifestyle factors.
RESULTS: Current smoking was significantly associated with early menopause
(adj. OR, 1.59; 95% CI, 1.11-2.28). Stopping smoking more than 10 years before
menopause considerably reduced the risk of early menopause (adj. OR, 0.13; 95%
CI, 0.05-0.33). Total exposure to smoking (the product of number of cigarettes per
day and time as a smoker) was positively related to early menopause and, at the
highest doses, nearly doubled the odds (adj. OR, 1.93; 95% CI, 1.12-3.30).
These data suggest a possible dose-response relationship between total exposure
to smoking and early menopause, but no dose-response relationship was detected
for the other variables examined. We found no significant association of coffee
or alcohol consumption with early menopause. Of the lifestyle factors tested,
high educational level (adj. OR, 0.50; 95% CI, 0.34-0.72) and high social
participation (adj. OR, 0.60, 95% CI, 0.39-0.98) were negatively associated
with early menopause. CONCLUSIONS: This cross-sectional study shows an
association between current smoking and early menopause. The data also suggest
that the earlier a woman stops smoking the more protected she is from early
menopause. Early menopause was not significantly associated with passive
smoking, or alcohol or coffee consumption.
J Sex Med. 2007 Jul;4(4i):859-866
Management of
Female Sexual Dysfunction in Postmenopausal Women by Testosterone
Administration: Safety Issues and Controversies.
Department of Medicine,
Introduction. A Food and Drug Administration advisory group has
questioned the long-term safety of testosterone administration to
postmenopausal women. Although only short-term data exist on safety from the
double-blind, placebo-controlled trials, testosterone has been used for more
than 50 years. Therefore, some data concerning the long-term safety issues must
exist in the literature. Aim. To review the published data concerning the
safety of administration of testosterone to women. Methods. Review of published
articles identified by a search of the Ovid databases and bibliographies from
articles identified as dealing with the topics of testosterone or androgen
treatment of women. Results. The major adverse reactions to exogenous androgens
are the expected androgenic side effects of hirsutism and acne. High-density
lipoprotein levels may be decreased with oral androgens. There are insufficient
long-term safety data regarding breast, endometrium, or heart safety to draw
strong conclusions, although the data available to date are reassuring.
Conclusions. Testosterone administration to postmenopausal women that result in
physiological to slightly supraphysiological serum-free testosterone levels is
safe for at least 2 years.
Neurobiol Aging. 2007 Jun 29; [Epub
ahead of print]
Menopausal
transition: A possible risk factor for brain pathologic events.
Bonomo SM, Rigamonti AE, Giunta M, Galimberti D, Guaita A, Gagliano MG, Müller EE, Cella SG.
Department of Medical Pharmacology, University of Milan, Fondazione
IRCCS Ospedale Maggiore Policlinico, Milan, Italy; Center of Excellence for
Neurodegenerative Diseases (CEND), University of Milan, Italy.
BACKGROUND AND OBJECTIVE: Incidence and prevalence of Alzheimer's
disease (AD) are higher in postmenopausal women than in age-matched men. Since
at menopause the endocrine system and other biological paradigms undergo
substantial changes, we thought to be of interest studying whether (and how)
the balance between some biological parameters allegedly neuroprotective (e.g.
related to estrogen, dehydroepiandrosterone and CD36 functions) and others
considered pro-neurotoxic (e.g. related to glucocorticoid and interleukin-6
activities) vary during lifespan in either sex in either normalcy or
neurodegenerative disorders. SUBJECTS AND METHODS: Along with this aim, we evaluated
the gene expression levels of estrogen receptors (ERs), glucocorticoid
receptors (HGRs), interleukin-6 (IL-6) and CD36, a scavenger receptor of class
B allegedly playing a key role in the proinflammatory events associated with
AD, in a population of 209 healthy subjects (73M, 106F, 20-91-year old) and 85
AD patients (36M, 49F, 65-89-year old). Results obtained were related to plasma
titers of estrogens, cortisol and dehydroepiandrosterone sulfate (DHEAS).
Studies were performed in peripheral leukocytes, since these cells (1) are
easily obtainable by a simple blood sampling, (2) express many molecules and
multiple receptors which are under the same regulatory mechanisms as those
operative in the brain and (3) some of them, e.g. monocytes, share many functions
with microglial cells. RESULTS: In healthy men all the study parameters were
quite stable during lifespan. In women, instead, at menopausal transition, some
changes that may predispose to neurodegeneration occurred. In particular, there
was (1) an up-regulation of ERs, and a concomitant increase of IL-6 gene
expression, events likely due to the loss of the inhibitory control exerted by
estradiol (E(2)); (2) an increase of HGRalpha:HGRbeta ratio, indicative of an
augmented cortisol activity on HGRalpha not sufficiently counteracted by the
inhibitory HGRbeta function; (3) a reduced CD36 expression, directly related to
the increased cortisol activity; and (4) an augmented plasma cortisol:DHEAS
ratio, widely recognized as an unfavorable prognostic index for the risk of
neurodegeneration. In AD patients of both sexes, the expression of the study
parameters was similar to that found in sex- and age-matched healthy subjects,
thus indicating their unrelatedness to the disease, and rather a better
correlation with biological events. CONCLUSIONS: Menopausal transition is a
critical phase of women's life where the occurrence of an unfavorable
biological milieu would predispose to an increased risk of neurodegeneration.
Collectively, the higher prevalence of AD in the female population would
depend, at least in part, on the presence of favoring biological risk factors,
whose contribution to the development of the disease occurs only in the
presence of possible age-dependent triggers, such as beta-amyloid deposition.
Calcif Tissue Int. 2007 Jul 6; [Epub ahead of print]
Evidence that
Treatment with Risedronate in Women with Postmenopausal Osteoporosis Affects
Bone Mineralization and Bone Volume.
Fratzl P, Roschger P, Fratzl-Zelman N, Paschalis EP, Phipps R, Klaushofer K.
Department of Biomaterials, Max Planck Institute of Colloids and
Interfaces,
Risedronate is used in osteoporosis treatment. Postmenopausal women
enrolled in the Vertebral Efficacy with Risedronate Therapy trial received
either risedronate (5 mg/day) or placebo for 3 years. Subjects received calcium
and vitamin D supplementation if deficient at baseline. Lumbar spine bone
mineral density (BMD) was measured at baseline and at 3 years. Quantitative
back-scattered electron imaging (qBEI) was performed on paired iliac crest
biopsies (risedronate, n = 18; placebo, n = 13) before and after treatment, and
the mineral volume fraction in the trabecular bone was calculated. Combining
dual-energy X-ray absorptiometric values with the mineral volume fraction for
the same patients allowed us to calculate the relative change in trabecular
bone volume with treatment. This showed that the effect on BMD was likely to be
due partly to changes in matrix mineralization and partly due to changes in
bone volume. After treatment, trabecular bone volume in the lumbar spine tended
to increase in the risedronate group (+2.4%, nonsignificant) but there was a
significant decrease (-3.7%, P < 0.05) in the placebo group. Calcium
supplementation with adequate levels of vitamin D led to an approximately 3.3%
increase in mineral content in the bone material independently of risedronate
treatment. This increase was larger in patients with lower matrix
mineralization at baseline and likely resulted from correction of calcium/vitamin
D deficiency as well as from reduced bone remodeling. Combining BMD and bone
mineralization density distribution data show that in postmenopausal
osteoporosis 3-year treatment with risedronate preserves or may increase
trabecular bone volume, unlike placebo. This analysis also allows, for the
first time, separation of the contributions of bone volume and matrix
mineralization to the increase in BMD.
Nutr Hosp. 2007 May-Jun;22(3):313-21.
Dietary food
habits, nutritional status and lifestyle in menopausal women in Spain
Ubeda N, Basagoiti M, Alonso-Aperte E, Varela-Moreiras G.
Dpto Nutrición,
Bromatología y Tecnología de los Alimento, Fac. Farmacia, Universidad CEU San
Pablo, Madrid.
AIM: To analyse the diet and the dietary food habits in a sample of
1,218 Spanish women, aged 40 to 77 years, in the menopausal or perimenopausal
condition. Women were recruited nationwide and the diet was assessed using a
food frequency questionnaire. RESULTS: Diet in our population group was close
to the representative dietary habits of the Spanish population, except for
dairy products. These were highly consumed (approximately 4 servings/day) by
menopausal women. Energy, protein and cholesterol intakes, as well as most
vitamins and mineral intakes, were very high, as compared to recommended
dietary allowances. We only found marginal deficient intakes for folate and
vitamin D. Women over 60 years consume less eggs, sweats, sugar and miscellany,
and therefore less lipids and cholesterol, as well as vitamin D, than younger
women. A high rate (61%) of overweight and obesity (BMI > 25) was present in
our population group and was associated with a higher intake of meat, fish and
eggs, as well as energy. A healthier diet (high intake of dairy products, fresh
vegetables, fruits, legumes, cereals and fish) was associated with a healthier
lifestyle (no smoking, physical exercise) and the use of fortified foods and
vitamin/mineral supplements. A high percentage of women regularly consumed
fortified food (52,7%) and micronutrient supplements (22,8%) although diets
provided enough vitamins and minerals. CONCLUSION: Diet in our study group is
in accordance to healthy dietary habits and physical activity recommendations.
This is probably due to a greater concern for health in women close to the
menopause condition.
Int J Oncol. 2007 Aug;31(2):303-12.
Immune-surveillance
and programmed cell death-related genes are significantly overexpressed in the
normal breast epithelium of postmenopausal parous women.
Balogh GA, Russo IH, Spittle C, Heulings R, Russo J.
Breast Cancer Research Laboratory,
Endocrine and reproductive influences significantly affect the lifetime
risk of breast cancer. Nulliparity is one of the most firmly established risk
factors for breast cancer, whereas early full-term pregnancy and parity confer
a significant protection. The breast attains its maximum development during
pregnancy and lactation. After menopause the breast regresses in both
nulliparous and parous women containing lobular structures designated lobules
type 1 (Lob 1). We have postulated that the degree of differentiation acquired
through early pregnancy changes the 'genomic signature' that differentiates the
Lob 1 from the early parous women from that of the nulliparous women by
shifting the Stem cell 1 to a Stem cell 2, making this the mechanism of
protection conferred by early full-term pregnancy. In order to elucidate the
molecular pathways through which pregnancy exerts a protective effect, we have
analyzed the genomic profile of Lob 1 present in reduction mammoplasty
specimens obtained from parous and nulliparous postmenopausal women. The genes
differentially expressed are related to immune-surveillance, DNA repair,
programmed cell death, transcription, and chromatin
structure/activators/co-activator. In the present study we performed real-time
RT-PCR using a low-density array or a microfluid card for genes related to the
immune system and programmed cell death, using 18S as an internal control
[TaqMan(R) Low Density Array Human Immune Panel (Applied Biosystems)]. Breast
epithelial cells from parous women significantly overexpressed 17 out of 20
genes (p<0.001) with respect to the nulliparous breast. BCL2-associated X
protein, Complement component 3, CD45 antigen, glyceraldehyde-3-phosphate
dehydrogenase, granulysin, and chemokine (C-C motif) ligand 19 were expressed
more than 30-fold with respect to nulliparous breast cells. Only three out of
20 genes [selectin P (granule membrane protein 140 kDa, antigen CD62), Fas (TNF
receptor superfamily, member 6) and chemokine (C-X-C motif) ligand 11], were
downregulated in parous breast with respect to nulliparous breast cells. The
data lead us to conclude that an early pregnancy, by shifting the Stem cell 1
to Stem cell 2, makes the latter more easily recognized by the
immune-surveillance system, which initiates the programmed cell death pathway
if exposure to toxic or carcinogenic agents occurs.
Clin Sci (Lond). 2007 Jul 4; [Epub
ahead of print]
Relations of waist
and hip circumference with coagulation and fibrinolysis in postmenopausal
women.
Peverill RE, Teede HJ, Malan E, Kotsopoulos D, Smolich JJ, McGrath BP.
The contribution of obesity to the occurrence of cardiovascular events
may not be wholly related to its influence on traditional risk factors.
Coagulation and fibrinolysis may also influence cardiovascular risk, but the
relationship of adiposity with these processes is unclear. The aim of this
study was to investigate the relationships of body mass index (BMI), waist
circumference, hip circumference and waist-to-hip ratio (WHR) with factor VII
activity (VIIc), plasma markers of thrombin generation (prothrombin fragment
1+2; F1+2), fibrin formation (soluble fibrin; SF) and fibrin turnover
(D-dimer), and plasminogen activator inhibitor-1 (PAI-1; a marker of
fibrinolytic inhibitory capacity). The study cohort was 80 healthy
postmenopausal women who were not diabetic, current smokers or taking hormone
therapy and who had a fasting sample of blood collected. VIIc, F1+2, SF and
PAI-1 were all positively correlated with BMI, waist circumference and WHR,
while D-dimer was positively correlated with waist circumference and WHR, but
not BMI. WHR was the strongest correlate of all the markers except for PAI-1
which was most closely related to BMI. Hip circumference was a negative
correlate of F1+2 and D-dimer after adjusting for waist circumference. The
relationships of WHR with F1+2 and SF, but not with VIIc and D-dimer, were
independent of traditional risk factors. The positive association between waist
circumference and markers of thrombin generation, fibrin production and fibrin
turnover suggests that abdominal adiposity may contribute to atherothrombosis
by activating intravascular coagulation. In contrast, a larger hip
circumference appears to have a protective affect against coagulation
activation.
Expert Rev Cardiovasc Ther. 2007
Jul;5(4):777-789.
Sex hormone
replacement therapy and modulation of vascular function in cardiovascular
disease.
Brigham and Women’s Hospital, Division of Vascular Surgery,
Epidemiological and experimental studies suggest vascular protective
effects of estrogen. Cardiovascular disease (CVD) is less common in
premenopausal women than in men and postmenopausal women. Cytosolic/nuclear
estrogen receptors (ERs) have been shown to mediate genomic effects that
stimulate endothelial cell growth but inhibit vascular smooth muscle
proliferation. However, the Heart and Estrogen/Progestin Replacement Study
(HERS), HERS-II and Women's Health Initiative clinical trials demonstrated that
hormone replacement therapy (HRT) may not provide vascular benefits in
postmenopausal women and may instead trigger adverse cardiovascular events. HRT
may not provide vascular benefits because of the type of hormone used. Oral
estrogens are biologically transformed by first-pass metabolism in the liver.
By contrast, transdermal preparations avoid first pass metabolism. Also,
natural estrogens and phytoestrogens may provide alternatives to synthetic
estrogens. Furthermore, specific ER modulators could minimize the adverse
effects of HRT, including breast cancer. HRT failure in CVD could also be
related to changes in vascular ERs. Genetic polymorphism and postmenopausal
decrease in vascular ERs or the downstream signaling mechanisms may reduce the
effects of HRT. HRT in the late postmenopausal period may not be as effective
as during menopausal transition. Additionally, while HRT may aggravate
pre-existing CVD, it may thwart its development if used in a timely fashion.
Lastly, the vascular effects of progesterone and testosterone, as well as
modulators of their receptors, may modify the effects of estrogen and thereby
provide alternative HRT strategies. Thus, the beneficial effects of HRT in
postmenopausal CVD can be enhanced by customizing the HRT type, dose, route of
administration and timing depending on the subject's age and cardiovascular
condition.
Arch Gynecol Obstet. 2007 Jun 29; [Epub
ahead of print]
Tibolone and
osteoporosis.
Lazovic G, Radivojevic U, Milosevic V, Lazovic A, Jeremic K, Glisic A.
BACKGROUND: We conducted a 5-year prospective, observational, controlled
study to assess the effects of tibolone 1.25 mg/day on bone mineral density
(BMD) in postmenopausal women with osteopenia or osteoporosis. METHODS: The
subjects were 420 women, an average of 66.4 years old, who had been
postmenopausal between 8 and 19 years when enrolled in the study. Of the 420
women enrolled, 346 agreed to take tibolone for 5 years. The 74 who refused
tibolone took only calcium/vitamin D supplements and served as the control
group. BMD was measured in the lumbar spine and total hip region at baseline
and annually by dual-energy X-ray absorptiometry (DXA). RESULTS: At the first
two follow-up visits, women taking tibolone had a significant increase in BMD
at the spine (P < 0.001) and at the hip (P < 0.001) when compared to
baseline values and when compared to BMD values for the control group, which
decreased from baseline. In the final 3 years of the study, BMD values (spine
and hip) continued to decrease in the control group and also tended to decrease
in the tibolone group, but at the end of the fifth year, mean BMD in the
tibolone group was still higher than BMD before the start of tibolone treatment
(P < 0.05). Calculations showed that if women taking tibolone continued to
lose BMD at the same rate as during the final 3 years of the study, after 11
years of tibolone treatment the average patient would have the same BMD as she
had when treatment started. CONCLUSION: This 5-year observational study
provides evidence that tibolone is effective in increasing BMD in
postmenopausal women with osteopenia and osteoporosis during the first 2 years
of treatment, but because BMD starts to decline in the third year, it is vital
that postmenopausal women start treatment with tibolone as early as possible,
so that bone mineral density levels are kept high as long as possible.
Int J Gynaecol Obstet. 2007 Jun 28; [Epub
ahead of print]
Effects of tibolone
on health-related quality of life in menopausal women.
Department of Obstetrics and Gynecology, Vivekananda Institute of
Medical Sciences,
OBJECTIVE: The present study assessed improvements in health-related
quality of life (HRQOL) in menopausal women using tibolone. METHODS: One
hundred women who underwent surgical menopause for various benign gynecological
conditions were advised to take tibolone (2.5 mg) daily. The Menopause Rating
Scale (MRS II) was used to assess the change in HRQOL after 3 months and 12
months of treatment. RESULTS: Sixty-two women returned for follow-up after 3 months,
while only 15 returned for after 12 months. Significant improvements in HRQOL
were found after 3 months, and further improvements were obtained after 12
months, although at a slower rate. Among the three subscales of MRS, maximum
improvement in the somatovegetative component and lesser improvements in the
other two subscales were found. CONCLUSION: Tibolone is effective in improving
the overall HRQOL of menopausal women. Somatovegetative symptoms show most
improvement.
J Am Diet Assoc. 2007
Jul;107(7):1155-65.
Predictors of
Dietary Change and Maintenance in the Women's Health Initiative Dietary
Modification Trial.
Tinker LF, Rosal MC, Young AF, Perri MG, Patterson RE, Van Horn L, Assaf AR, Bowen DJ, Ockene J, Hays J, Wu L.
OBJECTIVE: To identify predictors of dietary change to and maintenance
of a low-fat eating pattern (<20% energy from fat, >/=5 servings
fruits/vegetables daily, and >/=6 servings grains daily) among a cohort of
postmenopausal women. Candidate predictors included intrapersonal,
interpersonal, intervention program characteristics, and clinical center. DESIGN:
Longitudinal study within the Women's Health Initiative Dietary Modification
Trial. Dietary change was evaluated after 1 year of participation in the
Women's Health Initiative Dietary Modification Trial, and dietary maintenance
after 3 years. SUBJECTS: Postmenopausal women aged 50 to 79 years at baseline
who were randomized to the intervention arm of the Women's Health Initiative
Dietary Modification Trial (n=19,541). STATISTICAL ANALYSIS: Univariate and
multivariate linear regression analysis was performed and associations
evaluated between candidate predictors and each of the three dietary goals:
percent energy from fat, fruit/vegetable servings, and grain servings. RESULTS:
Year 1 (change) predictors of percent energy from fat (P<0.005) included being
younger (beta=2.12; 70 to 79 years vs 50 to 59 years), more educated
(beta=-.69; college vs high school), more optimistic (beta=-.07), attending
more sessions (beta=-.69), and submitting more self-monitoring records
(beta=-.74). At year 3 (maintenance), the predictors of percent energy from fat
(P<0.005) included attending more sessions (beta=-.65) and submitting more
self-monitoring scores (beta=-.71). The analytic model predicted 22% of the
variance in fat intake at year 1 and 27% at year 3 (P<0.01). CONCLUSIONS:
The strongest predictors of dietary change and maintenance were attending
intervention sessions and self-monitoring dietary intake. Novel was the finding
that optimism predicted dietary change.
Bone. 2007 Jun 5; [Epub ahead of print]
Differences in bone
mineral status between urban and rural Chinese men and women.
Gu W, Rennie KL, Lin X, Wang Y, Yu Z.
Institute for Nutritional Sciences,
BACKGROUND:: Few studies have investigated differences in bone health
and associated lifestyle factors between urban and rural populations in
countries, such as