Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA
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Comparative Study
Broadband ultrasound attenuation (BUA) of the heel bone and its correlates in men and women in the EPIC-Norfolk cohort: a cross-sectional population-based study.
Osteoporotic fractures have substantial clinical and public health impact. Bone quality is an important determinant of fracture risk. Quantitative ultrasound (QUS) of bone measured as broadband ultrasound attenuation (BUA) has been shown to predict fracture risk. ⋯ The BUA of those with a current smoking habit was 1.7% lower in women and 3.2% lower in men. Overall, there are substantial sex differences in the relationship of the physical and osteoporotic risk factors associated with BUA. A better understanding of these determinants of heel ultrasound may provide insights into how some of the sex differences in bone health can be explained and bone loss in later life minimised.
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To differentiate changes in trabecular and cortical bone density at a skeletal site bearing body weight, the main goal of this retrospective study was to develop and characterize two new regions of interest (ROIs) for DXA at the hip, one mainly focusing on trabecular bone and another mainly focusing on cortical bone. Specific aims were to maximize the precision of the ROIs and to characterize their usefulness for monitoring age-related bone loss and discriminating controls from fracture cases in a cross-sectional study population and to compare them with earlier ROIs designed by our group. The study used populations from two different previous studies conducted in our laboratory, with one comprising cohorts of healthy premenopausal women, healthy postmenopausal women, and postmenopausal osteoporotic women with at least one spinal fracture (Spine Fx Study) and the other one comprising two cohorts of age-matched postmenopausal women, in whom cases had sustained a hip fracture (Hip Fx study). ⋯ For the Spine Fx Study, only spinal and trochanteric BMD had significant OR. The new trabecular ROI had good short-term precision, comparable to the standard ROIs at the hip, but improving on that of Ward's triangle, the only standard ROI only including the anterior and posterior cortical walls and therefore more predominantly consisting of trabecular bone than other standard ROIs. The precision of the new cortical ROI was lower than standard DXA ROIs, except for Ward's triangle, but provides unique information on purely cortical bone at a skeletal site bearing body weight.
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Hip fracture has repeatedly been associated with increases in the risks of death and pulmonary embolism (PE), but few studies have considered whether other fractures are also associated with these adverse outcomes. The authors estimated the 90-day risks and relative risks of mortality and PE after fractures, and the longer-term relative risks of mortality, for each of ten fracture sites. Using the 5% US standard sample of the Medicare population, we identified 81,181 fractures of the pelvis, patella, and long bones occurring between July 1, 1986, and June 30, 1990, among beneficiaries aged 65 years or older. ⋯ Patients who survived 1 year after most fracture types had no clinically significant excess mortality compared with their surviving controls. For patients with hip, nonhip femur, and pelvis fractures, however, there remained an elevated risk of 1.6 to 1.8, and for patients with proximal humerus fractures the risk ratio was 1.4. All lower-limb fractures carried a higher risk of PE than any upper-limb fracture.
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Factors that determine a post-menopausal woman's bone mineral density (BMD) include her mass at the time of skeletal maturity (peak BMD), menopause and the rate of loss she experiences as she ages. Understanding the relative influence of each of these factors may help identify important preventive treatments and provide new ways to identify women at risk for osteoporosis. ⋯ The delay in the onset of osteoporosis (defined as BMD <2.5 SD from the young adult mean) caused by modifying peak BMD, age-related bone loss or the age at menopause is quantified. A 10% increase in peak BMD is predicted to delay the development of osteoporosis by 13 years, while a 10% change in the age at menopause or the rate of non-menopausal bone loss is predicted to delay osteoporosis by approximately 2 years, suggesting that peak BMD may be the single most important factor in the development of osteoporosis.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Effect of raloxifene combined with monofluorophosphate as compared with monofluorophosphate alone in postmenopausal women with low bone mass: a randomized, controlled trial.
Raloxifene effectively reduces the incidence of vertebral fractures in patients with postmenopausal osteoporosis. Recent data suggest that low-dose monofluorophosphate (MFP) plus calcium reduces the vertebral fracture rate in postmenopausal women with moderate osteoporosis. The objective of this study was to evaluate the combination of raloxifene and MFP in the treatment of postmenopausal women with osteopenia, osteoporosis and severe osteoporosis. ⋯ The addition of raloxifene in the combination arm blunted the rise in bone ALP, which remained nevertheless significant, and abolished the increase in U-CTX. The combination of raloxifene with MFP was generally well tolerated. This study demonstrates that, in postmenopausal women with osteopenia, osteoporosis and severe osteoporosis, the combination therapy of raloxifene plus MFP favorably influences the BMD and the bone formation and resorption balance, and may reduce the risk of multiple osteoporotic fractures compared to MFP alone.