甘肃省20-80岁和绝经后女性骨质疏松症患病影响因素分析

目的 了解甘肃省20-80岁汉族女性以及绝经女性骨质疏松症患病率,探讨女性骨质疏松症的影响因素。 方法 2016年7-8月采用分层整群随机抽样方法在甘肃省兰州市、张掖市、高台县、肃南裕固族自治县选取20-80岁汉族女性进行问卷调查,应用法国Medilink公司生产的Pegasus超声骨密度仪检测跟骨骨强度,采用?2检验和非条件logistic回归对骨质疏松症的可能影响因素进行分析。 结果 甘肃省20-80岁汉族女性骨质疏松症总患病率为15.10%,40-80岁绝经后女性骨质疏松症患病率为25.88%。体重指数越大(OR=0.392,95%CI: 0.229-0.672)、从事的职业劳动强度重(OR=0.461,95%CI: 0.295-0.721)和体育锻炼频次多(OR=0.565,95%CI: 0.407-0.786)有利于降低骨质疏松症发生,有既往骨折史的女性发生骨质疏松症风险高(OR=1.544, 95%CI: 1.080-2.205)。绝经是骨质疏松症的危险因素(P未绝经组=8.33% vs P绝经组=22.76%,P?0.0001;OR=2.633,95%CI: 1.655-4.190),其中绝经年限越长骨质疏松症的发生风险越高(OR=2.910,95%CI: 1.426-5.939),女性绝经年龄越晚发生骨质疏松症的风险越低(OR=0.354,95%CI: 0.172-0.628)。 结论 针对体重指数低、有既往骨折史、运动少、绝经年龄早和绝经年限长的女性应该格外关注。在膳食上注意补充钙和维生素D,生活上经常锻炼运动。了解骨质疏松症的患病情况及研究其影响因素对成年妇女的健康促进具有重要意义。     

Factors associated with bisphosphonate treatment failure in postmenopausal women with primary osteoporosis

Summary

Among 97 postmenopausal women with primary osteoporosis, adequate calcium and vitamin D supplementation, and good compliance to a 36-month bisphosphonate treatment, the 25.8 % of patients are inadequate responders. Current smoking and a bone turnover in the upper part of the normal range increase the risk of treatment failure.

Introduction

To evaluate the prevalence of the bisphosphonate treatment failure and its possible associated factors in women with primary osteoporosis (PO).

Methods

We studied 97 previously untreated postmenopausal women with PO and fragility fractures and/or a FRAX® 10-year probability of a major osteoporotic fracture ≥7.5 %, before and after a 36-month treatment with alendronate or risedronate and adequate vitamin D supplementation with good compliance. At baseline and after 36 months, lumbar spine (LS) and femoral bone mineral density (BMD) were assessed by Dual X-ray absorptiometry and vertebral fractures by spinal radiographs. Spinal deformity index (SDI) was calculated. Treatment failure was defined by the presence of ≥2 incident fragility fractures and/or a BMD decrease greater than the least significant change.

Results

Bisphosphonate treatment failure was observed in 25.8 % of patients. Age, body mass index, years since menopause, familiar history of hip fracture, number of falls, type of bisphosphonate used, 25-hydroxyvitamin D levels (25OHVitD), BMD, SDI, and FRAX® score at baseline were not different between responders and inadequate responders. Treatment failure was associated with current smoking (OR 3.22, 95 % CI 1.10–9.50, P?=?0.034) and baseline alkaline phosphatase total activity levels ≥66.5 U/L (OR 4.22, 95 % CI 1.48–12.01, P?=?0.007), regardless of age, number of falls, LS BMD, and baseline SDI.

Conclusions

The 25.8 % of PO postmenopausal women inadequately responds to bisphosphonates, despite a good compliance to therapy and normal 25OHVitD levels. The current smoking and bone turnover in the upper part of the normal range are associated with the inadequate response to bisphosphonates.     

Good maintenance of physical benefits in a 12-month exercise and nutritional intervention by voluntary,home-based exercise: a 6-month follow-up of a randomized controlled trial

We assessed the maintenance of physical benefits in a 12-month exercise and nutritional intervention in postmenopausal women (55–75 years of age) after 6-month postintervention follow-up by voluntary, home-based exercise, and examined whether physical factors responded differently to high or low exercise frequency during the 6-month postintervention period. Forty-five women completed the 12-month intervention program, followed by 6-month cessation of intervention, and were compared with 19 matched controls. Twenty-one of the former exercisers reported that they continued exercise training at least 30 min at least 3 days/week (high-frequency exerciser, HFE), while the remaining 24 former exercisers reported that they had done exercise training at least 30 min twice per week or less during the postintervention follow-up (low-frequency exerciser, LFE). The following items were measured at baseline, 12, and 18 months: bone strength, CS-30 test, 10-m obstacle walk, whole-body reaction time, one-leg stance, and grip strength. After 6-month postintervention follow-up, the beneficial effect on bone was not fully maintained. These benefits in physical performance obtained in the 12-month intervention program, except one-leg stance, were fully maintained for 6 months by voluntary, home-based exercise. The gained benefit in one-leg stance was not fully maintained; LFE showed a significant decrease over the 6-month postintervention follow-up period, suggesting that continued exercise training of at least 30 min at least 3 days/week is required to maintain the balance benefit. These findings suggest that a continued exercise program of voluntary, home-based exercise may be effective to maintain the physical benefits of exercise intervention that may lower fracture risk in later life.     

Ischaemic cardiac events and use of strontium ranelate in postmenopausal osteoporosis: a nested case–control study in the CPRD

Summary

We explored the cardiac safety of the osteoporosis treatment strontium ranelate in the UK Clinical Practice Research Datalink. While known cardiovascular risk factors like obesity and smoking were associated with increased cardiac risk, use of strontium ranelate was not associated with any increase in myocardial infarction or cardiovascular death.

Introduction

It has been suggested that strontium ranelate may increase risk for cardiac events in postmenopausal osteoporosis. We set out to explore the cardiac safety of strontium ranelate in the Clinical Practice Research Datalink (CPRD) and linked datasets.

Methods

We performed a nested case–control study. Primary outcomes were first definite myocardial infarction, hospitalisation with myocardial infarction, and cardiovascular death. Cases and matched controls were nested in a cohort of women treated for osteoporosis. The association with exposure to strontium ranelate was analysed by multivariate conditional logistic regression.

Results

Of the 112,445 women with treated postmenopausal osteoporosis, 6,487 received strontium ranelate. Annual incidence rates for first definite myocardial infarction (1,352 cases), myocardial infarction with hospitalisation (1,465 cases), and cardiovascular death (3,619 cases) were 3.24, 6.13, and 14.66 per 1,000 patient-years, respectively. Obesity, smoking, and cardiovascular treatments were associated with significant increases in risk for cardiac events. Current or past use of strontium ranelate was not associated with increased risk for first definite myocardial infarction (odds ratio [OR] 1.05, 95 % confidence interval [CI] 0.68–1.61 and OR 1.12, 95 % CI 0.79–1.58, respectively), hospitalisation with myocardial infarction (OR 0.84, 95 % CI 0.54–1.30 and OR 1.17, 95 % CI 0.83–1.66), or cardiovascular death (OR 0.96, 95 % CI 0.76–1.21 and OR 1.16, 95 % CI 0.94–1.43) versus patients who had never used strontium ranelate.

Conclusions

Analysis in the CPRD did not find evidence for a higher risk for cardiac events associated with the use of strontium ranelate in postmenopausal osteoporosis.     

The effect of prolonged breast-feeding on the development of postmenopausal osteoporosis in population with insufficient calcium intake and vitamin D level

Summary

Breast-feeding affects bone metabolism and calcium homeostasis, and prolonged breast-feeding may influence the development of postmenopausal osteoporosis, particularly in highly susceptible populations. The study determined that breast-feeding may be a risk factor for postmenopausal osteoporosis, especially in people with low calcium intakes and vitamin D deficiencies.

Introduction

The purpose of this study was to determine whether breast-feeding is a risk factor in the development of postmenopausal osteoporosis, especially in highly susceptible population.

Methods

The study was performed using data from the 2010 to 2011 Korea National Health and Nutrition Examination Survey, and it included 1231 postmenopausal women who were aged between 45 and 70 years. Osteoporosis was defined using the World Health Organization’s T-score criteria, namely, a T-score of ≤?2.5 at the femoral neck or the lumbar spine. The patients’ ages, body mass indexes, daily calcium intakes, serum vitamin D levels, exercise levels, smoking histories, and reproductive factors relating to menarche, menopause, delivery, breast-feeding, hormone treatment, and oral contraceptive use were evaluated. Comparisons between the osteoporosis and non-osteoporosis groups were undertaken using Student’s t test and the chi-square test, and logistic regression models were built.

Results

A significant increase in the risk of osteoporosis was apparent in postmenopausal women with prolonged breast-feeding histories (≥24 months) (model 1: odds ratio [OR]?=?2.489; 95 % confidence interval [CI]?=?1.111 to 5.578, p?=?0.027; model 2: OR?=?2.503; 95 % CI?=?1.118 to 5.602, p?=?0.026; model 3: OR?=?2.825; 95 % CI?=?1.056 to 7.56, p?=?0.039), particularly in those with inadequate serum vitamin D levels and calcium intakes (<800 mg/day).

Conclusions

Breast-feeding seems to increase the risk of postmenopausal osteoporosis; however, its impact may not be definitive in women with sufficient vitamin D levels and calcium intakes. Therefore, sufficient calcium intakes and adequate vitamin D levels may be important to prevent osteoporosis in postmenopausal women that is derived from breast-feeding.

     

Prevalence of Osteoporosis by Educational Level in a Cohort of Postmenopausal Women

To evaluate whether the prevalence of osteoporosis and related risk factors might be influenced by the level of education, as has been demonstrated for many other chronic diseases, 6160 postmenopausal women at their first densitometric referral were interviewed about reproductive variables, past and current use of estrogens, prevalence of chronic diseases, and lifestyle factors such as calcium intake, physical activity, smoking and overweight. This sample was stratified by years of formal education. Densitometric evaluation was performed by dual-energy X-ray absorptiometry. Age at menarche, past exposure to oral contraceptives, use of hormone replacement therapy, prevalence of chronic diseases, physical activity, overweight and smoking showed significant trends according to the years of education. The prevalence of osteoporosis showed an inverse relationship with level of education, ranging from 18.3% for the most educated to 27.8% for the least educated women. Multiple logistic regression analysis demonstrated a predictive role toward osteoporosis by age, age at menarche and menopause, hormone replacement therapy, calcium intake, physical activity and body mass index. Using the lowest educational level as reference category, increases in educational status were associated with a significantly reduced risk for osteoporosis (OR = 0.76, 95% CI 0.65–0.90 for 6–8 years of schooling; OR = 0.68, 95% CI 0.57–0.82 for 9 years or more). This study shows differences in the prevalence of osteoporosis among educational classes and the protective role played by increases in formal education. If these results are confirmed in other population studies, public health intervention programs will have to consider the socioeconomic and cultural background of the population strata that run a greater risk of osteoporosis. Received: 7 March 1998 / Accepted: 9 July 1998     

Osteoporosis/osteopenia as an independent factor associated with periodontitis in postmenopausal women: a case–control study

Summary

This study investigated whether osteoporosis/osteopenia has an influence on the progression of periodontitis in postmenopausal women. The findings highlight that postmenopausal women with osteoporosis/osteopenia had a greater chance of presenting periodontitis than those with normal bone mineral density, particularly among nonusers of osteoporosis medications and women with a greater number of remaining teeth, showing that osteoporosis/osteopenia has had an influence on the progression of periodontitis.

Introduction

This study investigated whether osteoporosis/osteopenia has an influence on the progression of periodontitis in postmenopausal women and explored the effects of use of osteoporosis medication and tooth loss on this association.

Methods

This case–control study involved 521 postmenopausal women, with minimum age of 50 years, in Feira de Santana, Bahia, Brazil. Sociodemographic characteristics, health conditions/medications, and lifestyle habits were recorded. A complete periodontal examination was performed and periodontitis was diagnosed. Bone mineral density was evaluated through lumbar spine and femoral bone densitometry, obtained using dual-energy X-ray absorptiometry. Logistic regression was used to calculate the strength of association between the occurrences of osteoporosis/osteopenia and periodontitis.

Results

Women with osteoporosis/osteopenia were twice as likely to present periodontitis, as were those with normal bone mineral density, even after adjusting for smoking, age, family income, and last visit to dentist (odds ratios (OR)_adjusted?=?2.24, 95 % CI [1.24–4.06], p?=?0.008). Among nonusers of osteoporosis medication (OR_adjusted?=?2.51, 95 % CI [1.33–4.73], p?=?0.004) and women with at least 10 remaining teeth (OR_adjusted?=?2.50 95 % CI [1.18–5.27], p?=?0.02), the odds ratio was higher and statistically significant.

Conclusions

These findings highlight that postmenopausal women with osteoporosis/osteopenia had a greater chance of presenting periodontitis than those with normal bone mineral density, particularly among nonusers of osteoporosis medications and women with a greater number of remaining teeth.     

Determinants of hormone replacement therapy among postmenopausal women enrolled in the French GAZEL cohort

Although the efficacy of hormonal replacement therapy (HRT) regarding numerous consequences of menopause is proven, its prevalence of use is low, as is compliance with the prescribed treatment. The aim of this work was to study the factors influencing a woman's decision to take HRT by analyzing the determinants of HRT use of at least 6 months' duration among postmenopausal women working for a French company and enrolled in a cohort study. Special attention was paid to the women's expectations of HRT. we compared two groups of women: 113 current HRT users who had been users for at least 6 months and 101 never users. Among the 113 current users, the most frequent treatment was a combination of oestrogen and progestin (86%). The determinants of HRT use for at least 6 months included a prior spinal radiograph, which showed a significant relationship with the use of hormone treatment (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.2–4.7), a current marriage (OR 2.5; 95% CI 1.3–5.1) and previous hot flushes (OR 2.4; 95% CI 1.2–4.9). The strongest determinant was an expectation that HRT would prevent osteoporosis (or 5.0; 95% CI 2.2–11.6). In this population concern about osteoporosis appears to be an important determinant of HRT use. Our results underline the importance of the diffusion of information among physicians and women about HRT's benefits, especially its efficacy in preventing osteoporosis.     

Randomized controlled trial of exercise intervention for the prevention of falls in community-dwelling elderly Japanese women

Falls are common in elderly people. Possible consequences include serious injuries and the post-fall syndrome, with functional decline and limitation of physical activity. The present randomized controlled study sought to clarify the benefits of a combined long-term and home-based fall prevention program for elderly Japanese women. The subjects were individuals aged over 73 years, living at home in a western suburb of Tokyo, who had attended a comprehensive geriatric health check. Persons with a marked decline in the basic activities of daily living (ADL), hemiplegia, or those missing baseline data were excluded. Fifty-two subjects who expressed a wish to participate in the trial were randomized, 28 to an exercise-intervention group and 24 to a control group. Baseline data for age, handgrip force, walking speed, total serum cholesterol, serum albumin, basic ADL, visual and auditory impairments, self-rated health, and experience of falls did not differ significantly between the two groups. Beginning from June 2000, the intervention group attended a 6-month program of fall-prevention exercise classes aimed at improving leg strength, balance, and walking ability; this was supplemented by a home-based exercise program that focused on leg strength. The control group received only a pamphlet and advice on fall prevention.The average rate of attendance at exercise class was 75.3% (range, 64% to 86%). Participants showed significant improvements in tandem walk and functional reach after the intervention program, with enhanced self confidence. At the 8-month follow-up, the proportion of women with falls was 13.6% (3/22) in the intervention group and 40.9% (9/22) in the control group. At 20 months, the proportion remained unchanged, at 13.6% in the intervention group, but had increased to 54.5% (12/22) in the control group, which showed a statistically significant difference between the two groups (Fishers exact test; P = 0.0097). The total number of falls during the 20-month follow-up period was 6 in the intervention group and 17 in the control group. We conclude that a moderate exercise intervention program plus a home-based program significantly decreases the incidence of falls in both the short and the long term, contributing to improved health and quality of life in the elderly.     

The effect of exercise and education on fear of falling in elderly women with osteoporosis and a history of vertebral fracture: results of a randomized controlled trial

Summary

This article explores the effect of a group-based exercise program and an educational session on the fear of falling among 89 women with osteoporosis and a history of vertebral fracture. This randomized clinical trial showed that the intervention had a positive and durable effect on the fear of falling.

Introduction

The aim of this study was to evaluate the effect of an intervention on fear of falling in women with osteoporosis and a history of vertebral fracture.

Methods

The study was a parallel-group randomized clinical trial with a blinded assessor. The participants were 89 community-dwelling elderly women with osteoporosis and a history of vertebral fracture. The intervention group (IT, n?=?47) received a 3-month group-based circuit exercise program combined with a 3-h educational session focusing on the reduction of the risk of falls and challenges specific to osteoporosis and vertebral fractures. The control group (CT, n?=?42) continued with their usual activities. Clinical outcomes were assessed at baseline, postintervention and 12 months after randomization. This article reports on the secondary outcome Falls Efficacy Scale—International (FES-I) from a previously reported trial.

Results

We found a significantly better result for the IT group compared with the CT group, both at 3 months (p?=?0.004) and 12 months (p?<?0.001) follow-up. The effect size at 3 months was small (0.4) and at 12 months moderate (0.7). Multiple regression analysis confirmed the effect of the intervention.

Conclusion

The intervention had a positive and durable effect on fear of falling as measured with the FES-I.     

绝经后女性肌少症和骨质疏松症对平衡能力的影响

摘要：目的 探讨绝经后女性肌少症和骨质疏松症对平衡能力的单独及联合影响。方法 从北京市社区招募符合要求的绝经后女性332人，分为正常组238人、肌少症组27人、骨质疏松症组44人、肌少-骨质疏松症组23人。根据亚洲肌少症工作组（AWGS）的诊断标准诊断肌少症，采用世界卫生组织（WHO）的骨质疏松症诊断标准诊断骨质疏松症，采用闭眼单脚站立时间（SST）评估静态平衡能力，通过定时起立-行走测试（TUGT）评估动态平衡能力，采用二元Logistic回归分析肌少症及骨质疏松症与平衡不良之间的关系。结果 肌少症和肌少-骨质疏松症患者静态和动态平衡不良发生率显著高于骨质疏松症患者和正常人（P<0.05），骨质疏松症患者与正常人静态和动态平衡不良发生率无显著差异（P>0.05）。二元Logistic回归分析结果显示，肌少症和肌少-骨质疏松症是静态平衡不良（OR=5.747, 95% CI: 1.871~17.651, P=0.002；OR=6.989, 95% CI: 1.902~25.685, P=0.003）的独立危险因素，也是动态平衡不良的独立危险因素（OR=6.843, 95% CI: 2.671~17.535, P=0.000；OR=9.779, 95% CI: 3.317~28.836, P=0.000），且患有肌少-骨质疏松症者静态平衡不良和动态平衡不良发生风险显著高于仅患有肌少症者；单独患有骨质疏松症对静态和动态平衡不良发生风险均无显著影响（P>0.05）。结论 患肌少症或肌少-骨质疏松症都会增加绝经后女性静态和动态平衡不良的发生风险；肌少症和骨质疏松症对绝经后女性静态平衡不良和动态平衡不良的发生具有协同效应。     

Hip fracture prevention with a multifactorial educational program in elderly community-dwelling Finnish women

Summary

Guidelines suggest identification of women at fracture risk by bone density measurement and subsequently pharmacotherapy. However, most women who sustain a hip fracture do not have osteoporosis in terms of bone density. The present non-pharmacological intervention among elderly women unselected for osteoporosis reduced hip fracture risk by 55 % providing an alternative approach to fracture prevention.

Introduction

Hip fractures are expensive for society and cause disability for those who sustain them. We studied whether a multifactorial non-pharmacological prevention program reduces hip fracture risk in elderly women.

Methods

A controlled trial concerning 60- to 70-year-old community-dwelling Finnish women was undertaken. A random sample was drawn from the Population Information System and assigned into the intervention group (IG) and control group (CG). Of the 2,547 women who were invited to the IG, 1,004 (39 %) and of the 2,120 invited to the CG, 1,174 (55 %) participated. The IG participated in a fracture prevention program for 1 week at a rehabilitation center followed by review days twice. The CG received no intervention. During the 10-year follow-up, both groups participated in survey questionnaire by mail. Outcome of interest was occurrence of hip fractures and changes in bone–health-related lifestyle.

Results

During the follow-up, 12 (1.2 %) women in the IG and 29 (2.5 %) in the CG sustained a hip fracture (P?=?0.039). The determinants of hip fractures by stepwise logistic regression were baseline smoking (odds ratio (OR) 4.32 (95 % confidence interval [CI] 2.14–8.71), age OR 1.15/year (95 % CI 1.03–1.28), fall history OR 2.7 (95 % CI 1.24–5.9), stroke history OR 2.99 (95 % CI 1.19–7.54) and participating in this program OR 0.45 (95 % CI 0.22–0.93). Starting vitamin D and calcium supplement use was more common in the IG compared with the CG.

Conclusions

The results suggest that this non-pharmacological fracture prevention program may reduce the risk of hip fractures in elderly Finnish women.     

Mechanism of HIV protein induced modulation of mesenchymal stem cell osteogenic differentiation

Background

While the Osteoporosis Canada 2002 Canadian guidelines provided evidence based strategies in preventing, diagnosing, and managing this condition, publication and distribution of guidelines have not, in and of themselves, been shown to alter physicians clinical approaches. We hypothesize that primary care physicians enrolled in the Quality Circle project would change their patient management of osteoporosis in terms of awareness of osteoporosis risk factors and bone mineral density testing in accordance with the guidelines.

Methods

The project consisted of five Quality Circle phases that included: 1) Training & Baseline Data Collection, 2) First Educational Intervention & First Follow-Up Data Collection 3) First Strategy Implementation Session, 4) Final Educational Intervention & Final Follow-up Data Collection, and 5) Final Strategy Implementation Session. A total of 340 circle members formed 34 quality circles and participated in the study. The generalized estimating equations approach was used to model physician awareness of risk factors for osteoporosis and appropriate utilization of bone mineral density testing pre and post educational intervention (first year of the study). Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated.

Results

After the 1^st year of the study, physicians' certainty of their patients' risk factor status increased. Certainty varied from an OR of 1.4 (95% CI: 1.1, 1.8) for prior vertebral fracture status to 6.3 (95% CI: 2.3, 17.9) for prior hip fracture status. Furthermore, bone mineral density testing increased in high risk as compared with low risk patients (OR: 1.4; 95% CI: 1.2, 1.7).

Conclusion

Quality Circle methodology was successful in increasing both physicians' awareness of osteoporosis risk factors and appropriate bone mineral density testing in accordance with the 2002 Canadian guidelines.     

Vitamin D receptor variability and physical activity are jointly associated with low handgrip strength and osteoporosis in community-dwelling elderly people in Taiwan: the Taichung Community Health Study for Elders (TCHS-E)

Summary

We studied 472 elders to assess joint association of vitamin D receptor (VDR) variability and physical activity on low handgrip strength (LHS) and osteoporosis (OST). Our findings showed that higher risks of OST were associated with physically inactive elders with some specific VDR variations, highlighting the importance of promotion program for physical activity.

Introduction

The aim of this study was to determine the joint association between VDR variability and physical activity on LHS and OST in community-dwelling elders.

Methods

Bone mineral density of the lumbar spine (LS), the femoral neck (FN), and the total hip were measured by dual-energy X-ray absorptiometry. Four single-nucleotide polymorphisms (SNPs) (rs7975232, rs1544410, rs2239185, and rs3782905) of the VDR gene were examined in 472 participants.

Results

Physical inactivity and each of the four SNPs were jointly associated with a significantly greater risk of LHS in people than that associated with each of the VDR SNPs or low physical activity alone. Physically inactive men with the AG or AA genotype of rs2239185 had a significantly greater risk of overall, LS, and FN OST than those of physically active men with the GG genotype [odds ratio (OR) 3.57, 95 % confidence interval (CI) 1.10–11.65; OR 4.74, 95 % CI 1.43–15.70; and OR 5.06, 95 % CI 1.08–23.71, respectively]. Similarly, physically inactive women with the CG or CC genotype of rs3782905 and the AG or AA genotype of rs1544410 had a significantly greater risk of FN OST than physically active women with the GG genotype (OR 5.33, 95 % CI 1.23–23.06 and OR 5.36, 95 % CI 1.11–25.94, respectively).

Conclusions

VDR polymorphisms and physical activity are jointly associated with LHS and OST in elders. Health care programs should promote physical activity among elders as a cost-effective way to prevent LHS and OST, especially in those who may be genetically predisposed.     

Association between osteoporosis and psoriasis: results from the Longitudinal Health Insurance Database in Taiwan

Summary

This population-based analysis explored the association between osteoporosis and a previous diagnosis of psoriasis. We found that the adjusted odds ratio (OR) of having been previously diagnosed with psoriasis for subjects with osteoporosis was 1.65 (95 % confidence interval [CI], 1.42–1.94) when compared to controls.

Introduction

Although previous studies have investigated this association between psoriasis and osteoporosis, significant controversy remains regarding its presence. Therefore, this study set out to explore the association between osteoporosis and a previous diagnosis of psoriasis through a population-based case–control study in Taiwan.

Methods

We identified 17,507 cases with a diagnosis of osteoporosis and randomly extracted 52,521 controls without a history of osteoporosis. We used conditional logistic regression analyses to calculate the OR for having been previously diagnosed with psoriasis.

Results

Subjects with osteoporosis had a significantly higher prevalence of previously diagnosed psoriasis (1.50 % vs. 0.87 %, p?<?0.001) compared to controls. Conditional logistic regression analysis revealed that the OR of having been previously diagnosed with psoriasis for subjects with osteoporosis was 1.65 (95 % CI, 1.42–1.94) when compared to controls after adjusting for monthly income, hypertension, diabetes, coronary heart disease, hyperlipidemia, rheumatoid arthritis, stroke, renal disease, Parkinson’s disease, hyperthyroidism, chronic hepatopathy, Cushing’s syndrome, malabsorption, tobacco use disorder, obesity, alcohol abuse/alcohol dependence syndrome, the use of SSRIs, and the use of systemic glucocorticoids. Furthermore, osteoporosis was significantly associated with a previous diagnosis of psoriasis in both sexes; the adjusted OR of prior psoriasis for cases when compared to controls was 1.52 (95 % CI, 1.16–1.99) and 1.73 (95 % CI, 1.44–2.13) for males and females, respectively. We also found that the adjusted OR of prior severe psoriasis for cases was 1.96 (95 % CI, 1.37–2.81) that of controls.

Conclusions

This investigation succeeded in detecting an association between osteoporosis and prior psoriasis among both men and women.     

Lifelong risk factors for osteoporosis and fractures in elderly women with low body mass index--a population-based study

Low body weight is associated with an increased risk for osteoporosis and fractures, but the contribution of other lifestyle related factors have not been previously studied within lean elderly women. The present study evaluated the association between lifelong lifestyle factors and bone density, falls and postmenopausal fractures in elderly women with low body mass index (BMI). A population-based sample of 1,222 women aged 70 to 73 years was stratified by BMI tertiles, and all 407 women in the lowest tertile participated. Data on falls and postmenopausal fractures, physical activity, functional capacity, calcium intake, smoking, alcohol intake and medical factors at different ages were obtained by a questionnaire. Calcaneum bone mass as broadband ultrasound attenuation (BUA) was assessed with a quantitative ultrasound (QUS) device, and bone mineral density (BMD) at the distal radius was measured with a dual-energy X-ray absorptiometry (DXA). Low current physical activity was associated with lower calcaneum BUA and factors associated with higher BUA were body weight, low lifetime occupational physical activity, hormone replacement and type 2 diabetes. Weight, type 2 diabetes and thiatzide use were associated with higher radius BMD. The final multivariate model consisted of four independent factors associated with fractures: low lifetime habitual physical activity (OR 3.7, 95% CI 1.9-7.1), diabetes (OR 0.2, 95% CI 0.1-1.0), living alone (OR 1.7, 95% CI 1.0-3.0) and calcaneum BUA (1.8, 95% CI 1.3-2.4). Poor functional ability and symptoms of depression were associated with recent falling. In elderly women with low BMI, lifelong physical activity may protect from fractures, while low calcaneum bone mass and living unpartnered appear to be associated with an increased risk for fractures. Poor functional ability and presence of depression may be associated with risk of falling. Type 2 diabetes may modify the risk of low bone mass and low-trauma postmenopausal fractures. Albeit that the results of this study need to be confirmed in prospective follow-up studies, multifactorial program with the emphasis on physical and social activation in the primary care setting for preventing falls and fractures in lean elderly women is recommended.     

Secondhand smoke exposure and osteoporosis in never-smoking postmenopausal women: the Fourth Korea National Health and Nutrition Examination Survey

Summary

The association between secondhand smoke (SHS) exposure and lumbar and femoral neck osteoporosis was assessed in postmenopausal never-smoking Korean women. The presence of family members who actively smoked was associated with femoral neck osteoporosis. The number of cigarettes consumed by cohabitant smokers was positively associated with lumbar and femoral neck osteoporosis.

Introduction

This study aimed to assess the association between SHS and postmenopausal osteoporosis.

Methods

Of 2,067 postmenopausal women (age, ≥55 years) participating in the Fourth Korea National Health and Nutrition Examination Survey, 925 never-smokers identified through interviews and urinary cotinine level verification were enrolled. Cross-sectional relationships between self-reported SHS exposure and osteoporosis of the lumbar vertebrae and femoral neck (defined using the World Health Organization T-score criteria) were investigated by bone densitometry.

Results

Participants having actively smoking family members showed increased adjusted odds ratio (aOR) for femoral neck osteoporosis compared with participants not exposed to SHS (aOR, 3.68; 95 % confidence interval [CI], 1.23–10.92). Participants whose cohabitant smokers consumed any number of cigarettes per day showed increased occurrences for lumbar and femoral neck osteoporosis compared with the nonexposed group. Participants whose cohabitant smokers consumed ≥20 cigarettes/day showed increased aORs for lumbar (aOR, 5.40; 95 % CI, 1.04–28.04) and femoral neck (aOR, 4.35; 95 % CI, 1.07–17.68) osteoporosis compared with participants not exposed to SHS.

Conclusions

In postmenopausal never-smoking Korean women, exposure to SHS was positively associated with osteoporosis. This finding further emphasizes a need to identify vulnerable groups exposed to SHS to increase bone health.     

Effect of walking exercise on bone metabolism in postmenopausal women with osteopenia/osteoporosis

The purpose of this prospective study was to determine whether moderate walking exercise in postmenopausal women with osteopenia/osteoporosis would affect bone metabolism. Fifty postmenopausal women, aged 49–75 years, with osteopenia/osteoporosis were recruited: 32 women entered the exercise program (the exercise group) and 18 served as controls (the control group). The exercise consisted of daily outdoor walking, the intensity of which was 50% of maximum oxygen consumption, with a duration of at least 1h with more than 8000 steps, at a frequency of 4 days a week, over a 12-month period. Lumbar (L2–L4) bone mineral density (BMD) was measured at the baseline and every 6 months with dual-energy X-ray absorptiometry (DXA) in both groups. Serum bone-specific alkaline phosphatase (BAP) and urinary cross-linked N-terminal telopeptides of type I collagen (NTX) levels were measured at baseline and at months 1, 3, 6, 9, and 12 by EIA and ELISA, respectively, in the exercise group, and urinary NTX level was measured at the baseline and every 6 months in the control group. There were no significant differences in baseline characteristics including age, height, body weight, bone mass index, years since menopause, lumbar BMD, and urinary NTX level between the two groups. Although no significant changes were observed in lumbar BMD and the urinary NTX level in the control group, lumbar BMD in the exercise group was increased as compared with the control group, but was sustained from the baseline. In the exercise group, the urinary NTX level rapidly responded to walking exercise from month 3, and this reduction was sustained until month 12, followed by reduction in the serum BAP level. A moderately negative correlation was found between the percent change in the urinary NTX level at month 3 and that in lumbar BMD at month 12 in the exercise group. This study clearly demonstrates that the mechanism for the positive response of lumbar BMD to moderate walking exercise in postmenopausal women with osteopenia/osteoporosis appears to be the suppression of bone turnover, and that an early change in the urinary NTX level may be useful to predict the long-term response of increasing lumbar BMD to exercise, although its efficacy for lumbar BMD may be quite modest.     

Effect of low-intensity back exercise on quality of life and back extensor strength in patients with osteoporosis: a randomized controlled trial

Summary Randomized controlled study in 80 postmenopausal women with osteoporosis was conducted to investigate the effect of a home-based, simple, low-intensity exercise. Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength. Introduction and hypothesis Back-strengthening exercise is effective in increasing back extensor strength and decreasing risk of vertebral fractures. We hypothesized that a home-based, simple, low-intensity exercise could enhance back extensor strength and improve the quality of life and/or spinal range of motion in postmenopausal women in a short-term follow-up. Methods Eighty postmenopausal women with osteoporosis were randomly assigned to a control group (n = 38) or an exercise group (n = 42). Subjects were instructed to lift their upper trunk from a prone position antigravity and maintain the neutral position. Isometric back extensor strength, spinal range of motion, and scores for quality of life were evaluated at baseline and 4 months. Results Back extensor strength significantly increased both in the exercise group (26%) and in the control group (11%). Scores for quality of life increased in the exercise group (7%), whereas it remained unchanged in the control group (0%). There was a significant difference in quality of life score between the groups (p = 0.012). Conclusions Low-intensity back-strengthening exercise was effective in improving the quality of life and back extensor strength in patients with osteoporosis.     

Association between osteoporosis and urinary calculus: evidence from a population-based study

Summary

This population-based case–control analysis investigated the association between osteoporosis and prior urinary calculus (UC) in Taiwan. We succeeded in detecting an association between osteoporosis and prior UC (adjusted odds ratio?=?1.66). This association was consistent and significant regardless of stone location.

Introduction

UC has been demonstrated to be a risk factor for osteoporotic fractures, but no studies to date have directly investigated the association between UC and osteoporosis. This case–control analysis aimed to investigate the association of osteoporosis with prior UC using a population-based dataset in Taiwan.

Methods

We first identified 39,840 cases ≥40 years who received their first-time diagnosis of osteoporosis between 2002 and 2009 and then randomly selected 79,680 controls. We used conditional logistic regression analyses to compute the odds ratio (OR) and the corresponding 95 % confidence interval (CI) for having been previously diagnosed with UC between cases and controls.

Results

The OR of having been previously diagnosed with UC for patients with osteoporosis was 1.66 (95 % CI?=?1.59–1.73) when compared to controls after adjusting for geographic location, urbanization level, type I diabetes mellitus, coronary heart disease, hyperlipidemia, rheumatoid arthritis, stroke, renal disease, Parkinson's disease, hyperthyroidism, chronic hepatopathy, Cushing's syndrome, malabsorption, gastrectomy, obesity, and alcohol abuse/alcohol dependence syndrome. The results consistently showed that osteoporosis was significantly associated with a previous diagnosis of UC regardless of stone location; the adjusted ORs of prior kidney calculus, ureter calculus, bladder calculus, and unspecified calculus when compared to controls were 1.71 (95 % CI?=?1.61–1.81), 1.60 (95 % CI?=?1.47–1.74), 1.59 (95 % CI?=?1.23–2.04), and 1.69 (95 % CI?=?1.59–1.80), respectively.

Conclusions

This study succeeded in detecting an association between osteoporosis and prior UC. In addition, our findings were consistent and significant regardless of stone location.