Ethnic variation in bone turnover in pre- and early perimenopausal women: effects of anthropometric and lifestyle factors

Bone mineral density (BMD) and fracture rates vary among women of differing ethnicities. Little is known, however, about ethnic variation in bone turnover. We measured serum osteocalcin (OC) and urinary N-telopeptide of type I collagen (NTX) levels in 2313 pre- or early perimenopausal women who were Caucasian (n = 1140), African-American (n = 651), Chinese (n = 247), or Japanese (n = 275) and were participating in the Study of Women's Health Across the Nation. Serum OC and urinary NTX levels were compared before and after adjustment for a series of lifestyle and anthropometric variables that can affect bone turnover. Unadjusted serum OC levels were highest in Caucasian women (P < 0.001 vs. all other groups), higher in African-American than Chinese women (P = 0.006), and similar in Chinese and Japanese women (P = 0.203) and African-American and Japanese women (P = 0.187). Unadjusted serum OC levels were 11-24% higher in Caucasians than in the other groups. Adjustment for covariates did not alter the ethnic pattern of serum OC levels. Unadjusted urinary NTX levels were statistically significantly higher in Caucasian and African-American women than in Chinese women (P < 0.001) for both comparisons). Unadjusted urinary NTX levels were higher in Caucasian than in Japanese women (P = 0.071) and higher in Japanese than in Chinese women (P = 0.055), but these differences were of borderline statistical significance. Unadjusted urinary NTX levels were 9-18% higher in African-Americans and Caucasians than in the other groups. Among Caucasians, there were significant geographic regional variations in both serum OC and urinary NTX levels, with higher levels in women from the Northeast and the Midwest than in women from California. These data demonstrate significant ethnic differences in bone turnover in pre- and early perimenopausal women. Although these differences in adult bone turnover may explain some of the known ethnic variation in BMD, ethnic patterns of adult bone turnover do not parallel patterns of BMD. Other factors, such as differences in bone accretion, are likely responsible for much of the ethnic variation in adult BMD.     

Sex steroids and bone density in premenopausal and perimenopausal women

Bone density begins to decline in women before menopause, and the degree of bone loss is variable. We performed a cross-sectional analysis on the entry data of a 5-yr prospective study of risk factors for osteoporosis to determine the correlation of bone density with serum sex steroid concentrations and body weight. We studied 292 healthy white women, aged 35-50 yr, who were menstruating regularly or had had menses in the past 12 months. Blood samples were drawn in the early follicular phase for estradiol (E2), testosterone (T), dehydroepiandrosterone sulfate, and sex hormone-binding globulin (SHBG). Free levels of E2 (FE2) and T (FT) were calculated based on total T and E2, SHBG, and albumin levels. Women were classified as premenopausal (FSH, less than 12 U/L) and perimenopausal (FSH greater than or equal to 12 U/L; n = 46; 16%). Bone density was measured by dual photon absorptiometry of the lumbar spine (L2-L4) and hip and by single photon absorptiometry of the wrist. Perimenopausal women were older than premenopausal women (45.5 +/- 3.5 and 41.0 +/- 3.9 yr, respectively), but did not differ in height or weight. While bone density did not correlate with age in each group, perimenopausal women had significantly lower bone density at the L2-L4 and femoral neck (L2-L4, 1.18 +/- 0.14 in perimenopausal and 1.24 +/- 0.12 g/cm2 in premenopausal women; femur, 0.84 +/- 0.11 in perimenopausal and 0.90 +/- 0.11 g/cm2 in premenopausal women; P less than 0.005). Body weight showed the strongest positive correlation with bone density. Log FT, percent FT, and FE2 percent correlated positively with bone density, even after controlling for weight. Log SHBG was negatively correlated with bone density in premenopausal women at the hip and wrist after controlling for weight. FSH was inversely correlated with bone density, and E2 and T were lower in perimenopausal than premenopausal women. These data suggest that women who are still menstruating may have relative deficiencies in both E2 and T, with reduced bone densities as a consequence.     

Ethnic variation in hypertension among premenopausal and perimenopausal women: Study of Women's Health Across the Nation

Data are sparse regarding hypertension prevalence, treatment, and control among some ethnic groups of American women. Furthermore, the effects of ethnicity on hypertension, independent of other factors that vary with ethnicity, are poorly understood. We examined the prevalence of hypertension (defined as systolic > or =140 or diastolic > or =90 mm Hg or receiving treatment), treatment, and control (to <140/<90 mm Hg) in a multiethnic study of premenopausal and perimenopausal women. Stepwise multivariable logistic regression was used to select covariates associated with hypertension. Among 3292 women, 46.9% were white, 28.3% were black, 8.7% were Hispanic, 7.6% were Chinese, and 8.5% were Japanese. Among these 5 ethnic groups, respectively, there was substantial variation in prevalence of normal blood pressure levels (<120/<80 mm Hg; 59.9%, 35.4%, 16.8%, 67.2%, and 63.7%) and hypertension (14.5%, 38.1%, 27.6%, 12.8%, and 11.0%). After multivariable adjustment, hypertension prevalence was 2 to 3x higher among black and Hispanic women but similar among Chinese and Japanese women compared with white women. Among hypertensive participants, prevalence of antihypertensive treatment was highest among blacks (58.9%) and whites (55.2%) and lowest among Chinese (34.4%). Prevalence of control to goal blood pressure levels was highest among whites (43.0%) and Japanese (38.7%) and markedly lower among Hispanic women (11.4%). Compared with whites, black and Hispanic women have significantly higher prevalence of hypertension independent of other factors, whereas Chinese and Japanese women have similar prevalence. Treatment and control rates vary considerably across ethnicities. Greater efforts must be made to improve hypertension awareness, treatment, and control in all middle-aged women, particularly those in ethnic minority groups.     

Weight training decreases vertebral bone density in premenopausal women: a prospective study

The effect of exercise on bone mass is unclear. To determine the skeletal effect of weight-bearing exercise in premenopausal women, we prospectively evaluated the effects of a weight-training program on lumbar spine bone mass in 10 women (mean +/- SEM, 36.2 +/- 1.3 yr) and compared the results with those in 7 sedentary women (40.4 +/- 1.6 yr). None of the women had previously participated in a weight-training program, and all ingested a 500-mg calcium supplement each day throughout the study. Axial loading and balance of large muscle groups were emphasized. Individual strength increased by 57 +/- 8% over 9 months. Despite the increase in muscle strength, lumbar spine bone density in the exercising women decreased by 2.90% at 4.5 months and 3.96% at 9 months (P = 0.01). In contrast, there was no change in lumbar density in the controls over the 9-month period. We conclude that short term weight training at this frequency and intensity decreases vertebral bone mass in premenopausal women.     

Bone mass and riks factors for bone los in perimenopausal Danish women

Abstract. Brot C, Jensen LB, Smensen OH (Copenhagen Municipal Hospital, Copenhagen, Denmark). Bone mass and risk factors for bone loss in perimenopausal Danish women
Objectives: To determine risk factors for low bone mass at menopause and risk factors for subsequent bone loss in the following period.
Design: A cross-sectional study and a 2-year prospective follow-up.
Setting: The catchment area of Sundby Hospital in Copenhagen.
Subjects: Four hundred and thirty-three women aged 45–58 years, with amenorrhea for 3–24 months, of whom 87 were followed for a 2-year period.
Measurements: Registration of life-style and anthropometric variables, reproductive history, and family history of fractures. Total body bone mineral content (BMC) was measured with dual energy X-ray absorptiometry.
Results: By means of multiple regression analysis height, body weight, and length of reproductive period were found to be positively related to whole body BMC (P < 0.001), whilst a negative relationship was found to age (P < 0.001), smoking (P < 0.001), and family history of fractures (P < 0.005).
In the longitudinal study, only body weight at the inclusion (P = 0.005) and subsequent changes in body weight and fat mass (P < 0.001) were related to the changes in bone mass.
Conclusion: The most significant predictors for bone loss were changes in body weight and fat mass. Hence, weight loss is a risk factor for bone loss in the early postmenopausal period, whereas weight gain seems to preserve bone.     

绝经前妇科手术对绝经后妇女骨量的影响

目的探讨绝经前不同术式切除子宫、卵巢与绝经后妇女骨量的关系。方法对2002年4月至2006年3月绝经20年内的妇女绝经前行一侧卵巢切除术18例、单纯子宫切除术者63例,子宫加单侧卵巢切除术者44例,子宫加双侧卵巢切除术者87例,以及同期自然绝经101例妇女进行骨密度测定,并对各组的骨密度和骨质疏松症的发生率进行比较。骨质疏松症的诊断标准为骨密度值低于或等于正常年轻妇女平均骨密度峰值减去2.5个标准差。结果自然绝经组与一侧卵巢切除术组平均年龄分别59.8±6.8,56.5±5.5岁;平均绝经年龄分别为49.8±3.2、49.5±3.9,两组在腰椎、股骨颈、大转子、华氏三角区骨密度差异无统计学意义,且两组骨质疏松症发生率分别为61.4%、50%,两组差异无统计学意义（P〉0.05）。单纯子宫切除术组、子宫加单侧卵巢切除术组、子宫加双侧卵巢切除术组腰椎骨密度分别为0.91±0.17、0.88±0.18、0.80±0.14（g/cm^2）,股骨颈骨密度分别为0.75±0.11、0.77±0.14、0.70±0.12（g/cm^2）,大转子骨密度分别为0.60±0.10、0.62±0.12、0.56±0.10（g/cm^2）,华氏三角区骨密度分别为0.56±0.13、0.59±0.16、0.50±0.12（g/cm^2）。子宫加双侧卵巢切除术组骨密度在腰椎、股骨颈、大转子、华氏三角区明显低于单纯子宫切除术组和子宫加单侧卵巢切除术组;后两组组间差异无统计学意义。单纯子宫切除术组、子宫加单侧卵巢切除、子宫加双侧卵巢切除术组骨质疏松症发生率分别为34.9%、38.6%、62.1%。子宫加双侧卵巢切除术组明显高于单纯子宫切除术组、子宫切除术加单侧卵巢切除术组（P〈0.01）,后两组间差异无统计学意义。结论1.绝经前行单侧卵巢切除后不影响绝经后妇女骨量、骨质疏松症的发生率;2.绝经前子宫切除术者尽可能保留单侧或双侧卵巢,以避免远期骨量降低,骨质疏松症发生率增加。     

Effect of endogenous subclinical hyperthyroidism on bone metabolism and bone mineral density in premenopausal women.

In this cross-sectional study, we evaluated 15 premenopausal women to elucidate whether bone turnover is increased and bone mineral density is reduced due to endogenous subclinical hyperthyroidism. Each patient had normal free thyroxine (FT4) and free triiodothyronine (FT3) levels associated with a stable suppression (<0.1 mU/L) of serum thyrotropin (TSH) levels during a period ranging between 6 and 11 months. Metabolic parameters of bone turnover (serum osteocalcin, bone specific alkaline phosphatase, procollagen I C-terminal peptide reflecting bone formation; urinary deoxypyridinoline and calcium excretion reflecting bone resorption) were assessed. Bone mineral density was measured at lumbar 1-4 vertebrae, femoral neck, and the forearm (midshaft radius and distal radius) by dual energy x-ray absorptiometry. All measurements were compared with 15 healthy age-, height-, and weight-matched premenopausal women who served as control group. Our findings suggest that endogenous subclinical hyperthyroidism is not associated with increased bone turnover, and bone mineral density is not reduced in premenopausal women, at least in the short term.     

Dietary calcium and bone mineral density in premenopausal women with systemic lupus erythematosus

The primary objective of this study was to determine the relationship between dietary calcium intake and bone mineral density (BMD) in premenopausal women with systemic lupus erythematosus (SLE) on corticosteroids (CS). The secondary aim was to identify other risk factors for osteoporosis in these patients. A cross-sectional sample of patients attending the SLE Clinic at a teaching hospital was recruited. BMD was measured using dual-energy X-ray absorptiometry. Daily dietary calcium intake was assessed using a structured validated food frequency questionnaire, in which patients were asked to estimate their food intake based on their recent 2-month dietary habits. Sixty subjects were recruited with a mean age of 33.70±8.46 years. The median duration of CS use was 5.5 years (range 0.08–24). The median cumulative dose of steroids was 17.21 g (range 0.16–91.37). The median daily dietary calcium intake was 483 mg (range 78–2101). There was no significant correlation between calcium intake and BMD, even after correcting for CS use. There were also no correlations between BMD and the duration of SLE, cumulative CS use, duration of CS use, smoking, alcohol intake, and SLE disease activity index score. Twenty-eight (46.7%) patients had normal BMD, 28 (46.7%) had osteopenia, and four (6.6%) had osteoporosis. Duration of SLE significantly correlated with cumulative CS dosage. In conclusion, 6.7% of these Asian premenopausal SLE women had osteoporosis and only 46.7% had normal BMD. Daily dietary calcium intake did not correlate with BMD.     

Reproductive and lifestyle factors associated with early menopause in Mexican women

OBJECTIVE: The purpose of this study was to evaluate the relationship between certain reproductive and lifestyle factors and the occurrence of early natural menopause. MATERIAL AND METHODS: A case/control study was conducted on a basal population of 2510 women participating in the "Mexican Institute of Social Security health workers cohort study". Cases were defined as those women for whom natural menopause presented by age 47. Information was obtained through a self-administered questionnaire. RESULTS: The risk of early menopause is associated with short menstrual cycles [<26 days, OR = 3.79 (IC 95% 1.37-10.52)], a short period of oral contraceptives use [<1 year, OR = 2.63 (IC 95% 1.10-6.29)], a lower number of pregnancies [<2, OR = 1.63 (IC 95% 1.03-2.57)], low body mass index [< or =27 kg/m2, OR = 1.64 (IC 95% 1.10-2.43)], low schooling level [<6 years, OR = 3.02 (IC 95% 1.26-7.23)], smoking history [>15 cigarettes/day, OR = 2.7 (IC 95% 1.00-7.30)], and birth cohorts [> or =950, OR = 4.09 (IC 95% 2.62-6.39)]. CONCLUSIONS: The findings of this study suggest that both reproductive and lifestyle factors are significant elements in the occurrence of early menopause in Mexican women.     

Radial and vertebral bone density in white and black women: evidence for racial differences in premenopausal bone homeostasis

The reasons for a different incidence of osteoporotic fractures in white and black women are unknown. Previous racial comparisons of bone mass have been limited by racial differences in body weight and socioeconomic, health, and nutritional status. This cross-sectional study examined bone density in 105 black and 114 white healthy nonobese women, 24-65 yr old, using dual photon absorptiometry of the lumbar spine and single photon absorptiometry of the distal radius. Bone density at both sites was higher in blacks at all ages than in whites. When adjusted for age and body mass index, mean bone density was 6.5% higher in blacks at both spine and radius (P less than 0.0001). The cross-sectional rate of decline of vertebral bone density was similar between races; however, radial density increased 3.8%/decade (P = 0.03) in premenopausal blacks under age 46 yr, while it declined 3.2%/decade (P = 0.09) in premenopausal whites. The racial difference in slopes in these premenopausal women is significant (P = 0.002). These findings suggest that attainment of higher peak bone mass and delayed onset of bone loss contribute to the lower incidence of osteoporotic fractures in black women.     

Loss of bone mineral density in premenopausal women with systemic lupus erythematosus.

OBJECTIVE--To evaluate bone mineral density (BMD) in premenopausal patients with systemic lupus erythematosus (SLE). METHODS--We measured BMD by dual energy x ray absorptiometry at lumbar vertebrae L2-4 and at the right femoral neck in 74 premenopausal white patients (mean age 30.8 years) with SLE who were receiving glucocorticoid therapy, and in a control group. RESULTS--The mean cumulative dose of prednisone was 32.5 (SD 28) g. The mean dose at the time of absorptiometry was 13.7 (6.9) mg. BMD was significantly reduced at the spine and at the femoral neck in SLE patients when compared with the control group: L2-4 = 0.943 (0.1) g/cm2 v 1.038 (0.1) g/cm2 (p < 0.001); femoral neck = 0.766 (0.09) g/cm2 v 0.864 (0.1) g/cm2 (p < 0.001). Nine patients (12.1%), but none of the control group, had a BMD less than the reference range. CONCLUSION--BMD in premenopausal patients with SLE was less than that in a control group and less than the reference range of values defining the presence of osteoporosis in 12.1%. We did not find a relationship between BMD and either cumulative or baseline dose of corticosteroid therapy.     

Serum vitamin D level and bone mineral density in premenopausal Egyptian women with fibromyalgia

Patients with fibromyalgia syndrome (FMS) have impaired mobility and therefore get less sunlight exposure, we postulated that they may be at increased risk of developing osteoporosis (OP). The aim of this study was to assess and compare serum vitamin D level and bone mineral density (BMD) value in patients with primary FMS (PFMS) and healthy controls. A total of 50 patients with PFMS participated in this case–control study, and 50 healthy females who were age-matched to the patients were used as the control group. Venous blood samples collected from all subjects were used to evaluate serum 25-hydroxyvitamin D3 (25-OHD). BMD was measured at the lumbar spine (L2–L4) anteroposterior, femoral neck and forearm by dual-energy X-ray absorptiometry. Patients with PFMS had significantly lower serum 25-OHD than controls (15.1 ± 6.1 and 18.8 ± 5.4 ng/ml, respectively, p = 0.0018). Apart from the BMD in the lumbar spine, which was significantly lower in the PFMS patients compared with controls (p = 0.0012), no significant difference was found in other measures of BMD. Compared to PFMS patients who had serum level of the 25-OHD >20 ng/ml, the patients with 25-OHD ≤20 ng/ml are more likely to have impaired short memory (46.4 vs. 13.6%, respectively, p = 0.0136), confusion (50 vs. 18.2%, respectively, p = 0.0199), mood disturbance (60.7 vs. 27.3%, respectively, p = 0.0185), sleep disturbance (53.6 vs. 22.7%, respectively, p = 0.0271), restless leg syndrome (57.1 vs. 27.3%, respectively, p = 0.0346) and palpitation (67.9 vs. 36.4%, respectively, p = 0.0265). Serum level of the 25-OHD is inversely correlated with visual analogue scale (VAS) of pain (p = 0.016), Beck score for depression (p = 0.020) and BMD at lumbar spine (p = 0.012). The lumbar BMD inversely correlated with VAS of pain (p = 0.013) and Beck score for depression (p = 0.016). This study confirmed high prevalence of hypovitaminosis D among in patients with PFMS. This study confirmed the concept that FMS is a risk factor for OP. Based on this, an early nutrition program rich in calcium and vitamin D, appropriate exercise protocols, and medical treatment should be considered in these patients in terms of preventing OP development.     

Evaluation of bone mineral density in women with chronic liver diseases during perimenopausal period

Osteoporosis is the most frequently occurring metabolic diseases of bones, observed especially in women after menopause. The goal of the paper was a comparison of bone mineral density (BMD) of health women with that in perimenopausal patients with chronic liver diseases. The study was performed in 47 patients with chronic liver diseases, aged: 37-56 years. Qualification criteria included chronic type B hepatitis, chronic type C hepatitis and cirrhosis of viral aetiology. The control group consisted of 15 healthy, age-matched women. All the women had been examined in order to identify other risk factors of osteoporosis development. RESULTS: The incidence of decreased BMD was statistically higher in the group of patients with chronic hepatic diseases, compared to the group of healthy subjects. No bone fracture was found in any of the examined patients. CONCLUSIONS: Routine densitometric examinations should be performed in all women in perimenopausal age with chronic liver diseases. Results of our studies indicate that in patients with liver diseases, the lowest BMD values are found in the group of patients with cirrhosis or chronic type C hepatitis. These women constitute a large risk group for secondary osteoporosis development.     

Relationship between body composition and bone mineral density (BMD) in perimenopausal Korean women

Objectives Osteoporosis is a disease that increases the fracture rates and it is the major cause of increased mortality and morbidity in the elderly people. To determine which component of body composition is most important to bone health, we analysed the relationship between elements of the body composition and bone mineral density (BMD) in Korean women. Design Cross‐sectional clinical study. Patients Totally 1694 women (mean age 51 years) were selected from subjects who participated in a medical check‐up program. Measurements Body composition analysis was performed by segmental bioelectric impedance method and lean mass, fat mass and per cent body fat measured. Waist : hip ratio (WHR) was assessed as a marker for visceral fat. Lumbar spine (l ‐spine) BMD was measured by dual X‐ray absorptiometry (DEXA). As menopausal status could not be confirmed in all subjects, we divided the subjects into two groups according to the age > 50 years and < 50 years. Results Among the entire population, 599 subjects (35·4%) were osteopaenic and 229 subjects (13·5%) were osteoporotic. The bivariate correlation among the variables showed that weight had the highest correlation with fat mass. Mean lean mass was decreased and the WHR increased as the subjects progressed from normal to osteoporotic status; fat mass was the highest among the osteopaenic subjects. l ‐spine BMD showed a positive correlation with lean mass, and a negative correlation with WHR by bivariate correlation analysis. However, fat mass had a negative correlation with l ‐spine BMD only after adjustment for age and weight. Multiple regression analysis with l ‐spine BMD as the dependent variable showed that age, height, fasting insulin, lean mass and WHR were significant determinants of the l ‐spine BMD (R² = 0·170, P < 0·05). Conclusion In this Korean female population, l ‐spine BMD showed a consistently positive correlation with lean mass and a negative correlation with WHR. Fat mass failed to show any consistent correlation with l ‐spine BMD in this study population.     

Predicting bone mineral density of postmenopausal healthy and cirrhotic Italian women using anthropometric variables

Background. Chronic liver diseases, including cirrhosis of the liver, have been shown to cause bone osteometabolic disease giving rise to osteoporosis and osteomalacia.

Aims. To develop mathematical prediction equations for the lumbar-spine, pelvis and total bone mineral density based on the osteoporosis risk factors age and body mass index in cirrhotic and healthy postmenopausal women.

Patients. Twenty-seven postmenopausal women with liver cirrhosis (Child–Pugh class A) and well-preserved liver function (Late postmenopausal cirrhotic), 27 women matched for age and body mass index (Late postmenopausal healthy) and 27 younger women matched only for body mass index (Early postmenopausal healthy).

Methods. Segmental and total fat mass, lean body mass and bone mineral density were measured for all participant women using dual X-ray absorptiometry.

Results. Segmental and total fat mass and bone mineral density were significantly lower for Late postmenopausal cirrhotic women as compared with Late and Early postmenopausal healthy women. Segmental and total lean body mass were comparable among the three study groups.

Conclusions. The mathematical equations based on the variables age and body mass index were capable of predicting lumbar-spine bone mineral density, pelvis bone mineral density and total bone mineral density for the three groups of postmenopausal women with the lowest standard error of estimation and root mean square residuals of predictions for equations describing the Late postmenopausal healthy group.     

Comparison of anthropometric parameters as predictors of serum lipids in premenopausal women

No single anthropometric parameter has yet been generally accepted as being superior to others in assessing the metabolic risk associated with abdominal obesity. To compare waist circumference (WC) with waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR), regarding their association with serum lipids, we studied 166 women aged 20 to 48 yr; 53 were obese [body mass index (BMI) 30-39.9 Kg/m2], 50 were overweight (BMI 25-29.9 Kg/m2) and 63 normal weight (BMI 18.5-24.9 Kg/m2). Height, body weight, waist and hip circumferences, total serum cholesterol (Ch), low (LDL) and high density lipoprotein (HDL)-Ch and triglyceride (TG) concentrations were measured. The correlation coefficients between the concentration of serum lipid fractions and each anthropometric parameter did not differ significantly for any lipid variable when WC, WHR and WHtR were compared in the 166 women. The same applied for the obese and the overweight group, whereas in normal weight women there was significant association only between WC and LDL-Ch and between WHR and Ch/HDL-Ch ratio. Stepwise regression analysis showed that the proportion of variance in serum lipids did not change significantly when WHR or WHR+WHtR were added to WC into the regression model (18%, 18% and 18% for Ch; 13%, 18% and 18% for HDL-Ch; 18%, 18% and 12% for LDL-Ch; 35%, 35% and 37% for TG, respectively). These results indicate that WC is the main parameter associated with serum lipid levels and that the ratios studied do not provide additional substantial information in women who need weight management.     

Age-related changes in bone mineral density and serum bone-related proteins in premenopausal and postmenopausal Japanese women

The purpose of this cross-sectional study was to characterize the age-related change in bone metabolism during the pre- and postmenopausal periods, and to define the standard levels of three serum markers of bone metabolism, pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), carboxyterminal propeptide of type I procollagen (PICP), and bone gla protein (BGP), in Japanese adult women. The bone mineral density (BMD) of the lumbar spine (L2-L4) and the serum levels of ICTP, PICP and BGP were determined in a total of 207 healthy Japanese women (108 premenopausal and 99 postmenopausal). The lumbar BMD decreased significantly with increasing age not only in postmenopausal women (P<0.001) but also in premenopausal women (P=0.014). There was a clear gap in the serum levels of ICTP, PICP and BGP between the premenopausal and postmenopausal group (P<0.001), but those were absolutely the same within each group except for ICTP in the postmenopausal women. These findings and the values of serum ICTP, PICP and BGP in pre- and postmenopausal women obtained in this study are expected to be very useful for treatment of postmenopausal osteoporosis.     

The effects of adjuvant chemotherapy on bone density in postmenopausal women with early breast cancer

PURPOSE: Adjuvant chemotherapy for breast cancer can have adverse effects on bone. We investigated the effects of adjuvant chemotherapy on bone mineral density in postmenopausal women with early-stage breast cancer. METHODS: We performed a chart review of all our breast center patients who had spine or hip bone density measured by dual-energy X-ray absorptiometry at our institution after treatment for stage I or II breast cancer. Patients who had other causes of metabolic bone disease were excluded. Multivariate regression analysis was used to adjust for confounding factors. Results were expressed as age-adjusted standard deviation units (Z scores). RESULTS: Of the 130 eligible women, 36 (28%) received adjuvant chemotherapy and 94 (72%) did not. Mean adjusted bone density scores in both the hip (0.65 SD units; 95% confidence interval [CI]: 0.32 to 0.98 SD units; P = 0.0002) and spine (0.60 SD units; 95% CI: 0.01 to 1.19 SD units; P = 0.05) were significantly lower in patients who had received adjuvant chemotherapy compared with those who had not. CONCLUSION: Women who were postmenopausal when they developed breast cancer and who received adjuvant chemotherapy had lower bone density than those who did not. Whether this effect is caused by adjuvant chemotherapy remains to be determined.     

The effects of race and body habitus on bone mineral density of the radius, hip, and spine in premenopausal women

The incidence of osteoporosis and fractures of the hip are diminished in blacks and in obese subjects. To determine whether bone mass is increased in them, bone mineral density (BMD) of the lumbar spine, trochanter, and femoral neck was measured by dual photon absorptiometry in 89 nonobese white and 51 nonobese black women, all of whom were within 30% of their ideal body weight and between the ages of 20 and 50 yr, and in 21 obese white women and 21 obese black women, all of whom weighed 30% on more than their ideal body weight and were in the same age range. The BMD of the mid radius was also measured by single photon absorptiometry. The mean BMD of the mid radius was higher in black than in white nonobese women [0.73 +/- 0.01 (+/- SE) vs. 0.70 +/- 0.01 g/cm2; P less than 0.01] and was not altered by obesity in either group. The mean BMD was higher in the black than in the white nonobese women at the lumbar spine (1.23 +/- 0.02 vs. 1.16 +/- 0.01 g/cm2; P less than 0.01), trochanter (0.78 +/- 0.02 vs. 0.72 +/- 0.01 g/cm2; P less than 0.01) and femoral neck (0.96 +/- 0.02 vs 0.90 +/- 0.02 g/cm2; P less than 0.02). The mean body weight was higher in the obese than in the nonobese white women (92 +/- 2 vs. 61 +/- 1 kg; P less than 0.001) and black women (94 +/- 3 vs. 63 +/- 1 kg; P less than 0.001). The mean BMD was higher in the obese than in the nonobese white women at the lumbar spine (1.24 +/- 0.03 g/cm2; P less than 0.05), trochanter (0.89 +/- 0.04; P less than 0.001), and femoral neck (0.99 +/- 0.03; P less than 0.01) and was higher in the obese than in the nonobese black women at the lumbar spine (1.33 +/- 0.03 g/cm2; P less tham 0.01), trochanter (0.88 +/- 0.04 g/cm2; P less than 0.05), and femoral neck (1.04 +/- 0.03 g/cm2; P less than 0.05). Multivariate regression analysis revealed positive correlations between body weight and BMD at each of the 3 weight-bearing sites, but not at the mid radius, in both the black women and white women.(ABSTRACT TRUNCATED AT 400 WORDS)