Interaction of Nutritional Calcium and HRT in Prevention of Postmenopausal Bone Loss: A Prospective Study

The aim of this study was to investigate the interactive effects between nutritional calcium (Ca) intake and hormone replacement therapy (HRT) on bone loss. The study population, 937 peri- and postmenopausal women, was selected from a random sample (n = 2025) of the OSTPRE-study cohort (n = 13,100) in Kuopio, Finland. Of them, 545 women had never used HRT and 392 women reported its use during the follow-up period of 6 years. Women were divided in groups according to self-reported daily nutritional Ca intake (mg/day): <648 (1st), 648–927 (2nd), >927 (3rd). Bone mineral density of the lumbar spine and femoral neck was measured with dual X-ray absorptiometry at baseline in 1989–91 and at the 5-year follow-up in 1994–97. According to analysis of variance, there were no statistically significant differences in annual bone loss rate between Ca intake tertiles in HRT never users. In HRT users the annual bone loss at the femoral neck was significantly lower in the third tertile than in the second and first tertiles. In a linear regression model, Ca intake prevented femoral bone loss in HRT users (P<0.001) but contrast had no effect in never users. At lumbar spine, the corresponding Ca effect was weak (P = 0.063). Adjustment for potentially modifying parameters did not change these effects. In addition, HRT prevented femoral bone loss only among women with the highest Ca intake. At the lumbar spine, the difference between HRT users/non-users was significant in all tertiles but was greater in the second and third tertiles than in the first. In conclusion, nutritional Ca intake may protect HRT users from bone loss and vice versa, low nutritional calcium intake may be a risk factor for non-response to HRT.     

Physical activity and dietary calcium interactions in bone mass in Scottish postmenopausal women

Summary  In this population-based cohort of 1,254 older Scottish women we found significant interactions between the mechanical component of self-reported habitual physical activity (PA) and dietary calcium (Ca) in BMD, independent of other risk factors. At low and/or medium Ca intakes BMD was higher amongst the most active people. Introduction  Although there is general agreement that increased activity (PA) and dietary calcium (Ca) consumption may help maintain bone mass in later life and prevent fractures, the amount required remains uncertain. Methods  In 2001–2003, 1,847 postmenopausal women (mean ± SD age: 69.3 ± 5.5 years) underwent bone mineral density (BMD) measurement and, in 2004, 68.7% (n = 1,254) completed a bone-specific Physical Activity Questionnaire (bsPAQ) and a food frequency questionnaire. The bsPAQ measures the metabolic and mechanical components of PA. Interactions of PA and Ca in BMD were examined using ANCOVA. Results  Significant interactions were identified in the BMD of the lumbar spine (LS), right hip (RH) and left hip (LH), after adjustment for confounders, between tertiles of PA classified according to the mechanical component and tertiles of energy-adjusted Ca intake (ANCOVA p = 0.006, p = 0.004 and p = 0.013 respectively). For example, at medium Ca intakes LH BMD was higher by 7.8% in the highest tertile of PA compared with the lowest tertile of PA. Conclusions  These data suggest that health promotion campaigns to increase PA would be most effective in populations with a low/medium calcium intake.     

Smoking and bone loss among postmenopausal women.

We examined the effect of smoking on bone mineral density (BMD), rates of bone loss, and fractional whole-body retention of 47Ca in healthy postmenopausal women enrolled in a 2-year calcium supplementation trial. Bone density was measured by single- and dual-photon absorptiometry. BMD of the radius at the study baseline was inversely related to pack-years of exposure when controlled for body mass index and years since menopause (partial r = -0.18, p = 0.05, n = 125). The adjusted mean (+/- SD) annualized rate of bone change from the radius was greater among smokers than nonsmokers (-0.914 +/- 2.624%/year, n = 34, versus 0.004 +/- 2.568%/year, n = 278, respectively; p = 0.05). Similar trends were observed at the femoral neck, os calcis, and spine. Rates were were adjusted for caffeine intake, alcohol use, supplement type, and, at the spine only, menopausal status. At entry into the trial higher serum levels of alkaline phosphatase and lower levels of total and ionized calcium were found in smokers compared to nonsmokers. These differences did not persist with supplementation. In 44 women studied fractional 47Ca retention was lower in the 8 smokers than the 36 nonsmokers (16.6 versus 19.1%, respectively; p = 0.03). These results demonstrate an increased rate of bone loss at the radius after menopause and suggest that smoking is associated with decreased calcium absorption.     

Urinary calcium is a determinant of bone mineral density in elderly men participating in the InCHIANTI study

BACKGROUND: It is generally acknowledged that calcium excretion is a determinant of bone mineral density. Since data confirming this hypothesis are not conclusive, the present study evaluates the relationship between calcium excretion and volumetric bone mineral density (vBMD) in a sample of general population mostly composed of elderly subjects. METHODS: This relationship was studied in 595 subjects in good health (M/F 302/293), selected from the InCHIANTI population, an epidemiologic survey on aging in Tuscany (Italy). Of these subjects, 432 (72.6%) were 65 years old or older. Trabecular and cortical apparent vBMDs were measured by peripheral quantitative computed tomography at right tibia and standardized to age and body mass index (BMI) in each gender (z-score). RESULTS: Men in the highest tertile of calcium excretion had significantly lower trabecular vBMD, and were more likely to have a trabecular z-score of -1 or less. These results were confirmed in men older than 64 years, but not in women and younger men. Sodium excretion and 25-hydroxycolecalciferol (25(OH)D) were greater in men and women in the highest tertile. No differences among tertiles were observed for cortical vBMD, circulating levels of interleukin-1beta and interleukin-6, and intake of principal nutrients and calcium. The lower levels of vBMD z-score were confirmed in men in the highest tertile of calcium excretion, standardized to creatinine clearance, sodium excretion, plasma calcium, and logarithm of circulating 25(OH)D, and resulted to be associated with calcium excretion at multiple regression analysis in men. CONCLUSION: High calcium excretion is associated with a decreased trabecular BMD in elderly men and may predispose men to trabecular bone loss.     

Dairy Food Intake,Peripheral Bone Structure,and Muscle Mass in Elderly Ambulatory Women

Previous studies suggest that dairy intake may be associated with reduced bone and muscle loss with aging, but there are limited data in the very old. We evaluated the association between intake of dairy foods and peripheral bone structure and muscle mass in 564 elderly women aged 80 to 92 (mean 84.7) years, who were participants of the Calcium Intake Fracture Outcome Study/CAIFOS Aged Extension Study (CAIFOS/CARES) cohort and attended the 10‐year follow‐up. Assessments included dairy consumption (milk, yogurt, and cheese) by a validated food frequency questionnaire, 15% tibia bone mass, area and volumetric bone mineral density (vBMD) by peripheral quantitative computed tomography (pQCT), and appendicular bone and skeletal muscle mass by dual‐energy X‐ray absorptiometry (DXA). Women were categorized according to tertiles of dairy intake: first tertile (≤1.5 servings/d), second tertile (1.5 to 2.2 servings/d) and third tertile (≥2.2 servings/d). Controlling for confounding factors, pQCT assessment at the 15% tibia showed that compared with those in the first tertile of dairy intake, women in the third tertile had 5.7% greater total bone mass (p = 0.005), principally because of an increase in cortical and subcortical bone mass (5.9%, p = 0.050), resulting in a 6.2% increase in total vBMD (p = 0.013). Trabecular but not cortical and subcortical vBMD was also higher (7.8%, p = 0.044). DXA assessment showed that women in the third tertile of dairy intake had greater appendicular bone mass (7.1%, p = 0.007) and skeletal muscle mass (3.3%, p = 0.014) compared with tertile 1. The associations with bone measures were dependent on dairy protein and calcium intakes, whereas the association with appendicular muscle mass was not totally dependent on dairy protein intake. Our results suggest a positive association of dairy intake with appendicular bone mineralization and muscle mass in elderly women. Because many fractures in this age group are of the appendicular skeleton often associated with falls, dairy intake may be a modifiable lifestyle factor contributing to healthy aging. © 2014 American Society for Bone and Mineral Research.     

Natural history and risk factors for bone loss in postmenopausal Caucasian women: a 15-year follow-up population-based study

SUMMARY: In this 15-year follow-up study, we found that the estimated rate of bone loss at the femoral neck (FN) for women aged 45-68 was linear at a rate of 1.67% per year, but quadratic for lumbar spine (LS) at a rate of 3.12% initially, and slowing down with age. We also confirmed the protective role of HRT, increasing weight, and lean mass in long-term bone loss. INTRODUCTION: The objective was to describe the natural history of bone loss and explore the role of environmental factors in postmenopausal women over a 15-year period. METHODS: Bone mineral density (BMD) at the FN and the LS were measured in postmenopausal women from the Chingford Study. Height, weight, HRT status, and calcium/vitamin D supplement were assessed at each visit. Osteoarthritis of hip and spine was assessed by X-ray at baseline and at year 8. RESULTS: A total of 955 postmenopausal women with an average age of 54.7 at baseline were included. Both FN and LS BMD decreased significantly with age (p<0.0001). The decline was larger in the LS (-3.12% per year), which showed a quadratic relationship, than in the FN (-1.67% per year) with a linear relationship. The rate of bone loss was reduced by one third annually for the FN and LS respectively in current HRT users. Change in weight was positively associated with both DeltaFN and DeltaLS BMD (beta=0.16% and 0.09% change in DeltaFN and DeltaLS BMD per kilogramme change in weight respectively, p<0.0001 for both sites). Spine OA and progression were positively associated with DeltaLS BMD (beta=1.22% change in DeltaLS BMD per grade in spine OA and 0.45% change in DeltaLS BMD for patients who progressed, p<0.0001 for spine OA and p=0.002 for spine OA progression). Spine OA (beta=0.54% change in DeltaFN BMD per grade, p<0.0001), but not progression, and hip OA were positively associated with DeltaFN BMD. Furthermore, both age and body weight at baseline were positively associated with both DeltaFN and DeltaLS BMD (beta=0.02-0.04% change in DeltaFN and DeltaLS BMD per year increase in age at baseline and 0.004-0.007% change in DeltaFN and DeltaLS BMD per kilogramme increase in weight at baseline, all p<0.0001). CONCLUSION: This large population-based longitudinal study demonstrated that the decline of BMD over 15 years is linear with age for the FN, but quadratic for the LS. The study confirmed the protective role of HRT, increased weight and lean mass in long-term bone loss.     

Calcium and calcitriol prophylaxis attenuates posttransplant bone loss

We performed a prospective, randomized, double-blind study to determine whether calcium and calcitriol prevents posttransplant bone loss. Thirty-eight nondiabetic and 26 diabetic patients without prior steroid exposure undergoing their first kidney or kidney-pancreas transplant were randomized to calcium, calcium plus calcitriol, or placebo. Lumbar spine (LS), femoral neck (FN), and distal radius (DR) bone mineral density scans (BMDs) were obtained at baseline, 6, and 12 months. At 1 year, patients treated with placebo experienced a 2% decline in BMD at the LS and DR and a 1.3% increase at the FN. In contrast, patients treated with calcium and vitamin D had a 0.1% decline at the LS and 2.9% and 4.8% increases at the DR and FN, respectively. Patients receiving cyclosporine had more bone loss than those receiving tacrolimus. Our results demonstrate a small therapeutic effect of calcium and calcitriol and suggest that tacrolimus is less osteotoxic than cyclosporine.     

Influence of weight and weight change on bone loss in perimenopausal and early postmenopausal Scottish women

Weight is recognized as an important factor in determining an individuals risk of osteoporosis. However, little is known about whether weight or weight change influences bone loss around the time of the menopause, and the relationship with energy intake and physical activity level remains largely undefined. Healthy premenopausal women (1,064 selected from a random population of 5,119 women aged 45–54 years at baseline) each had bone mineral density (BMD), weight and height measurements, and completed a food frequency and physical activity questionnaire. Of the original participants, 907 women (85.2%) returned 6.3 ± 0.6 years later for repeat BMD measurements, and 896 women completed the questionnaires. Bone loss at the hip (FN) and spine (LS) occurred before the menopause. Weight change rather than weight was associated with FN BMD loss (r=0.102, p=0.002), but weight at follow-up was associated with LS BMD change (r=0.105, p=0.002). Although an increase in physical activity level (PAL) appeared to be beneficial for FN BMD in women who were heavy weight gainers, PAL was associated with increased LS BMD loss in women who lost weight. For current HRT users, neither weight nor weight change was associated with change in BMD. Postmenopausal women not taking HRT should be made aware that low body weight or losing weight during this particularly vulnerable period may worsen bone loss.     

Hyperparathyroidism and long-term bone loss after renal transplantation

BACKGROUND: While early bone loss after renal transplantation (RT) is well described, factors affecting the long-term fate of bone have received less attention. METHODS: Whole body (WB), lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD) was measured using dual energy X-ray absorptionometry in 126 stable RT patients and repeated in 114 survivors after 3 yr. Percentage change per year (%/yr) was correlated to clinical and biochemical markers of bone metabolism. RESULTS: Low bone mass was a marker of increased mortality (FN < 80% normal 6.3%/yr; >80% 2.2%/yr). Percent change was WB -0.7 +/- 1.5 (p < 0.01); LS -0.3 +/- 2.6; FN -1.0 +/- 3.0 (p < 0.01) and, corrected for expected loss for age and sex: WB -0.5 (p < 0.01); LS 0.0; FN -0.8 (p < 0.05). Factors associated with increased loss rates were (LS%): short RT duration [<2 yr: -3.1 (p < 0.01)], high prednisone dose [>9 mg/d: -1.9 (p < 0.01)], high cyclosporine trough concentration [>175 ng/L: -1.9 (p < 0.05)], high hyperparathyroidism (PTH) [>150 ng/L: -1.5 (p < 0.05)], high alkaline phosphatase [>275 U/L: -1.6 (p < 0.05)], high osteocalcin [>75 microg/L: -1.6 (p < 0.05)]. Marginal detrimental effects of uremia, hypoalbuminemia and hyperphosphatemia were noted. Thiazide treatment seemed to protect against, and furosemide to exacerbate, bone loss, but this may have been related to associated uremia. Patients treated with vitamin D gained bone, while untreated patients with low initial 1,25-dihydroxyvitamin D lost bone [FN%-2.1 (p < 0.05)]. The prevalence of PTH (52%) and hypercalcemia (22%) remained unchanged. There was no effect of sex hormone levels, calcium and phosphate excretion, or serum calcium. CONCLUSION: While LS BMD stabilizes after RT, there is a continuing loss of WB and FN BMD. The major causes of bone loss are steroid therapy and continuing PTH, with no tendency towards spontaneous resolution. Increased vitamin D and calcium therapy should be considered for this patient group, and more aggressive therapy, e.g. parathyroidectomy given for patients with resistant PTH of >150 ng/L.     

Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study.

Few studies have evaluated protein intake and bone loss in elders. Excess protein may be associated with negative calcium balance, whereas low protein intake has been associated with fracture. We examined the relation between baseline dietary protein and subsequent 4-year change in bone mineral density (BMD) for 391 women and 224 men from the population-based Framingham Osteoporosis Study. BMD (g/cm2) was assessed in 1988-1989 and in 1992-1993 at the femur, spine, and radius. Usual dietary protein intake was determined using a semiquantitative food frequency questionnaire (FFQ) and expressed as percent of energy from protein intake. BMD loss over 4 years was regressed on percent protein intake, simultaneously adjusting for other baseline factors: age, weight, height, weight change, total energy intake, smoking, alcohol intake, caffeine, physical activity, calcium intake, and, for women, current estrogen use. Effects of animal protein on bone loss also were examined. Mean age at baseline (+/-SD) of 615 participants was 75 years (+/-4.4; range, 68-91 years). Mean protein intake was 68 g/day (+/-24.0; range, 14-175 g/day), and mean percent of energy from protein was 16% (+/-3.4; range, 7-30%). Proportional protein intakes were similar for men and women. Lower protein intake was significantly related to bone loss at femoral and spine sites (p < or = 0.04) with effects similar to 10 lb of weight. Persons in the lowest quartile of protein intake showed the greatest bone loss. Similar to the overall protein effect, lower percent animal protein also was significantly related to bone loss at femoral and spine BMD sites (all p < 0.01) but not the radial shaft (p = 0.23). Even after controlling for known confounders including weight loss, women and men with relatively lower protein intake had increased bone loss, suggesting that protein intake is important in maintaining bone or minimizing bone loss in elderly persons. Further, higher intake of animal protein does not appear to affect the skeleton adversely in this elderly population.     

Premenopausal smoking and bone density in 2015 perimenopausal women.

The importance of cigarette smoking in relation to bone mass remains uncertain, especially in younger women. In a recent meta-analysis including 10 studies in premenopausal women no effect was seen in this age group. We used baseline data from a large national cohort study (Danish Osteoporosis Prevention Study [DOPS]) to study the cumulated effect of pre- and perimenopausal smoking on bone mineral density (BMD) measured shortly after the cessation of cyclic bleedings. Baseline observations on 2015 recently menopausal women were available. Eight hundred thirty-two women were current smokers and 285 were exsmokers. Significant negative associations of cigarette smoking coded as current, ex-, or never smoking were seen on bone mass in the lumbar spine (P = 0.012), femoral neck (P<0.001), and total body (P<0.001). Quantitatively, the differences between current smokers and never smokers were limited to 1.6, 2.9, and 1.9%, respectively. A statistical interaction was found between smoking and fat mass, indicating that women in the highest tertile of fat mass were unaffected by cigarette smoking. Serum vitamin D levels and osteocalcin were inversely related to the number of cigarettes smoked per day (r = 0.11 and P<0.001; r = 0.17 and P = 0.04), respectively. Bone alkaline phosphatase (BALP) and urinary hydroxyproline (U-OHP) were unaffected by current smoking. The average cumulated effect of premenopausal smoking on bone is small but biologically significant. Reduced body mass in smokers explains part of the negative effect on the skeleton and a complex interaction between smoking and fat mass on the skeleton is indicated. Serum levels of 25-hydroxyvitamin D (25-OHD) and osteocalcin are lower in smokers, which may effect rate of bone loss.     

Smoking and bone metabolism in elderly women

Cigarette smoking has been implicated as a risk factor for osteoporosis. In the present study, the relationship between smoking and bone mineral density, calcitropic hormones, calcium absorption, and biochemical indices related to bone and mineral metabolism was examined at baseline, in subjects recruited for an osteoporotic study. The subjects included 489 elderly women, aged 65-77 years. After exclusions (thiazide users), 54 women constituted the smoking group and 390 women were classified as nonsmokers. The effect of frequency of smoking was also examined in this population (33 light smokers [<1 pack/day] and 21 heavy smokers [>1 pack/day]). Adjusted mean total body bone mineral density was 4% lower (0.968 +/- 0.019 vs. 1.009 +/- 0.004) and the total hip density was 6% lower (0.778 +/- 0.024 vs. 0.826 +/- 0.006) in heavy smokers compared with nonsmokers. At the other sites measured (spine, midradius, femoral neck, trochanter, and Ward's triangle), a similar nonsignificant trend was observed. The adjusted mean calcium absorption corrected for weight was lower (13%) both in light and heavy smokers compared with nonsmokers, and serum 25-hydroxyvitamin D was significantly lower (16%) in heavy smokers than nonsmokers. Serum parathryroid hormone (PTH) was higher in heavy smokers, but was not significantly different from that of nonsmokers. A significant increase in bone remodeling markers, serum osteocalcin (4.35 +/- 0.271 vs. 3.79 +/- 0. 066) and urine N-telopeptide/creatinine (NTx/Cr) ratio (74.5 +/- 5. 75 vs. 49.8 +/- 1.4) was seen in heavy smokers compared with nonsmokers. These results suggest that smoking lowers bone mineral density, and is a result of decreased calcium absorption associated with secondary hyperparathyroidism and increased bone resorption.     

Evaluation of Bone Mineral Density Loss in Morbidly Obese Women After Gastric Bypass: 3-Year Follow-Up

Studies that evaluate the influence of gastric bypass (RYGP) on bone mass are limited to short-term follow-up. We analysed changes in bone mineral density (BMD) three years after surgery and evaluated the main determinants of the development of bone disease. Prospective study of 59 morbidly obese white women aged 46 ± 8 years. BMD scanning using DEXA and plasma determinations of calcium, parathyroid hormone, 25-hydroxyvitamin D and insulin-like growth factor-I were made prior, at 12 months and 3 years after surgery. In the first postoperative year BMD decreased at femoral neck (FN) 10.2 % and in the lumbar spine (LS) 3.2 %, in the third year it additionally decreased 2.7 % and 3.1 %, respectively. BMD at both sites remained above the values of women of the same age. In the follow-up, 1.7 % developed osteoporosis at FN and 6.8 % at LS. Patients with bone disease were older, the percentage of women with menopause was greater in this group and had lower initial and final values of lean mass. The percentage of BMD loss at FN remained positively associated with the percentage of lean mass loss [β 0.304, p = 0.045], and menopause [β 0.337, p = 0.025]. Major osteoporotic fracture and hip fracture risk was low even in menopausal patients (3.1 % and 0.40 %, respectively). After RYGP menopausal women and those with greater lean mass loss are at higher risk of BMD loss but progression to osteoporosis is uncommon and the risk of fracture is low.     

Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study.

Few studies have evaluated risk factors for bone loss in elderly women and men. Thus, we examined risk factors for 4-year longitudinal change in bone mineral density (BMD) at the hip, radius, and spine in elders. Eight hundred elderly women and men from the population-based Framingham Osteoporosis Study had BMD assessed in 1988-1989 and again in 1992-1993. BMD was measured at femoral neck, trochanter, Ward's area, radial shaft, ultradistal radius, and lumbar spine using Lunar densitometers. We examined the relation of the following factors at baseline to percent BMD loss: age, weight, change in weight, height, smoking, caffeine, alcohol use, physical activity, serum 25-OH vitamin D, calcium intake, and current estrogen replacement in women. Multivariate regression analyses were conducted with simultaneous adjustment for all variables. Mean age at baseline was 74 years +/-4.5 years (range, 67-90 years). Average 4-year BMD loss for women (range, 3.4-4.8%) was greater than the loss for men (range, 0.2-3.6%) at all sites; however, BMD fell with age in both elderly women and elderly men. For women, lower baseline weight, weight loss in interim, and greater alcohol use were associated with BMD loss. Women who gained weight during the interim gained BMD or had little change in BMD. For women, current estrogen users had less bone loss than nonusers; at the femoral neck, nonusers lost up to 2.7% more BMD. For men, lower baseline weight and weight loss also were associated with BMD loss. Men who smoked cigarettes at baseline lost more BMD at the trochanter site. Surprisingly, bone loss was not affected by caffeine, physical activity, serum 25-OH vitamin D, or calcium intake. Risk factors consistently associated with bone loss in elders include female sex, thinness, and weight loss, while weight gain appears to protect against bone loss for both men and women. This population-based study suggests that current estrogen use may help to maintain bone in women, whereas current smoking was associated with bone loss in men. Even in the elderly years, potentially modifiable risk factors, such as weight, estrogen use, and cigarette smoking are important components of bone health.     

Bone mineral density in lung-transplant recipients before and after graft: prevention of lumbar spine post-transplantation-accelerated bone loss by pamidronate.

BACKGROUND: Lung-transplant recipients are at risk of osteoporosis. They may have low bone mass even before posttransplantation immunosuppressive therapy. We studied bone mineral density (BMD) before and after lung transplantation and compared the efficacy of antiresorptive therapies to calcium and vitamin D supplementation. METHODS: Areal BMD was assessed in 42 patients awaiting lung transplantation and measured again after surgery at 6 (n = 29), and at 12 months (n = 20). Nineteen patients received antiresorptive therapy (30 mg pamidronate IV every 3 months (n = 14), or hormonal replacement therapy (n = 5)), and 10 patients received only calcium and vitamin D supplements.RESULTS: Mean age- and gender-adjusted lumbar spine (LS) and femoral neck (FN) BMD was significantly decreased prior to transplantation (- 0.6 +/- 0.2, p< 0.01, and - 1.5 +/- 0.2 standard deviation, p < 0.001, respectively). At that time, 29% were osteoporotic (T-score < - 2.5 below the peak bone mass), while 55% were below - 1.0 T-score. Antiresorptive therapy decreased the rate of LS bone loss during the first 6 months and led to a significant increase of BMD at 1 year, with LS changes of + 0.2 +/- 0.1 vs - 0.4 +/- 0.1 Z-score in the calcium-vitamin D group (p< 0.002), and + 0.2 +/- 0.1 vs - 0.04 +/- 0.1 for FN (NS). One out of 20 patients experienced clinically evident fractures during antiresorptive therapy, and 3 out of 12 in the calcium-vitamin D group. CONCLUSION: A significant proportion of patients awaiting lung transplantation was osteoporotic or osteopenic. Antiresorptive therapy (pamidronate or hormone-replacement therapy (HRT)) prevented accelerated LS bone loss after graft.     

Relation of fractional 47Ca retention to season and rates of bone loss in healthy postmenopausal women.

Fractional whole-body retention of 47Ca (retention fraction) in 58 healthy postmenopausal women participating in a calcium supplementation trial was examined for seasonal variation and for relationships to rates of bone loss and plasma vitamin D levels. Retention fraction was measured after 18 months in the trial. Bone mineral densities of the radius, femoral neck, and lumbar spine were measured at baseline, 12 months, and 24 months in the trial, and plasma 1,25-dihydroxyvitamin D [1,25-(OH)2D] and 25-hydroxyvitamin D (25-OHD) at 12, 18, and 24 months. The adjusted retention (retention fraction adjusted for total calcium intake, smoking status, and log years since menopause) was significantly higher in women evaluated in the months of August through October (mean +/- SD, 19.8 +/- 4.1%, n = 13) than in March through May (mean +/- SD, 17.0 +/- 4.7%, n = 18, p = 0.05). Plasma 25-OHD was associated with retention fraction only in women with low calcium intakes (partial r = 0.69 controlling for total calcium intake and log body mass index, n = 14, p = 0.01). Plasma 1,25-(OH)2D was not related to retention fraction. Adjusted retention, independent of total calcium intake, log years since menopause, smoking status, and season, explained 8% of the variability in the annual change in radius density (partial r = 0.29, p less than 0.05). No significant associations were seen at the spine and femur.(ABSTRACT TRUNCATED AT 250 WORDS)     

Vertebral Fracture Risk Is Reduced in Women Who Lose Femoral Neck BMD With Teriparatide Treatment

Response to osteoporosis therapy is often assessed by serial BMD testing. Patients who lose BMD without secondary causes of bone loss may be considered to be “nonresponders” to treatment. We examined vertebral fracture (VF) risk, change in lumbar spine (LS) BMD, and change in amino‐terminal extension peptide of procollagen type I (PINP) in postmenopausal women whose femoral neck (FN) BMD decreased, increased, or was unchanged after receiving teriparatide (TPTD) or placebo (PL) in the Fracture Prevention Trial. FN and LS BMD were measured at baseline and 12 mo. VFs were assessed by lateral spine radiographs at baseline and study endpoint. A BMD change from baseline of >4% was considered to be clinically significant. Decreases of >4% FN BMD were less common in women receiving TPTD (10%) versus PL (16%, p < 0.05), yet women on TPTD who lost FN BMD still had significant reductions in VF risk compared with PL (RR = 0.11; 95% CI = 0.03–0.45). VF risk reduction with TPTD compared with PL was similar across categories of FN BMD change from baseline at 12 mo (loss >4%, loss 0–4%, gain 0–4%, or gain >4%; interaction p = 0.40). Irrespective of FN BMD loss or gain, TPTD‐treated women had statistically significant increases in LS BMD and PINP compared with PL. In both groups, losses or gains in FN BMD at 12 mo corresponded to losses or gains in BMC rather than changes in bone area. In conclusion, loss of FN BMD at 12 mo in postmenopausal women with osteoporosis treated with TPTD is nevertheless consistent with a good treatment response in terms of VF risk reduction.     

Change in bone mineral density and tooth loss in Japanese community-dwelling postmenopausal women: a 5-year cohort study

The aim of this longitudinal study was to investigate the association between the change in bone mineral density (BMD) and tooth loss in Japanese community-dwelling postmenopausal women. The subjects were 404 women. At baseline (2005) and follow-up (2010), BMDs of the lumbar spine and right femoral neck were measured using dual-energy X-ray absorptiometry (QDR4500a) and participants were classified by tertiles of the annual percentage change in BMD. The number of teeth was counted at the baseline and follow-up to calculate the number of lost teeth over 5 years. Poisson regression analysis was conducted with tertiles of the changes in BMDs of the lumbar spine and femoral neck as the main exposures to estimate their influence on the number of lost teeth. Participants in the tertile with a greater decrease in BMD at each skeletal site (lumbar spine and femoral neck, respectively) had a larger number of lost teeth, controlling for possible confounders. The adjusted relative risks (95% confidence interval) for the mean number of lost teeth in the first, second, and third tertiles were 1.00, 1.15 (0.91-1.45), and 1.38 (1.11-1.72) for the lumbar spine and 1.00, 1.17 (0.93-1.47), and 1.27 (1.01-1.59) for the femoral neck, respectively. In conclusion, a significant relationship exists between a change in BMD and the number of lost teeth during 5-year study period in Japanese community-dwelling postmenopausal women.     

Osteoporosis in elderly men and women: effects of dietary calcium, physical activity, and body mass index.

Dietary calcium intake and physical activity are considered practical measures for prevention of osteoporosis. However, their associations with bone mineral density (BMD) in the elderly are not clear. The present study examined the association between osteoporosis and these two factors in relation to body mass index (BMI) in a cross-sectional, epidemiological study involving 1075 women and 690 men, aged 69 +/- 6.7 years (mean +/- SD). Dietary calcium intake (median of 580 mg/day) was inversely related to age (p = 0.01), positively related to physical activity index (PAI) (p = 0.01), femoral neck BMD (p = 0.01) in women, and higher lumbar spine (p = 0.003) and femoral neck BMD (p = 0.03) in men. Quadriceps strength was negatively associated with age (p < 0.0001) and positively related to BMI (p < 0.0001) and BMD (p < 0.0001) in both men and women. The PAI was associated with quadriceps strength (p < 0.0001) and femoral neck and lumbar spine BMD in women (p < 0.001) and with femoral neck BMD in men (p = 0.04); however, these associations were not significant after adjusting for age, BMI, quadriceps strength, and dietary calcium. Women in the top tertile of quadriceps strength (> or =23 kg) and dietary calcium intake (> or =710 mg/day) had 15% higher BMD than those in the lowest tertiles (< or =15 kg and < or =465 mg/day); the difference was comparable in men (11%). Among subjects with the lowest tertiles of BMI (< or =23 kg/m2 for women and < or =24 kg/m2 for men), quadriceps strength (< or =15 kg for women and < or =28 kg for men), and dietary calcium intake (< or =465 mg/day), 64% and 40% of women and men, respectively, were classified as having osteoporosis (based on a 2.5-SD reduction from the young-normal mean). The prevalence was only 12% in women and 1.5% in men among those in the highest tertiles of the three factors. Adequate dietary calcium intake and maintaining a physically active lifestyle in late decades of life could potentially translate into a reduction in the risk of osteoporosis and hence improve the quality and perhaps quantity of life in the elderly population.     

The relationship between regional bone turnover measured using 18F-fluoride positron emission tomography and changes in BMD is equivalent to that seen for biochemical markers of bone turnover.

Bone turnover is an important determinant of fracture risk. (18)F-fluoride positron emission tomography ((18)F-PET) allows the direct assessment of bone turnover at the clinically important skeletal sites such as the lumbar spine. The aim of this study was to determine if the relationship between regional bone turnover measured using (18)F-PET and changes in bone mineral density (BMD) is equivalent to that seen for global skeletal measurements of biochemical markers of bone turnover. Forty-three women who had previously had an (18)F-PET scan at the lumbar spine, assessment of biochemical markers of bone turnover, and a dual-energy X-ray absorptiometry scan of BMD at the lumbar spine and hip (baseline assessments) were split into 1 of 2 groups: (1) 22 women who commenced treatment for osteoporosis within 2mo of having the baseline assessments (Treatment group); (2) 21 women who had not taken any treatments for osteoporosis since having the baseline assessments (Untreated group). Sixteen of the women in the Treatment group started risedronate therapy as part of a prospective study they were participating in, whereas the decision to treat the remaining 6 women was made by the subject's treating physician. Subjects had between 2 and 5 BMD scans over a median follow-up time of 4.1yr to estimate the annual percentage change in BMD since baseline. The relationship between the tertiles of (18)F-PET skeletal kinetic parameter K(i), reflecting regional bone turnover, and annual changes in lumbar spine and hip BMD were compared to that seen for bone formation (bone-specific alkaline phosphatase, BSALP) and bone resorption (urinary deoxypyridinoline) markers. Treated women in the highest tertile of both regional ((18)F-PET) and global (biochemical markers) bone turnover showed the greatest annual percentage increases in lumbar spine BMD. The annual increase in lumbar spine BMD was 1.8%, 2.2%, and 3.2% for women in the lowest, middle, and highest tertile of BSALP, respectively, which was similar to that obtained for the regional measurement of K(i) of 1.7%, 2.2%, and 2.7% respectively. Untreated women in the highest tertile of regional and global bone turnover had larger decreases in lumbar spine BMD compared to those women in the lowest tertile, with a 1.4- to 4.8-fold difference in the annual decrease in BMD between the two. Less consistent patterns were observed when assessing the relationship between regional and global bone turnover with changes in hip BMD. This study has demonstrated that the relationship between regional bone turnover measured directly at the lumbar spine with changes in BMD is similar to that seen for global skeletal bone turnover using biochemical markers.