Estrogen therapy for geriatric osteoporosis: just one ball in a complex juggling act.

The use of estrogens is the single therapy that has been found consistently to prevent bone loss and fractures in postmenopausal women. Traditional osteoporotic risk factors should be used to select women for bone densitometry. The numeric result provided by densitometry, combined with age-based comparisons, is extremely useful in convincing reluctant women to be treated. The few studies that have been done in geriatric women show that estrogen therapy continues to be effective in reducing bone loss, but the absolute benefit is less than in perimenopausal women. The effects of estrogen therapy extend beyond osteoporosis. A consensus of epidemiologic reports has shown that women who comply with postmenopausal estrogen therapy have a 30% to 50% reduction in the risk of coronary artery disease. Given the frequency of these two conditions, widespread use of estrogen as a national health care policy would be appropriate if it were not for the evidence that estrogens may increase the risk of breast cancer and endometrial cancer. Given these lingering cancer fears, recent calls for a randomized national women's health study of postmenopausal estrogen therapy should be heeded.     

Prevention and treatment of osteoporosis in women with breast cancer

Women who have had breast cancer may be at higher risk for osteoporosis than other women. First, they are more likely to undergo early menopause, due to chemotherapy-induced ovarian failure or oopherectomy. In addition, chemotherapy may have a direct adverse effect on bone mineral density (BMD), and osteoclastic activity may increase from the breast cancer itself. While estrogen therapy is considered standard for the prevention and treatment of osteoporosis, use of estrogen in women with a history of breast cancer is usually contraindicated. The approach to osteoporosis in women with breast cancer is also affected by the use of tamoxifen in many, as this drug appears to have opposite effects on BMD in premenopausal and postmenopausal women. We have reviewed therapeutic alternatives for the prevention and treatment of osteoporosis, focusing on patients with a history of breast cancer. Alendronate and raloxifene are currently approved in the United States for the prevention of osteoporosis; alendronate, raloxifene, and calcitonin are approved for treatment. Alendronate has the greatest positive effect on BMD and reduces the incidence of vertebral and nonvertebral fractures. Raloxifene and calcitonin appear to reduce the incidence of vertebral fractures; their effects on the incidence of nonvertebral fractures are not yet proven. Although no published studies specifically address the use of these approved agents for osteoporosis in women with breast cancer, understanding their relative effects on BMD in postmenopausal women in general will facilitate therapy selection in this population. Postmenopausal women with a history of breast cancer should undergo bone mineral analysis. Normal results and absence of other risk factors ensure that calcium and vitamin D intake are adequate. If osteopenia or other risk factors are present, preventive therapy with alendronate or raloxifene should be considered. For osteoporosis, treatment with alendronate should be strongly considered. Raloxifene and calcitonin are alternatives when alendronate is contraindicated. Further studies are needed to evaluate the optimal timing of initial bone mineral analysis in premenopausal women after breast cancer diagnosis and to determine the value of preventive treatment in women scheduled to undergo chemotherapy.     

Efficacy of nonloading exercises in prevention of vertebral bone loss in postmenopausal women: a controlled trial

A considerable increase in muscle strength and bone mass can be achieved in young adults through athletic exercise programs. We studied a less demanding nonloading exercise program for the back extensor muscles in postmenopausal women who were not on estrogen therapy. We randomly assigned 65 healthy Caucasian women without evidence of or risk factors for osteoporosis into an exercise group and a control group. The strength of the back extensor muscles and bone mineral density of the lumbar spine were measured at baseline and every 6 months for 2 years. In addition, a physical activity score was determined. Compliance was assessed by regular interviews and review of diaries. During the 2-year study, the mean rates of bone loss in the two groups were not statistically different. The strength of the back extensor muscles increased in both groups but significantly more (P = 0.002) in the exercise group. We conclude that postmenopausal bone loss is unaffected by a modest exercise program despite an increase in muscle strength. Nonloading muscle exercise may be ineffective in retarding vertebral bone loss in ambulatory, healthy postmenopausal women.     

RISEDRONATE: CLINICAL USAGE

Risedronate is a new bisphosphonate – a family of drugs that inhibit bone resorption – and thus can be used in various bone conditions involving increased levels of bone resorption, such as postmenopausal osteoporosis, glucocorticoid-induced bone loss, and Paget's disease of bone. In placebo-controlled clinical trials, risedronate has been shown to prevent bone loss in postmenopausal women, to decrease the incidence of vertebral and non vertebral (including hip) fractures in postmenopausal women with osteoporosis, and to prevent bone loss in men and women treated with moderate to high doses of glucocorticoids. Risedronate has also been shown substantially to decrease the severity of bone pain and the level of bone turnover in Paget's disease of bone, and to improve the radiographic lesions of this disease. Risedronate is safe and well tolerated. Thus, risedronate is a new option for the management of postmenopausal osteoporosis, Paget's disease of bone and corticosteroid-induced bone loss.     

Hormone replacement therapy in a postmenopausal woman with epilepsy

OBJECTIVE: To prospectively evaluate the effects of hormone replacement therapy (HRT) on seizure activity in a postmenopausal woman with epilepsy. BACKGROUND: Postmenopausal women are at an increased risk for cardiovascular disease and osteoporosis secondary to a lack of estrogen's protective effects. As a result, women without known contraindications often take HRT to counteract this risk. Postmenopausal women with epilepsy are at a greater risk for osteoporosis because of the negative effects that certain antiepileptic drugs have on bone density. Clinical studies and experience have shown that hormonal variances across a woman's lifetime play a significant role in seizure activity, but the effects of HRT in postmenopausal women with epilepsy are unknown. CASE SUMMARY: We report the case of a 51-year-old postmenopausal white woman with epilepsy who presented with frequent vasomotor flushing. To determine individual effects of HRT on seizure activity, therapy was initiated in two three-month phases, with monthly evaluation. A weekly transdermal patch of estradiol 0.1 mg/d was initiated for the first three months. During the second three months, the regimen was expanded to include oral medroxyprogesterone acetate 2.5 mg once daily. Antiepileptic medications and their dosages remained constant. HRT was associated with a decreased incidence of seizures, cessation of vasomotor flushing, improved sleep, and a positive impact on the lipid profile. CONCLUSIONS: This case report describing the prospective addition of HRT in a postmenopausal woman with epilepsy suggests that HRT can be initiated in certain women to achieve therapeutic benefits without adversely affecting seizure activity.     

Denosumab for the management of postmenopausal osteoporosis

View the National Osteoporosis Foundation Clinician's Guide Postmenopausal osteoporosis is a major concern to public health. Fractures are the major clinical consequence of osteoporosis and are associated with substantial morbidity, mortality, and health care costs. Despite the availability of screening and treatment guidelines, osteoporosis diagnosis and treatment remain low. Health care providers may consult guidelines in the clinical management of their patients with osteoporosis, including those from the National Osteoporosis Foundation, and the new fracture risk assessment tool from the World Health Organization. Bisphosphonates are the most commonly used treatment for postmenopausal osteoporosis. Although these agents are effective in preventing fractures and bone loss, the benefits of treatment may be limited by suboptimal adherence and compliance. Denosumab is a human monoclonal antibody that targets and inhibits RANK ligand, an essential mediator of bone resorption. In clinical trials in postmenopausal women with osteoporosis, denosumab 60 mg given subcutaneously every 6 months was well tolerated and statistically significantly reduced the risk of vertebral, nonvertebral, and hip fractures. The introduction of denosumab into clinical practice provides physicians with another option for the treatment of postmenopausal osteoporosis, and the twice-yearly dosing regimen has the potential to improve adherence.     

Serum bone sialoprotein: a marker of bone resorption in postmenopausal osteoporosis

Thirty healthy perimenopausal women who had normal lumber spine bone mineral density (LS-BMD) measured by dual energy X-ray absorptiometry (DEXA) participated in this study as controls. The pathological group comprised 50 postmenopausal osteoporotic women who had LS-BMD more that 2 SD below the normal mean of healthy perimenopausal women. Postmenopausal osteoporotic patients were allocated to three different therapeutic modalities (hormone replacement therapy HRT, alendronate or combined HRT and alendronate). Blood and urine samples were collected from all groups before and 12 months after treatment. Serum bone sialoprotein (BSP) was measured by a specific radioimmunoassay and urinary pyridinoline N-telopeptide of type l collagen (NTX ) were determined as biomarkers of bone resorption. In addition, serum IL-11 and TGF &#103 2 were measured by enzyme immunoassays. The results obtained showed that serum BSP was significantly elevated in postmenopausal osteoporosis compared to that of healthy perimenopausal controls. Significant positive correlations exist between serum BSP and biomarkers of bone resorption (Pyr,DPyr,NTX ) as well as bone resorptive cytokines (IL-11,TGF &#103 2 ). Serum BSP decreased after different antiresorptive treatments and this decrease paralleled the decrease of bone resorption markers and the increase of LS-BMD. Based on these data, circulating BSP appears to be a valuable marker of bone resorption and monitoring therapy with antiresorptive drugs in postmenopausal osteoporosis. (Pyr), deoxy-pyridinoline (DPyr) and     

Estrogen, SERM

Osteoporosis is uncommon before menopause and dramatically increases in prevalence thereafter. That is why estrogens provide protection against osteoporosis. Studies of women receiving estrogen replacement have demonstrated improvements in bone mineral density (BMD) as well as endothelial function. Recent randomized trials, however, have produced equivocal results and raised questions about whether combined hormonal replacement therapy (HRT) prevents later cardiovascular events. Investigations of alternatives to HRT have suggested that selective estrogen receptor modulators (SERMs) may confer cardiovascular and osteoporosis protection. Raloxifene is a second-generation SERM used for the prevention and treatment of postmenopausal osteoporosis. Raloxifene decreases the incidence of vertebral fractures by 30-50% in postmenopausal women with osteoporosis. We also studied its effect on postmenopausal elderly women with osteoporosis.     

绝经后女性膝骨关节炎的骨量变化

目的 探讨绝经后女性膝骨关节炎( knee osteoarthritis,KOA)患者骨量变化相关因素.方法 收集参研医院100例绝经后女性KOA住院患者一般情况、血液生化、骨代谢指标血清碱性磷酸酶(ALP)、骨钙素(OC)、β胶原特殊序列(β-crosslaps)及骨密度、X线、MRI影像学、西安大略和麦克马斯特大学骨关节炎指数(WOMAC)评分等临床资料,分析绝经后女性KOA患者骨量变化相关因素.结果 ①100例绝经后KOA女性骨质疏松症(OP)发生率23.0％(23/100),骨量减少发生率50.0％(50/100).②绝经后女性KOA骨量与体质量指数(BMI)、高密度脂蛋白胆固醇(HDL-C)呈正相关(P＜0.05),与年龄、血尿酸(UA)、OC、β-crosslaps呈负相关(P＜0.05).③BMI、HDL-C在骨质疏松症组低于骨量减少组(P＜0.05),骨量减少组低于骨量正常组(P＜0.05).④UA、OC、β-Crosslaps在骨质疏松症组高于骨量减少组(P＜0.05),骨量减少组高于骨量正常组(P＜0.05).ALP骨质疏松症组低于骨量减少组和骨量正常组(P＜0.05).⑤依据X线片Kellgen和Lawrence诊断分级标准,绝经后女性KOA的X线片分级Ⅱ与Ⅲ、Ⅲ与Ⅳ级之间骨量变化有统计学意义(P＜0.05).结论 绝经后女性KOA患者骨量受多因素影响,其骨量变化与BMI、HDL C呈正相关,与年龄、UA、OC、β-Crosslaps呈负相关;绝经后女性KOA骨量减少具有高转换型骨代谢特点,患者骨量变化随X线分级病情从轻到重并非线性变化规律,而是呈曲线波动.     

Bone mineral density and bone turnover in postmenopausal women treated for breast cancer

Chemotherapy and endocrine treatments for breast cancer are believed to increase risk of osteoporosis by causing early menopause in premenopausal women and by further depleting estrogen levels in postmenopausal women. Multivariate analyses were used to evaluate the contributions of 7 predictors (age, body mass index [BMI], family history of osteoporosis, months since menopause, past use of chemotherapy, and current use of tamoxifen or aromatase inhibitors) in explaining variability in bone mineral density (BMD) at the hip and the spine and bone turnover in 249 postmenopausal women who are breast cancer survivors. This report was an analysis of baseline data from a federally funded (1 R01 NR07743-01A1) intervention study on osteoporosis prevention. Mean age of the women was 58.5 years, and average BMI was 26.7 kg/m; 98% were white. All had measurable bone loss, 167 had chemotherapy, 76 were on tamoxifen, and 21 were on aromatase inhibitors. Women with higher BMI had higher BMD at the hip (P < .001) and the spine (P = .004). Women on tamoxifen had lower measures of bone formation (Alkphase B) (P < .001), suggesting less bone turnover, and higher BMD at the hip (P = .035). There was a trend for women who had received chemotherapy to have lower BMD at the spine (P = .06). The implications of these findings are discussed in the article.     

Short- and long-term effects of estrogen and synthetic anabolic hormone in postmenopausal osteoporosis

In 29 women with postmenopausal osteoporosis, the proportion of total bone surface undergoing resorption or formation was evaluated by microradiography of iliac crest biopsy samples before and after short-term (2(1/2)-4 months) and long-term (26-42 months for estrogen and 9-15 months for anabolic hormone) treatment. After estrogen administration, values for bone-resorbing surfaces decreased, although less prominently after long-term than after short-term therapy. The magnitude of this decrease was positively correlated with the pretreatment value for bone-resorbing surfaces (P < 0.001). When the pretreatment value for bone-resorbing surfaces was used as a covariable, estrogen and anabolic hormone appeared to be equally effective. For bone-forming surfaces, short-term therapy with either hormone had no effect but long-term therapy significantly decreased the values. Serum immunoreactive parathyroid hormone (IPTH) increased significantly after estrogen therapy; the change in IPTH was inversely related to the change in serum calcium (P < 0.001, sign test). We conclude that the primary effect of sex hormones in postmenopausal osteoporosis is to decrease the increased level of bone resorption, perhaps by decreasing the responsiveness of bone to endogenous parathyroid hormone. However, this favorable effect, at least in part, is negated after long-term treatment by a secondary decrease in bone formation. Our data are consistent with the concept that the maximal benefit that can be derived from sex hormone therapy in postmenopausal osteoporosis is arrest or slowing of the progession of bone loss.     

Serum bone sialoprotein: a marker of bone resorption in postmenopausal osteoporosis.

Thirty healthy perimenopausal women who had normal lumber spine bone mineral density (LS-BMD) measured by dual energy X-ray absorptiometry (DEXA) participated in this study as controls. The pathological group comprised 50 postmenopausal osteoporotic women who had LS-BMD more that 2 SD below the normal mean of healthy perimenopausal women. Postmenopausal osteoporotic patients were allocated to three different therapeutic modalities (hormone replacement therapy HRT, alendronate or combined HRT and alendronate). Blood and urine samples were collected from all groups before and 12 months after treatment. Serum bone sialoprotein (BSP) was measured by a specific radioimmunoassay and urinary pyridinoline (Pyr), deoxy-pyridinoline (DPyr) and N-telopeptide of type 1 collagen (NTX) were determined as biomarkers of bone resorption. In addition, serum IL-11 and TGFbeta2 were measured by enzyme immunoassays. The results obtained showed that serum BSP was significantly elevated in postmenopausal osteoporosis compared to that of healthy perimenopausal controls. Significant positive correlations exist between serum BSP and biomarkers of bone resorption (Pyr,DPyr,NTX) as well as bone resorptive cytokines (IL-11,TGFbeta2). Serum BSP decreased after different antiresorptive treatments and this decrease paralleled the decrease of bone resorption markers and the increase of LS-BMD. Based on these data, circulating BSP appears to be a valuable marker of bone resorption and monitoring therapy with antiresorptive drugs in postmenopausal osteoporosis.     

Teriparatide (rhPTH 1-34) for the treatment of osteoporosis

Osteoporosis is a skeletal disorder characterised by compromised bone strength predisposing a person to an increased risk of fracture. Osteoporosis develops through an imbalance between bone resorption by osteoclasts and bone formation by osteoblasts resulting in increased bone loss. Numerous agents used for the prevention and treatment of osteoporosis slow bone loss by decreasing both bone resorption and formation. These include bisphosphonates, hormone replacement therapy, selective oestrogen receptor modulators and calcitonins. All reduce vertebral fracture risk and some reduce non-vertebral fracture risk, but none routinely increases bone mass and strength or restores lost bone architecture. In many respects, antiresorptive therapies halt the progression of osteoporosis. However, for patients who have osteoporosis, particularly those who have sustained their first fracture and are at high risk for subsequent fractures, there is a need to develop agents that stimulate bone formation and, thus, reverse osteoporosis. Teriparatide is the recombinant human 1-34 amino acid sequence of parathyroid hormone recently approved in the US for the treatment of men and postmenopausal women at high risk for osteoporotic fracture and in Europe for the treatment of postmenopausal women with osteoporosis. When given by once-daily injection, teriparatide increases bone mass by stimulating formation of new bone, resulting in the restoration of bone architecture.     

The evaluation of cardiovascular risk in postmenopausal women with osteopenia

The purpose of the study was to evaluate the prevalence of the most important cardiovascular risk factors in postmenopausal women in correlation with bone mineral density (BMD). A hundred and fifty postmenopausal women were included in a case control study. The subjects were distributed into three equal groups: normal bone mass; osteopenia; non-complicated osteoporosis. BMD was measured with lumbar double-energy X-ray absorptiometry. Cardiovascular risk factors were assessed. The level of triglycerides was significantly higher in patients with osteoporosis vs. subjects with normal BMD. Arterial hypertension and a 10-year fatal risk of more than 0% were significantly more prevalent in the group with normal BMD. Osteoporosis presents an independent cardiovascular risk factor. Postmenopausal women with decreased BMD should be considered to have a higher risk of cardiovascular events, because standard risk scales do not take BMD into account.     

绝经后2型糖尿病女性雌激素水平与骨质疏松的相关性研究

【目的】探讨绝经后2型糖尿病（T2DM）合并骨质疏松（OP）妇女雌激素水平及骨密度的变化及其相关性。【方法】120例绝经后女性T2DM患者根据骨密度值分为骨密度正常组即T组（62例）,骨质疏松组即P组（58例）。另选取60例血糖及骨密度均正常的绝经后女性作为正常对照组,即N组（60例）。比较三组骨代谢、糖代谢及性激素等指标。【结果】P组骨碱性磷酸酶（sBAP）、骨钙素（sOC）、Ⅰ型胶原交联C 端肽（sCTx）和尿Ⅰ型胶原交联N 端肽（uNTx）明显低于T组。P组与T组、N组比较,血清卵泡刺激素（FSH）、促黄体激素（LH）升高,雌二醇（E2）下降（ P＜0．05）。相关性分析显示,患者O P与糖尿病病程、年龄、糖化血红蛋白（HbA1C）、空腹血糖（FPG）、FSH、LH、uNTx与肌酐（Cr）呈显著负相关,与sBAP、sOC、sCTx无相关性。【结论】绝经后T2DM妇女骨质疏松与糖代谢及雌激素水平有关。     

Health maintenance for postmenopausal women

Menopause is the permanent cessation of menstruation resulting from the loss of ovarian and follicular activity. It usually occurs when women reach their early 50s. Vasomotor symptoms and vaginal dryness are frequently reported during menopause. Estrogen is the most effective treatment for management of hot flashes and night sweats. Local estrogen is preferred for vulvovaginal symptoms because of its excellent therapeutic response. Bone mineral density screening should be performed in all women older than 65 years, and should begin sooner in women with additional risk factors for osteoporotic fractures. Adequate intake of calcium and vitamin D should be encouraged for all postmenopausal women to reduce bone loss. Coronary artery disease is the leading cause of death in women. Postmenopausal women should be counseled regarding lifestyle modification, including smoking cessation and regular physical activity. All women should receive periodic measurement of blood pressure and lipids. Appropriate pharmacotherapy should be initiated when indicated. Women should receive breast cancer screening every one to two years beginning at age 40, as well as colorectal cancer screening beginning at age 50. Women younger than 65 years who are sexually active and have a cervix should receive routine cervical cancer screening with Papanicolaou smear. Recommended immunizations for menopausal women include an annual influenza vaccine, a tetanus and diphtheria toxoid booster every 10 years, and a one-time pneumococcal vaccine after age 65 years.     

Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women.

OBJECTIVE: To examine whether postmenopausal women with diabetes experienced a higher incidence of hip fracture than women without diabetes. RESEARCH DESIGN AND METHODS: A prospective cohort of 32,089 postmenopausal women residing in Iowa were surveyed by mail in 1986 and followed for 11 years. Diabetes status and other potential risk factors were assessed by questionnaires at baseline; incidence of hip fracture was ascertained by follow-up questionnaires. RESULTS: A total of 490 hip fractures were reported over 306,900 person-years of follow-up. After adjustment for age, smoking status, estrogen use, BMI, and waist-to-hip ratio, women with type 1 diabetes (n = 47) were 12.25 times (95% CI 5.05-29.73) more likely to report an incident hip fracture than women without diabetes. Women with type 2 diabetes had a 1.70-fold higher risk (1.21-2.38) of incident hip fracture than women without diabetes. Longer duration of type 2 diabetes was associated with higher incidence, as was use of insulin or oral diabetes medications in women with type 2 diabetes. Furthermore, women who were initially free of diabetes but in whom diabetes developed had a relative risk of hip fracture of 1.60 (1.14-2.25) compared with women who never had diabetes. CONCLUSIONS: Postmenopausal women who have diabetes or in whom diabetes develops are at higher risk for hip fracture than nondiabetic postmenopausal women. Strategies to prevent osteoporosis and/or falling may be especially warranted in women with diabetes.     

Osteoporosis associated with primary hyperparathyroidism

Primary hyperparathyroidism (pHPT) is cited as one of diseases which cause secondary osteoporosis and predominantly affects cortical bone. This disease occurs frequently during the postmenopausal period. Parathyroidectomy (PTX) is the only option available for the radical cure of pHPT and brings about marked increase in bone mass even in postmenopausal women. On the other hand, this disease is now recognized as a disorder with few overt manifestations, presenting as asymptomatic hypercalcemia. Even in these cases, a considerable increase in bone mass can be obtained by PTX. Bisphosphonate as well as estrogen and raloxifene are also reported to increase bone mass in elderly pHPT. patients. These drugs are considered as alternative therapy for mild pHPT patients who have many complications and/or are unfit for surgery.     

LC-MS-based plasma metabolomics reveals metabolic variations in ovariectomy-induced osteoporosis in female Wistar rats

Osteoporosis with a reduction in bone mineral density has become one of the most common metabolic bone diseases. Postmenopausal women are a high-risk group that suffers from osteoporosis when the production of estrogen in their body rapidly declines. Early prediction and diagnosis of osteoporosis will be conducive to having a greater chance to control the deterioration in condition of osteoporosis patients; however, there are still no effective measures in practice. In this study, we aimed at exploring metabolic variations in postmenopausal osteoporosis using ovariectomized female rats as an animal model. The research was performed using liquid chromatography/mass spectrometry (LC/MS) combined with multivariate statistical analysis for plasma metabolome analysis. The results reveal that metabolic variations of ovariectomized-induced osteoporosis involve 18 differentially expressed metabolites and 13 related metabolism pathways such as valine, leucine and isoleucine biosynthesis as well as arachidonic acid and glycerophospholipid metabolism. Notably, the ingenuity pathway analysis platform for further understanding the relationship between metabolic alteration and osteoporosis shows that the change in the levels of metabolites mainly lead to the abnormal state of cellular compromise, cell signaling, inflammation, molecular transport and lipid metabolism. Metabolomics, as a novel way to characterize resolute endogenous small metabolites in organisms, describes the variation in the early stages of metabolic alteration for offering valuable information on pathogenic mechanisms.

Osteoporosis with a reduction in bone mineral density has become one of the most common metabolic bone diseases.     

Height change and bone mineral density: revisited

PURPOSE: To evaluate the relationship between height change, osteoporosis risk factors, and bone mineral density. SAMPLE: Secondary data collected on 168 healthy women, ages 50 to 65 years, who had a dual energy x-ray absorptiometry screening of the hip and spine to determine bone mineral density. METHOD: A quantitative secondary analysis of data that replicated in part a study by Hunt (1996). FINDINGS: The relationships between height change, osteoporosis risk factors, and bone mineral density were not significant for this group of healthy postmenopausal women. However, these women did not meet daily minimum requirements for dietary calcium intake and daily exercise. IMPLICATIONS: The good news is that healthy women ages 50 to 65 years still have time to engage in osteoporosis preventing behaviors to prevent bone loss and eventual height loss. The use of measured height change, as an indicator for osteoporosis risk, is a cost-saving tool and should be considered as one component of a comprehensive osteoporosis health appraisal incorporating daily calcium intake and exercise. Further research, with more precise measurement of height, needs to be done to evaluate the relationship between height change, osteoporosis risk factors, and bone mineral density.