Effectiveness of a community-based osteoporosis education and self-management course: a wait list controlled trial

Summary  Osteoporosis is an increasing burden on individuals and health resources. The Osteoporosis Prevention and Self-Management Course (OPSMC) was designed to assist individuals to prevent and manage osteoporosis; however, it had not been evaluated in an Australian setting. This randomised controlled trial showed that the course increased osteoporosis knowledge. Introduction and hypothesis  Osteoporosis is a major and growing public health concern. An OPSMC was designed to provide individuals with information and skills to prevent or manage osteoporosis, but its effectiveness has not previously been evaluated. This study aimed to determine whether OPSMC attendance improved osteoporosis knowledge, self-efficacy, self-management skills or behaviour. Materials and methods  Using a wait list randomised controlled trial design, 198 people (92% female) recruited from the community and aged over 40 (mean age = 63) were randomised into control (n = 95) and intervention (n = 103) groups. The OPSMC consists of four weekly sessions which run for 2 h and are led by two facilitators. The primary outcome were osteoporosis knowledge, health-directed behaviour, self-monitoring and insight and self-efficacy. Results  The groups were comparable at baseline. At 6-week follow-up, the intervention group showed a significant increase in osteoporosis knowledge compared with the control group; mean change 3.5 (p < 0.001) on a measure of 0–20. The intervention group also demonstrated a larger increase in health-directed behaviour, mean change 0.16 (p < 0.05), on a measure of 0–6. Conclusion  The results indicate that the OPSMC is an effective intervention for improving understanding of osteoporosis and some aspects of behaviour in the short term.     

A nomogram for predicting osteoporosis risk based on age, weight and quantitative ultrasound measurement

Introduction Quantitative ultrasound measurement (QUS) or clinical risk index alone are not reliable tools for the identification of women with osteoporosis. This study examined the prognostic value of combined QUS and clinical risk index for predicting osteoporosis risk in Thai women. Methods The study was designed as a cross-sectional investigation with 300 women of Thai background, aged between 38 and 85 years (mean age: 58). Femoral neck bone mineral density (BMD) was measured by DXA (Hologic QDR-4500; Bedford, MA, USA). A femoral neck BMD T-scores ≤ −2.5 was defined as “osteoporosis”; otherwise, “non-osteoporosis”. QUS was measured by Achilles+ (GE Lunar, Madison, WI, USA) and converted to T-score. Three models for predicting osteoporosis were considered: model I included age, weight and QUS, model II included age and weight, and model III included only QUS. The prognostic performance among the models was assessed by the area under the receiver operating characteristic curve (AUC). Results The prevalence of osteoporosis was 12.7% (n = 38/300) by femoral neck BMD. Age, weight and QUS were each significantly associated with osteoporosis risk. The AUC±SE value for model I was 0.86 ± 0.03, which was significantly higher (p = 0.02) than that for model II (AUC = 0.80 ± 0.04) or model III (AUC = 0.79 ± 0.04). Based on the estimated parameters of model I, a nomogram was constructed for predicting osteoporosis. Conclusion These data suggest that the combination of QUS and age and weight could significantly improve the prognosis of osteoporosis in Asian women, and that the nomogram can assist primary care physicians in the identification of high-risk women.     

Low bone mineral density at femoral neck is a predictor of increased mortality in elderly Japanese women

Summary  

This study aimed to determine whether low bone mineral density (BMD) at the femoral neck independently predicts all-cause mortality in elderly Japanese women. A prospective cohort study of 271 women aged 67–89 years was conducted. A Cox proportional hazard model was used to examine independent associations between BMD and total mortality. During a 12-year follow-up period, the mortality risk (as measured by hazard ratio [HR]) was significantly increased in the three categories of baseline BMD (diagnostic criteria of osteoporosis, tertile of BMD, and quartile of BMD). After adjusting for major potential confounding variables for mortality, significantly increased mortality risks were found in subjects with osteoporosis (HR = 2.17, p = 0.032), in subjects in the lowest tertile (HR = 2.57, p = 0.007), and in subjects in the lowest quartile (HR = 3.13, p = 0.014], respectively. Our findings suggest that preventive strategies should be considered to increase and maintain high BMD at the femoral neck in the elderly women not only to prevent hip fractures but also probably to reduce mortality risk.     

Association between iron overload and osteoporosis in patients with hereditary hemochromatosis

Summary  In 87 patients with hereditary hemochromatosis, osteoporosis was detected in 25%, and osteopenia in 41%. Bone mineral density was independently associated with BMI, ALP levels, hypogonadism/menopause, and the amount of iron removed to reach depletion, but not with cirrhosis. Osteoporosis is influenced by iron overload in hemochromatosis. Introduction  To analyze prevalence, clinical characteristics and genetic background associated with osteoporosis in a retrospective study in Italian patients with hereditary hemochromatosis (HHC). Methods  In 87 consecutive patients with HHC, bone mineral density was systematically evaluated by dual energy x-ray absorptiometry of the lumbar spine (n = 87) and femoral neck (n = 66). Results  Osteoporosis was detected in 22 (25.3%), and osteopenia in 36 (41.4%) patients. Mean Z scores were −0.92 ± 1.42 at lumbar spine and −0.35 ± 1.41 at femoral neck. Lumbar spine T-score was independently associated with total ALP (p = 0.002), hypogonadism/menopause (p = 0.026), and iron overload (p = 0.033 for ferritin and p = 0.017 for iron removed). We observed a borderline significance for BMI (p = 0.069) and smoking status (p = 0.086). Lumbar spine osteoporosis was independently associated with lower BMI (OR 0.73, 95% CI 0.54–0.94), total ALP (OR 1.17, 95% CI 1–1.39 per 10 unit increase) and the amount of iron removed (OR 1.53, 95% CI 1–2.5 per 5 g increase). HFE genotypes did not differ between patients with and without osteoporosis. Conclusions  Osteoporosis is observed in a quarter of unselected patients with HHC, independently of the genetic background, and is associated with ALP, hypogonadism, body weight, and severity of iron overload.     

Increase of Bone Resorption and the Parathyroid Hormone in Postmenopausal Women in the Long-term after Roux-en-Y Gastric Bypass

Background  The effects of Roux-en-Y Gastric Bypass (RYGB) on bone in the long-term remains unclear. We assessed bone metabolism and bone mineral density (BMD) 1 to 5 years after RYGB. Methods  We designed a retrospective cohort study in 26 postmenopausal women (58.0 ± 3.9 years old) with RYGB 3.5 ± 1.1 years before (body mass index (BMI) 29.5 ± 3.8 kg/m², presurgery 43.6 ± 5.5 kg/m²) and 26 nonoperated women (57.5 ± 4.7 years old, BMI 29.2 ± 4.1 kg/m²) matched by age and BMI. The main measures were BMD, serum carboxy telopeptide (CTx), total alkaline phosphatases (ALP), parathyroid hormone (PTH), 25-hydroxyvitamin D (25OHD), and ghrelin. Results  RYGB group, compared to nonoperated women, had higher CTx (0.71 ± 0.21 vs. 0.43 ± 0.15 ng/ml; P < 0.01) and PTH (68.3 ± 35 vs. 49.4 ± 16 pg/ml; P = 0.02). There were no differences between RYGB and nonoperated women in: calcium and vitamin D intake (759 ± 457 vs. 705 ± 460 mg/day; 176 ± 160 vs. 111 ± 86 UI/day), ghrelin (763 ± 336 vs. 621 ± 274 pg/ml), ALP (101 ± 22 vs. 94 ± 25 UI/l), 25OHD (18.8  ± 7.6 vs. 17.4 ± 5.9 ng/ml), lumbar spine BMD (1.059 ± 0.32 vs. 1.071 ± 0.207 g/cm²), or femoral neck BMD (0.892 ± 0.109 vs. 0.934 ± 1.1 g/cm²). Conclusions  RYGB is associated to high bone resorption and hyperparathyroidism prevalence in postmenopausal women in the long-term. This occurs independently of the intake of calcium, vitamin D status, or ghrelin and does not seem to affect BMD after RYGB.     

Increased augmentation index and central aortic blood pressure in osteoporotic postmenopausal women

Summary Osteoporosis has been associated with cardiovascular disease. We found increased augmentation index, a measure of wave reflections and arterial stiffness, and central pressures in osteoporotic postmenopausal women. They also showed a higher estimated aortic pulse wave velocity, indicating a stiffer aorta. These changes may increase cardiovascular risk in postmenopausal osteoporosis. Introduction Evidence suggests a link between osteoporosis and cardiovascular disease. We investigated whether augmentation index (AIx), a measure of pulse wave reflections and arterial stiffness, is increased and related to the osteoprotegerin (OPG)/receptor activator of nuclear factor-kappa B ligand (RANKL) system in postmenopausal osteoporosis. Methods AIx and central aortic haemodynamics were assessed using pulse wave analysis in 182 cardiovascular disease-free osteoporotic postmenopausal women and in 160 controls. Statistical analysis was performed by unpaired t test, Mann-Whitney test, Spearman‘s correlation coefficient, and multivariate linear regression analysis. Results AIx (37.2 ± 7.0 vs. 29.6 ± 9.2 %, P < 0.0001) and central aortic systolic (117.5 ± 12.1 vs. 111.4 ± 12.2 mmHg, P < 0.0001) and pulse (40.5 ± 10.3 vs. 36.4 ± 8.1 mmHg, P = 0.0007) pressures were significantly higher in osteoporotic patients than in controls. The estimated aortic pulse wave velocity (PWV) was also significantly higher in the osteoporotic group. In multivariate analysis for osteoporotic patients, femoral neck and lumbar spine bone mineral density T scores were independent negative predictors of AIx (P < 0.0001). AIx was not correlated with serum levels of OPG and RANKL. Conclusions Osteoporotic postmenopausal women show increased AIx and central aortic pressures, and a higher estimated aortic PWV, indicating a stiffer aorta. Such alterations may increase cardiovascular risk in postmenopausal osteoporosis.     

Teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: an analysis by gender and menopausal status

Summary  

The effects of teriparatide versus alendronate were compared by gender and menopausal status in patients with glucocorticoid-induced osteoporosis. At 18 months, increases in lumbar spine BMD were significantly greater in the teriparatide versus alendronate group in postmenopausal women (7.8% versus 3.7%, p < 0.001), premenopausal women (7.0% versus 0.7%, p < 0.001), and men (7.3% versus 3.7%, p = 0.03).     

Harnessing stakeholder perspectives to improve the care of osteoporosis after a fracture

Summary  This study used in-depth interviews and focus groups to evaluate osteoporosis care after a fracture. Patients (eligible women aged 67 who sustained a clinical fracture(s)), clinicians, and staff stated that an outreach program facilitated osteoporosis care management, but more-tailored education and support and increased participation of orthopedic specialists appear necessary. Introduction  Osteoporosis treatment reduces fracture risk, but screening and treatment are underutilized, even after a fracture has occurred. This study evaluated key stakeholder perspectives about the care of osteoporosis after a fracture. Methods  Participants were from a nonprofit health maintenance organization in the United States: eligible women members aged 67 or older who sustained a clinical fracture(s) (n = 10), quality and other health care managers (n = 20), primary care providers (n = 9), and orthopedic clinicians and staff (n = 28); total n = 67. In-depth interviews and focus groups elicited participant perspectives on an outreach program to patients and clinicians and other facilitators and barriers to care. Interviews and focus group sessions were transcribed and content-analyzed. Results  Patients, clinicians, and staff stated that outreach facilitated osteoporosis care management, but important patient barriers remained. Patient knowledge gaps and fatalism were common. Providers stated that management needed to begin earlier, and longer-term patient support was necessary to address adherence. Orthopedic clinicians and staff expressed lack of confidence in their osteoporosis management but willingness to encourage treatment. Conclusions  Although an outreach program assisted with the management of osteoporosis after a fracture, more-tailored education and support and increased participation of orthopedic specialists appear necessary to maximize osteoporosis management. Disclaimers: This study was supported in part by a research contract from Merck & Co., Inc. The sponsor had no role in the study design, methods, subject recruitment, data collection, analysis, or preparation of the paper. Dr. Feldstein has received research grant support from Merck & Co, Inc.; Amgen; and Sanofi-Aventis. Dr. Vollmer has served on ad hoc advisory boards for Merck and Co., Inc., and is director of the Burden of Obstructive Lung Disease (BOLD) Operations Center, funding for which includes unrestricted educational grants to his employer, the Center for Health Research, Kaiser Permanente Northwest, from Boehringer Ingelheim, Pfizer, ALTANA, GlaxoSmithKline, AstraZeneca, Novartis, Chiesi, and Merck. Dr. Smith has received research grant support from Sanofi-Aventis, Abbot, Amgen, and Genzyme.     

Nitrate use and changes in bone mineral density: the Canadian Multicentre Osteoporosis Study

Summary  Nitrates may have beneficial effects on bone. To determine if nitrates were associated with increased bone mineral density (BMD), we conducted a secondary analysis using data from subjects in a prospective study. Subjects reporting nitrate use had increased BMD compared with non-users, confirming that nitrates have positive BMD effects in women and men. Introduction  Prior studies suggest positive associations between nitrates and bone. Methods  We used linear regression models, stratified by gender and adjusted for age, weight, and baseline differences, to determine the association between daily nitrate use and BMD among subjects participating in the Canadian Multicentre Osteoporosis Study. All results are reported as annualised percent change in BMD at the hip and spine among nitrate users compared to non-users. Results  We included 1,419 men (71 reported daily nitrate use) and 2,587 women (97 reported daily nitrate use). Male non-users had decreased hip BMD (−1.3%; 95% confidence interval [95%CI] = −1.6 to −1.1) and increased spine BMD (2.8%; 95%CI = 2.5 to 3.1). Male nitrate users had increased hip BMD (1.4%; 95%CI = 0.1 to 2.8) and spine BMD (4.5%; 95%CI = 3.2 to 5.7). Among women, non-users had decreased hip BMD (−1.9; 95%CI = −2.1 to −1.7) and increased spine BMD (2.1%; 95%CI = 1.9 to 2.4) whilst users had an increase in hip BMD (2.0%; 95%CI = 1.2 to 2.8) and spine BMD (4.1%; 95%CI = 3.4 to 4.9). Conclusion  Nitrate use is associated with increased BMD at the hip and spine in men and women.     

Effect of raloxifene on clinical fractures in Asian women with postmenopausal osteoporosis

Osteoporosis is becoming a major public health problem in Asian countries, with a rapid increase in osteoporotic fractures projected as urbanization increases, particularly in China. The purpose of this post hoc analysis was to assess the effects of 12 months of treatment with raloxifene on the incidence of clinical fractures in postmenopausal Asian women, compared to a placebo, by combining two independently designed studies (one Japanese study and one Chinese study). A total of 488 women, 284 in Japan and 204 in China were included in the analysis. Baseline characteristics (mean ± SD) for the Japanese and Chinese women were: age, 64.8 ± 6.3 years and 65.3 ± 6.0 years; body mass index, 21.8 ± 2.8 kg/m² and 23.0 ± 2.9 kg/m²; and prevalent vertebral fractures, 26.4% and 13.7%, respectively. In both studies, the clinical vertebral and nonvertebral fractures were confirmed by radiographs or clinical reports at a central research facility. From the two combined studies, the incidence of new clinical vertebral fractures was significantly lower in the raloxifene 60 mg/day (RLX60) group (0 out of 194, P = 0.01) and in the pooled raloxifene group (those taking 60 mg/day and those taking 120 mg/day) (0 out of 289, P = 0.002), compared with the placebo group (7 out of 199, 3.5%). The pooled raloxifene group, as well as the RLX60 group, also had a significantly lower incidence of any new clinical fracture (P = 0.001 and P = 0.01, respectively) compared to the placebo group. In conclusion, raloxifene treatment at 60 mg/day for 1 year resulted in a significant reduction in the risk of new clinical vertebral fractures and any new clinical fracture in postmenopausal Asian women with osteoporosis.     

Osteoporosis among Ethiopian immigrant women: a risk analysis

Summary The objective was to evaluate the prevalence of osteoporosis among Ethiopian immigrant and Israeli-born women and to determine the risk factors. The study revealed extreme prevalence of osteoporosis among Ethiopian immigrants (38.7). A strong association between calcium intake during adolescence, BMI, lactation duration, physical activity, oral contraceptive and osteoporosis is suggested. Introduction Osteoporosis is a chronic disease characterized by low bone mass and deterioration in the micro-architecture of bone that increases its susceptibility to fractures. We set out to evaluate the prevalence of osteoporosis among Ethiopian immigrant and Israeli-born women and to determine the risk factors. Methods A cross-sectional study among 181 Ethiopians immigrants and 98 Israeli-born women. Hip, forearm and spinal bone mineral density (BMD) were measured. Risk factor information was obtained from an interview. BMD and osteoporosis rates were compared between the groups. Step-wise regression models were constructed for osteoporosis as the dependent variable controlling for potential confounders. Results We defined 38.7% Ethiopian and 5.2% Israeli-born women as having osteoporosis. Rates of low BMI, prolonged lactation, age at first giving birth and sunlight exposure were higher in Ethiopian women compared to the Israeli-born. Multivariate analysis revealed a strong association between calcium intake during adolescence, BMI, lactation duration, physical activity, oral contraceptive use and osteoporosis. Conclusions The prevalence of osteoporosis among Ethiopian immigrant women living in Israel is extremely high compared to national and international rates. Therefore, we suggest that an immediate prevention program among Ethiopian women be started and guidelines for care-givers be developed, in order to raise their awareness for osteoporosis. Drs. Peled and Dahan contributed equally to this article.     

Effect of daily oral minodronate on vertebral fractures in Japanese postmenopausal women with established osteoporosis: a randomized placebo-controlled double-blind study

Summary  A randomized placebo-controlled trial was conducted to examine the effect of daily oral 1 mg minodronate on vertebral fractures in 704 postmenopausal women with established osteoporosis for 24 months. Minodronate treatment reduced vertebral fractures by 59% without serious adverse events. Minodronate is a safe and effective bisphosphonate for osteoporosis treatment. Introduction  Minodronate increases bone mineral density (BMD) in postmenopausal osteoporotic patients. However, its efficacy in reducing osteoporotic fractures has not been tested. Methods  To examine anti-fracture efficacy and safety of daily oral minodronate in postmenopausal women with established osteoporosis, a randomized, double-blind, placebo-controlled trial was conducted in 704 postmenopausal women (55 to 80 years) with one to five vertebral fractures and low BMD. Subjects were randomly assigned to receive daily oral 1 mg minodronate (n = 359) or placebo (n = 345) for 24 months, with daily supplements of 600 mg calcium and 200 IU vitamin D₃. Results  Daily 1 mg minodronate for 24 months reduced the risk of vertebral fractures by 59% (95% CI, 36.6–73.3%). Furthermore, when fractures during the first 6 months were eliminated, the risk of vertebral fractures from 6 to 24 months was reduced by 74% in minodronate-treated group. Minodronate treatment also reduced height loss. Bone turnover markers were suppressed by about 50% after 6 months of minodronate treatment and remained suppressed thereafter. The overall safety profile including gastrointestinal safety was similar between the two groups. Conclusions  Daily oral minodronate is safe, well-tolerated, and is effective in reducing vertebral fracture risk in postmenopausal women with established osteoporosis. ClinicalTrials.gov Identifier: NCT00212667.     

Changes in 25-Hydroxyvitamin D3 to oral treatment with vitamin D3 in postmenopausal females with osteoporosis

Summary  This study reports on oral treatment with different doses of vitamin D3 ranging from 25 to 200 μg in females with 25-hydroxyvitamin D3 levels < 60 nmol/L screened for participation in an osteoporosis trial. A guidance to safely and efficiently achieve 25-hydroxyvitamin D3 levels > 60 nmol/L is presented. Introduction  The importance of vitamin D for skeletal health has been implemented in clinical trials in osteoporosis. The threshold of 25-hydroxyvitamin D for inclusion has changed from 30 to 60 nmol/L. This study reports on oral treatment with different doses of vitamin D3 in females with 25-hydroxyvitamin D3 levels < 60 nmol/L. Methods  In 131 postmenopausal females screened for participation in an osteoporosis trial, the 25-hydroxyvitamin D3 concentration was < 60 nmol/L. They were treated with 25 (n = 22), 50 (n = 19), 75 (n = 19), 100 (n = 41) or 200 μg (n = 30) of vitamin D3 daily for at least 10 days. Results  In the females treated with 25, 50, 75, 100 and 200 μg of vitamin D3 daily the 25-hydroxyvitamin D3 concentrations increased significantly from 32.4 ± 2.7 (mean ± SEM) to 50.8 ± 2.9, from 46.7 ± 2.8 to 65.8 ± 2.6, from 41.6 ± 2.7 to 67.4 ± 2.9, from 46.7 ± 1.4 to 64.4 ± 2.2 and from 42.1 ± 2.0 to 71.2 ± 2.8 nmol/L, respectively (p < 0.001). S-calcium increased significantly but within the reference range (p < 0.006). Conclusion  Oral vitamin D3 safely increased 25-hydroxyvitamin D3 concentrations in all females above 60 nmol/L. This study demonstrates how to achieve the new recommended 25-hydroxyvitamin D concentrations within the screening period of a clinical trial.     

Differentiation between post-menopausal women with and without hip fractures: enhanced evaluation of clinical DXA by topological analysis of the mineral distribution in the scan images

Summary  We introduce an algorithm to evaluate hip DXA scans using quantitative image analysis procedures based on the Minkowski functionals (MF) for differentiation between post-menopausal women with and without hip fracture. In a population of 30 post-menopausal women, the new parameter has a highly discriminative potential with a performance superior to standard densitometry providing complementary information compared to BMD. Introduction  We introduce a novel algorithm to evaluate DXA scans of the hip using quantitative image analysis based on the Minkowski functionals (MF) to identify post-menopausal women with hip-fracture and to compare the results with densitometry. Methods  BMD of 30 women (73.9 ± 10.3 years), 15 of whom had a recent hip fracture, is obtained by DXA using the “total hip” ROI. The topology of mineral distribution in the scan images is evaluated using the MF-based parameter MF2D. ROC analysis is employed to assess the discriminative potential (fracture/non-fracture). Results  The area-under-the-curve (AUC) for identification of patients with/without fractures by BMD is .72(p = 0.04), AUC for MF2D is .85(p = 0.001). No statistically significant correlation exists between MF2D and BMD. By discriminant analysis we can show that by combination of MF2D and BMD the outcome increases significantly: using BMD or MF2D alone, 63% and 70% of cases are classified correctly versus 77% of cases in the multivariate model. Conclusion  The topology-based parameter has a high predictive potential with respect to identification of patients with high risk of hip fracture, performance is superior to densitometry. The new method provides information complementary to BMD. Best classification results are obtained when BMD and MF2D are combined in a multivariate model.     

High prevalence of fractures in Brazilian patients with inflammatory bowel disease: lack of association with bone mass density and quantitative ultrasound measurements

Summary To investigate the impact of inflammatory bowel disease (IBD) on bone status, a cross-sectional study was conducted including 102 Brazilian patients with ulcerative colitis or Crohn’s disease. Our results demonstrated the higher prevalence of low bone mass and fragility fractures in Brazilian patients compared with other populations with IBD. Introduction The prevalence of low bone mass and fractures in Brazilian patients with Crohn’s disease (CD) and ulcerative colitis (UC) was investigated. Methods Patients with CD or UC answered a questionnaire detailing clinical risk factors for fracture. Bone mineral density (BMD) and quantitative ultrasound (QUS) measurements were performed in all patients. Spine X-ray was performed to determine the prevalence of vertebral fractures. Non-vertebral fracture data were obtained from medical history. Results A total of 61 women and 41 men (mean age 41.2 years) were included. Fractures were observed in 40.8% and 33.3% of the UC and CD patients respectively. 31.9% and 7.2% of the patients had vertebral and non-vertebral fractures respectively. Weight and body mass index were higher in patients with fracture than in those without (p < 0.01), while other clinical variables did not differ significantly between groups. Densitometric osteoporosis was detected in 14.7% of the population. Osteoporosis was more prevalent among men than women (p = 0.014). CD patients had significantly lower BMD values than UC patients. BMD and QUS values were not associated with fractures. Conclusion We observed a high prevalence of vertebral fractures (37.1%) in a young Brazilian IBD population. BMD and QUS were not associated with fracture in these patients.     

Poverty is a risk factor for osteoporotic fractures

Summary  This study assesses the possible association between poverty and osteoporosis and/or fragility fractures in a population of postmenopausal women. We found that postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. Introduction  Some lifestyles are related to the presence of osteoporosis and/or fragility fractures, whereas poverty is related to some lifestyles. Because of this, we studied the possible association of poverty with osteoporosis and fractures. Methods  This was an observational, cross-sectional study performed in the Canary Islands, Spain. Participants consisted of a total of 1,139 ambulatory postmenopausal women aged 50 years or older with no previous osteoporosis diagnosis and who were enrolled in some epidemiological studies. The prevalence of fractures (vertebral and non-vertebral) and the prevalence of osteoporosis (T-score <–2.5 either at the lumbar spine or the femoral neck). A previously validated questionnaire elicited the most important risk factors for osteoporosis: socioeconomic status, defined by the annual income was also assessed by a personal interview. A dorso-lateral X-ray of the spine was performed, and bone mineral density (BMD) was measured by DXA in the lumbar spine (L2–L4) and proximal femur. Results  Compared to women with a medium and high socioeconomic status (n = 665), those who were classified into poverty (annual family income lower than 6,346.80 Euros, in a one-member family, n = 474), were older and heavier and had lower height, lower prevalence of tobacco and alcohol consumption, lower use of HRT and higher use of thiazides. After correcting for age and body mass index (BMI), women in poverty had lower spine BMD values than women with a medium and high socioeconomic status (0.840 g/cm² vs. 0.867 g/cm², p = 0.005), but there were no statistical differences in femoral neck BMD between groups. The prevalence of osteoporosis was also higher in women in poverty [40.6% vs. 35.6%, (OR 1.35, CI 95%: 1.03; 1.76)] after adjusting by age and BMI. Moreover, 37.8% of women in poverty had a history of at least one fragility fracture compared to 27.7% of women not in poverty (OR: 1.45, CI 95%: 1.11; 1.90). The prevalence of vertebral fractures was also higher in women in poverty 24.7% vs. 13.4%, (OR 2.01, CI 95%: 1.44; 2.81). Conclusions  Postmenopausal women with low socioeconomic status had lower values of BMD at the lumbar spine, and a higher prevalence of densitometric osteoporosis, and a higher prevalence of total and vertebral fractures. Because of this, apart from the well known risk factors for osteoporosis, poverty should be taken into account as a possible risk factor for both osteoporosis and fragility fractures, in order to establish sanitary strategies to protect unfavoured postmenopausal women. This study was support by an unrestricted grant of the Canarian Society of Osteoporosis (SOCAOS SL).     

Evaluation of Bone Disease in Morbidly Obese Women After Gastric Bypass and Risk Factors Implicated in Bone Loss

Background  In patients undergoing gastric bypass, massive weight loss and impairment of calcium intake and absorption in the duodenum and proximal jejunum may increase the risk of bone mass loss and fractures. However, few data are available regarding the impact of this surgery on the skeleton. The aim of our study was to examine the skeletal changes in a cohort of morbidly obese Caucasian women during the first year after gastric bypass and to analyse the factors implicated in the development of bone loss. Methods  Sixty-two morbidly obese white women aged 45.3 ± 8.9 years were studied. Anthropometric measurements, bone mineral density (BMD) screening using dual-energy X- ray absorptiometry and plasma determinations of calcium, phosphorus, parathyroid hormone (PTH), 25-hydroxyvitamin D [25(OH) D₃] and insulin-like growth factor-I (IGF-I) were made prior to and 12 months after surgery. Results  A year after surgery, BMD significantly decreased at the femoral neck (10.2 ± 5.7%) and at the lumbar spine (3.2 ± 4.4%). In the follow-up, 16.1% of women had osteopenia at the femoral neck and 19.3% at the lumbar spine, and 1.6% developed osteoporosis at the lumbar spine. Patients with bone disease were significantly older; the percentage of women with menopause was greater in this group and had lower initial and final values of lean mass. However, no differences in body mass index, weight loss, fat mass, calcium, PTH, 25(OH) D₃ or IGF-I values were found between groups. In the logistic regression analysis, lean mass 12 months after surgery and menopause were found to be the main determinants of osteopenia after adjusting for age with odds ratios of 0.82 and 9.13, respectively. Conclusions  There is a significant BMD loss at the femoral neck and lumbar spine a year after gastric bypass. Menopausal patients and those with greater lean mass loss are at greater risk and, consequently, should be closely followed up with periodic densitometries.     

Peroxisome proliferator-activated receptor gamma polymorphism is related to peak bone mass: the JPOS study

Summary  

We analyzed 1,217 women to examine the effect of peroxisome proliferator-activated receptors gamma (PPARγ) C161 → T on bone status. Among 664 premenopausal women, the C161 → T is associated with low bone mineral density (BMD) at the total hip and femoral neck. Moreover, the odds ratio for osteopenia or osteoporosis at the femoral neck was 1.98 for premenopausal CT/TT genotypes.     

Fracture incidence and changes in quality of life in women with an inadequate clinical outcome from osteoporosis therapy: the Observational Study of Severe Osteoporosis (OSSO)

Summary In this observational study of women with an inadequate clinical outcome to osteoporosis therapy, those with a fracture at baseline were more likely to sustain an incident fracture and have a worse health-related quality of life than those without prior fracture. Introduction The Observational Study of Severe Osteoporosis (OSSO) was designed to assess the fracture incidence and health-related quality of life (HRQoL) in women with an inadequate clinical outcome to osteoporosis therapy. Methods Post-menopausal women (N = 1,885) with established osteoporosis and an inadequate clinical response to osteoporosis drug therapy defined as: a) a fragility fracture despite therapy for one year (index fracture, N = 988), or b) discontinued drug therapy due to adverse effects and/or non-compliance (N = 897), were assessed during one year for HRQoL using the EQ-5D and the QUALEFFO questionnaires. Results One hundred and sixty-six (8.8%) women had a total of 209 incident fractures (1,139 fractures/10,000 women-years). Women with an index fracture were more likely to sustain an incident fracture than those without prior fractures (hazard ratio 1.91; 95% CI: 1.37–2.66; p < 0.001). Co-morbidities or antidepressant use at baseline also increased the risk of incident fracture. Median total EQ-5D Health State Values and QUALEFFO scores were worse in women with an incident fracture regardless of index fracture status. The worst scores were reported in the EQ-5D sub-domains of self-care, usual activities and pain/discomfort. Conclusions Women with an inadequate response to osteoporosis therapy had a high rate of incident fracture which had an adverse impact on HRQoL.