Preference for wine is associated with lower hip fracture incidence in post-menopausal women

Background

Past studies of relationships between alcohol and hip fracture have generally focused on total alcohol consumed and not type of alcohol. Different types of alcohol consist of varying components which may affect risk of hip fracture differentially. This study seeks to examine the relationship between alcohol consumption, with a focus on type of alcohol consumed (e.g. beer, wine, or hard liquor) and hip fracture risk in post-menopausal women.

Methods

The longitudinal cohort consisted of U.S. post-menopausal women aged 50–79 years enrolled between 1993–1998 in the Women’s Health Initiative Clinical Trials and Observational Study (N=115,655).

Results

Women were categorized as non-drinkers, past drinkers, infrequent drinkers and drinkers by preference of alcohol type (i.e. those who preferred wine, beer, hard liquor, or who had no strong preference). Mean alcohol consumption among current drinkers was 3.3 servings per week; this was similar among those who preferred wine, beer and liquor. After adjustment for potential confounders, alcohol preference was strongly correlated with hip fracture risk (p = 0.0167); in particular, women who preferred wine were at lower risk than non-drinkers (OR=0.78; 95% CI 0.64-0.95), past drinkers (OR=0.85; 95% CI 0.72-1.00), infrequent drinkers (OR=0.73; 95% CI 0.61-0.88), hard liquor drinkers (OR=0.87; 95% CI 0.71-1.06), beer drinkers (OR=0.72; 95% CI 0.55-0.95) and those with no strong preference (OR=0.89; 95% CI 0.89; 95% CI 0.73-1.10).

Conclusions

Preference of alcohol type was associated with hip fracture; women who preferentially consumed wine had a lower risk of hip fracture compared to non-drinkers, past drinkers, and those with other alcohol preferences.

     

Loss of hip bone mineral density over time is associated with spine and hip fracture incidence in osteoporotic postmenopausal women

The objective of the study assess the relationship between bone mineral density (BMD) loss over time and fracture incidence in postmenopausal women. This is a posthoc analysis that includes women from the placebo group of two large randomized controlled trials having assessed the efficacy of a new anti-osteoporotic drug. BMD was assessed every 6 months during 3 years at the lumbar spine, the femoral neck and the total proximal femur. Vertebral fractures were assessed using a semiquantitative method. Hip fractures were based on written documentation. All patients received calcium and vitamin D. In the present study that included 1,775 patients (with complete data at baseline and after 3 years), the logistic regression analysis, adjusted for covariates, showed that 3-year change in lumbar BMD was not statistically associated with the new vertebral fractures after 3 years. However, femoral neck and total proximal femur BMD changes was statistically correlated with the incidence of new vertebral fractures (P < 0.001). When considering change in BMD after the first year of follow-up, a decrease in total proximal femur BMD was statistically associated with an increase in the incidence of new vertebral fractures during the last 2 years of follow-up (P = 0.048). The 3-year change in femoral neck and total proximal BMD was statistically correlated with the incidence of hip and fragility fracture after 3 years (all P < 0.001). In this elderly osteoporotic population receiving calcium and vitamin D, a decrease in hip BMD after 1 or 3 year of follow-up, is associated with an increased risk of fracture incidence. However, spine BMD changes do not influence vertebral fracture incidence.     

Downturn in hip fracture incidence.

Although there was evidence of a decline in hip fracture incidence in the northern United States between 1984 and 1987, most historical data in the United States and Northern Europe indicate that the age-adjusted incidence is rising. Analysis of data from Rochester, MN, from 1928 to 1992 demonstrates that age-adjusted hip fracture incidence rates rose in women from 1928 to 1950, and in men from 1928 to 1980, with falling rates thereafter. These trends were accounted for by initial hip fractures due to moderate trauma in the oldest age groups. Current data from this population show decreased incidence rates within 10% of the goals outlined in "Healthy People 2000," especially among women. A better understanding of the reasons for the decline of hip fracture incidence in Rochester, MN, may provide the basis for more focused interventions in similar populations.     

Race and sex differences in hip fracture incidence

Incidence rates for hip fracture in the United States were estimated using non-federal hospital discharges from the National Hospital Discharge Survey for the years 1974-1979. Age-specific incidence curves for women and for men showed similar patterns of increase in risk with age, with risks approximately doubling every five years after age 50. Age-specific rates by five-year age groups were compared among the four race-sex groups. No significant differences were observed between Black females, Black males, and White males. In contrast, rates for White females were one and one-half to four times those for Black females after age 40 and were approximately double those for White males after age 50. Analysis based on an independent data source of non-federal hospital discharges in Washington, DC confirmed these relationships. In the Washington study, White women were at twice the risk for hip fracture (controlled for age) compared with Black women and at 2.7 times the risk for hip fracture (controlled for age) compared to White men. No significant differences were observed between Black women and Black men.     

Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study

OBJECTIVES: This study examined the effect of birth cohort on incidence rates of hip fracture among women and men in the Framingham Study. METHODS: Age-specific incidence rates of first hip fracture were presented according to tertile of year of birth for 5209 participants of the Framingham Study, a population-based cohort followed since 1948. Sex-specific incidence rate ratios were calculated by Cox regression to assess the relation between birth cohort and hip fracture incidence. RESULTS: An increasing trend in hip fracture incidence rates was observed with year of birth for women (trend, P =.05) and men (trend, P =.03). Relative to those born from 1887 to 1900 (incidence rate ratio [IRR] = 1.0), age-specific incidence rates were greatest in the most recent birth cohort, born from 1911 to 1921 (IRR = 1.4 for women, IRR = 2.0 for men), and intermediate in those born from 1901 to 1910 (IRR = 1.2 for women, IRR = 1.5 for men). CONCLUSIONS: Results suggest risk of hip fracture is increasing for successive birth cohorts. Projections that fail to account for the increase in rates associated with birth cohort underestimate the future public health impact of hip fracture in the United States.     

Ethnic differences in hip fracture: a reduced incidence in Mexican Americans

To confirm a previous report of lower risks of hip fracture in Mexican Americans, we calculated the incidence of hip fractures among Hispanics, blacks, and non-Hispanic whites residing in Bexar County, Texas, during 1980. A total of 576 residents with hip fracture not due to severe trauma were identified. The 1980 census data were used to calculate ethnic-specific incidence rates which were age-adjusted using the entire 1980 US population as the standard. Hip fractures were more common among non-Hispanic white women (139 per 100,000; 95% confidence interval (CI) = 124-153) than among Mexican-American (67 per 100,000; 95% CI = 51-82) or black (55 per 100,000; 95% CI = 27-83) women. Thus, Mexican Americans and blacks are relatively protected from hip fractures, and they may benefit less than whites from prophylactic therapies for osteoporosis.     

可吸收螺钉固定治疗髋关节后脱位伴股骨头骨折

目的 研究可吸收螺钉固定治疗髋关节后脱位伴股骨头骨折的疗效.方法 对23例髋关节后脱位伴股骨头骨折患者进行可吸收螺钉固定治疗,根据不同类型选择相应的空心钉或重建钢板加以辅助固定,并对术后关节功能进行评定.结果 23例患者中,2例失访,1例死亡,余20例患者随访3个月至5年,平均随访9.5个月.疗效评定标准参照美国矫形外科研究院评估髋关节功能的方法,本组患者中优6例,良9例,可2例,差3例,优良率为75%.结论 可吸收螺钉是治疗股骨头骨折的良好生物材料,值得临床推广应用.     

Caffeine and the risk of hip fracture: the Framingham Study

Caffeine increases urinary calcium output and has been implicated as a risk factor for osteoporosis. The authors examined the effect of caffeine on hip fracture risk in 3,170 individuals attending the 12th (1971-1973) Framingham Study examination. Coffee and tea consumption, age, Framingham examination number, weight, smoking, alcohol consumption, and estrogen use were used to evaluate hip fracture risk according to caffeine intake. Hip fractures occurred in 135 subjects during 12 years of follow-up. Fracture risk over each 2-year period increased with increasing caffeine intake (one cup of coffee = one unit of caffeine, one cup of tea = 1/2 unit of caffeine). For intake of 1.5-2.0 units per day, the adjusted relative risk (RR) of fracture was not significantly elevated compared with intake of one or less units per day. Consumption of greater than or equal to 2.5 units per day significantly increased the risk of fracture. Overall, intake of greater than two cups of coffee per day (four cups of tea) increased the risk of fracture. In summary, hip fracture risk was modestly increased with heavy caffeine use, but not for intake equivalent to one cup of coffee per day. Since caffeine use may be associated with other behaviors that are, themselves, risk factors for fracture, the association may be indirect. Further studies should be performed to confirm these findings.     

Fish intake is positively associated with breast cancer incidence rate

Animal studies have, in general, been supportive of a protective effect of fish and fish (n-3) PUFA against breast cancer risk; but the epidemiologic evidence of such a relationship is limited. Case-control and cohort studies have rarely shown significant associations. The association between total fish intake and the effect of fat content and preparation method of the fish, in relation to the incidence rate ratios of breast cancer, were investigated among postmenopausal women. We also investigated the effect of fish intake with respect to estrogen receptor expression of breast cancer tumors. A total of 23,693 postmenopausal women from the prospective study "Diet, Cancer and Health" were included in the study. During follow-up, 424 women were diagnosed with breast cancer. The incidence rate ratio (IRR) and 95% CI per each additional 25 g of mean daily intake of fish were 1.13 (CI, 1.03-1.23). Analysis of fatty fish gave IRR of 1.11 (CI, 0.91-1.34), and the result for lean fish was 1.13 (CI, 0.99-1.29). When fish intake was stratified into three types of preparation methods, the IRR for fried fish was 1.09 (CI, 0.95-1.25), for boiled fish 1.09 (CI, 0.85-1.42), and for processed fish 1.12 (CI, 0.93-1.34). The IRR per additional 25 g of mean daily intake of fish was 1.14 (CI, 1.03-1.26) for estrogen receptor-positive (ER+) and 1.00 (CI, 0.81-1.24) for estrogen receptor-negative (ER-) breast cancer. In conclusion, this study showed that higher intakes of fish were significantly associated with higher incidence rates of breast cancer. The association was present only for development of ER+ breast cancer.     

Skin cancer incidence is highly associated with ultraviolet-B radiation history

Recently, the increased amount of ultraviolet-B (UV-B) exposure due to ozone depletion has been found to be associated with increased incidence of skin cancer across the world. The quantification of individual, regional, and historical UV exposure directly affects establishment of the association between skin cancer and UV exposure, but accurate assessment and measurement have been challenging for decades. As a sequence, cumulative studies using different metrics reported conflicting results on whether UV radiation, including sunburns, early childhood sun exposure, and chronic exposure, increases melanoma risk. This paper aims to establish the relationship between UV-B and melanoma incidence across the continental U.S. using an ecological approach that incorporate more accurate UV-B exposure measured by the National Aeronautical and Space Administration Nimbus-7 total ozone mapping spectrometer, and the United State Department of Agriculture ground-based network. Using statistical linear mixed models, we found strong positive associations between the skin cancer and the past UV exposure or the past cumulative 3-year UV exposure 3 or 4 years ago. UV has regional distributions and its regional effects on the skin cancer incidence are still significant after adjusting the effect of UV exposure. Research findings yield deepened understanding of spatiotemporal distribution of melanoma incidence rates and a greater appreciation for the complexity and heterogeneity of melanoma risk factors especially the UV-B exposure at different temporal and spatial scales.     

老年髋关节骨折术后的护理研究

目的:探讨老年髋关节骨折术后的康复护理要点.方法:64例老年髋关节骨折患者折行髋关节或股骨头置换术为研究对象,随机将患者分成对照组(32例)与观察组(32例),对照组予普通护理,观察组术后在普通护理基础上进行康复综合护理,评估两组老年髋关节骨折患者术后的恢复情况.结果:与对照组比较,观察组髋关节局部疼痛、髋关节功能恢复等情况均优于对照组,两组比较差异有统计学意义(P<0.05).结论:应用康复综合护理可以促进老年髋关节骨折术后患者早日康复,值得临床推广应用.     

Parathyroid hormone response to severe vitamin D deficiency is sex associated: An observational study of 571 hip fracture inpatients

Objectives

To investigate the association between sex and parathyroid hormone response to severe vitamin D deficiency after hip fracture.

Design

Cross-sectional study.

Setting

Rehabilitation hospital in Italy.

Participants

571 consecutive inpatients with hip fracture and severe vitamin D deficiency (serum 25-hydroxyvitamin D < 12ng/ml), without hypercalcemia or estimated glomerular filtration rate (GFR) < 15ml/min.

Measurements

In each patient we assessed PTH (by two-site chemiluminescent enzyme-labelled immunometric assay), 25-hydroxyvitamin D (by immunoenzymatic assay), albumin-adjusted total calcium, phosphate, magnesium, and creatinine 21.3 ± 6.1 (mean ± SD) days after fracture occurrence. Functional level was assessed using the Barthel index. PTH response to vitamin D deficiency was classified as either secondary hyperparathyroidism (serum PTH >75pg/ml) or functional hypoparathyroidism, i.e., inappropriate normal levels of PTH (≤75pg/ml).

Results

Among the 571 patients, 336 (59%) had functional hypoparathyroidism, whereas 235 (41%) had secondary hyperparathyroidism. PTH status was significantly different between sexes (p=0.003): we found functional hypoparathyroidism in 61% of women and 43% of men (secondary hyperparathyroidism in 39% of women and 57% of men). The significance of the between-sex difference was maintained after adjustment for age, estimated GFR, phosphate, albumin-adjusted total calcium, albumin, Barthel index scores, 25-hydroxyvitamin D, and hip fracture type (either cervical or trochanteric). The adjusted odds ratio was 1.85 (95%CI from 1.09 to 3.13; p=0.023).

Conclusions

Data shows that PTH response to vitamin D deficiency was sex-associated following a fracture of the hip. The higher prevalence of secondary hyperparathyroidism may play a role in the known prognostic disadvantage found in hip-fracture men.     

alpha-Linolenic acid intake is not beneficially associated with 10-y risk of coronary artery disease incidence: the Zutphen Elderly Study

BACKGROUND: Data on the relation between alpha-linolenic acid intake and coronary artery disease (CAD) are limited. Other dietary components appear to modify the reported relation between alpha-linolenic acid intake and CAD. OBJECTIVE: We examined whether dietary alpha-linolenic acid intake was inversely associated with risk of CAD. DESIGN: We prospectively studied 667 men aged 64-84 y from the Zutphen Elderly Study who were free of CAD at baseline. Dietary intake was assessed by using a cross-check dietary history method. RESULTS: During the 10-y follow-up, we documented 98 cases of CAD. After adjustment for age, standard coronary risk factors, and intake of trans fatty acids and other nutrients, alpha-linolenic acid intake was not significantly associated with CAD risk. The relative risk of CAD for the highest compared with the lowest tertile of alpha-linolenic acid intake was 1.68 (95% CI: 0.86, 3.29). alpha-Linolenic acid intake from sources containing trans fatty acids was also nonsignificantly, yet positively, associated with CAD risk. alpha-Linolenic acid intake from foods that did not contain trans fatty acids was not associated with CAD risk, the relative risk of CAD for the highest compared with the lowest tertile was 1.15 (95% CI: 0.63, 2.11). CONCLUSION: We did not observe a beneficial effect of dietary alpha-linolenic acid intake on the risk of 10-y CAD incidence. Investigating this hypothesis was complicated by the association between intakes of alpha-linolenic acid and trans fatty acids. Given the results of current prospective studies, a protective cardiac effect of alpha-linolenic acid is questionable.     

Carbohydrate nutrition is associated with the 5-year incidence of chronic kidney disease

It has been shown that dietary glycemic index (GI) and fiber could have a role in the development of chronic diseases; however, the link between carbohydrate nutrition and development of chronic kidney disease (CKD) is unclear. We aimed to determine whether cross-sectional and longitudinal associations exist between carbohydrate nutrition (mean dietary GI, dietary intakes of carbohydrate, sugar, starch, and fiber) and CKD. Data included 2600 Blue Mountains Eye Study (1997-1999) participants aged ≥50 y. Baseline biochemistry including serum creatinine was measured. Moderate CKD was defined as estimated glomerular filtration rate (eGFR) < 60 mL·min(-1)·1.73 m(-2). Dietary data were collected in a semiquantitative FFQ. Cross-sectionally, participants in the 4th quartile of mean dietary GI intake compared with those in the first quartile (reference) had a 55% increased likelihood of having eGFR < 60 mL·min(-1)·1.73 m(-2) [multivariable-adjusted OR = 1.55 (95% CI = 1.07-2.26); P-trend = 0.01]. After multivariable adjustment, participants in the 4th quartile of dietary cereal fiber intake compared with those in the first quartile (reference) had a 50% reduced risk of incident moderate CKD (P-trend = 0.03). Higher baseline consumption of energy-dense, nutrient-poor sources of carbohydrate (e.g. cookies) yielded a 3-fold higher risk of incident CKD (P-trend = 0.01). In summary, we observed a novel link between high cereal fiber intake and reduced incidence of moderate CKD and this was supported by the cross-sectional association with dietary GI. Conversely, our data suggest that higher intake of energy-dense, nutrient-poor sources of carbohydrate, potentially through acute hyperglycemia, could impair renal function.