Osteoporosis and African American women

The incidence of osteoporosis and related fractures in African American women is half that of Caucasian women. African American women who sustain osteoporosis-related fractures have increased disability and decreased survival. Given the exponential increase in hip fracture rate among African American women over the age of 70 years, the risk of osteoporosis among this population may be underestimated. This review focuses on racial differences in women's bone mineral density (BMD) and bone metabolism and on various explanations for these observed differences. Environmental risk factors for osteoporosis and related fractures among African American women and modalities for prevention and treatment of osteoporosis are discussed. African American women begin menopause with higher BMD and have lower rates of women's bone loss after menopause, which account for their decreased incidence of osteoporosis and related fractures. The risk factors for osteoporosis among African American women are similar to those found in Caucasian women. Lifestyle interventions, such as calcium and vitamin D supplementation, smoking cessation, and increased physical activity, should be encouraged to enhance peak bone mass and to decrease bone loss. These interventions and other treatment modalities, such as hormone replacement therapy, bisphosphonates, and selective estrogen receptor modulators, should be studied further in African American women.     

Effectiveness of screening for osteoporosis by bone density measurement for the prevention of fractures: a review of the evidence

To review evidence on the benefits of screening women and men for osteoporosis, a Pub Med search was performed in English papers published between 1990 and 2002. We used data from a cohort study to estimate risk of fracture from bone mineral density. Bone mineral density measured by dual X-ray absorptiometry (DXA) can predict bone fracture among elderly women, peri- and early post-menopausal women, and elderly men. It is recommended that all white women older than 65 years be screened routinely for osteoporosis. We suggest that Japanese elderly women should receive BMD measurements as a screening, but we have still issues to be solved including age from when the screening should be started, methods, and how to treat the women found to have osteoporosis at the screening. For peri- and postmenopausal women and elderly men, it might be beneficial to measure BMD as a screening and start treatment for those patients found to have osteoporosis. However, incidence of fractures for these people is lower than that for elderly women. One bone mass measurement can predict bone fracture risk for as long as over 10 years or more, but predictive ability of BMD decreases with time. Therefore, cost effectiveness needs to be reviewed to determine the benefits of screening among peri-menopausal women and men. Although bone assessment by quantitative ultra sound (QUS) method by ultrasound can also predict future fractures, only a relatively small number of longitudinal studies have been conducted in the Western countries, and there is no established evidence by means of longitudinal studies among Japanese. It is necessary in Japan to seek such evidence, however, since this method is widely used for an osteoporosis examinations.     

绝经妇女肌力改变对骨量的影响

流行病学显示骨质疏松症是老年人常见的疾患其可导致骨折,使患者骨折后,生活质量明显下降.由于女性期望寿命长于男性,老年妇女发生慢性疾病如肌力异常和骨质疏松症增加,该文对高风险人群绝经妇女肌力改变对骨量影响进行分析,认为肌力衰变是绝经妇女骨质疏松的重要影响因素,通过改善肌力,可能是积极预防、治疗绝经妇女骨质疏松或骨质疏松症的较好策略.     

岳池县中老年女性骨代谢指标与骨质疏松的相关性研究

目的 分析中老年女性骨质疏松发生情况,并探讨骨代谢指标与骨质疏松的相关性,为中老年女性骨质疏松的防治工作提供参考资料。方法 以2020年1—12月岳池县某医院进行健康体检的≥45岁中老年女性作为研究对象,进行骨密度、血清中骨钙素（OC）、β胶原特殊序列（βCTX）、骨碱性磷酸酶（BALP）、25-羟基维生素D [25-（OH）D]水平检测,采用描述性分析方法对该人群骨质情况进行分析,在校正年龄、体质指数（BMI）基础上采用多因素Logistic回归分析方法对骨代谢指标水平对骨质疏松影响情况进行分析。结果 共对1 124名中老年女性进行调查,年龄45~78岁,平均（61.4±5.8）岁。共检出骨质疏松558例,发生率为49.6%。不同年龄、BMI的中老年女性骨量情况差异均有统计学意义（P<0.05或P<0.01）。不同居住地、年龄、BMI、绝经情况和骨量情况的中老年女性骨代谢指标差异均有统计学意义（均P<0.01）。随着年龄增长,25-（OH）D水平呈下降趋势,OC、BALP水平在55~64岁明显升高后呈逐渐下降趋势,βCTX呈升高趋势。多因素Logistic回归分析结果显示,OC（OR=0.537）、BALP（OR=0.791）、25-（OH）D（OR=0.674）水平越高,发生骨质疏松的可能性越低;βCTX水平越高（OR=1.919）,发生骨质疏松的可能性越大。结论 岳池县≥45岁中老年女性骨质疏松发生率较高,骨代谢指标OC、βCTX、BALP、25-（OH）D能够有效反映骨代谢活动,且与骨质疏松发生情况密切相关,监测骨代谢指标可以及早发现骨代谢异常,有利于及早预防和发现骨质疏松症。     

Osteoporosis in women with disabilities

Women with physical and cognitive disabilities are at high risk for osteoporosis and osteoporosis-related fractures. Women with physical disabilities frequently are nonambulatory and have bone loss due to immobility. Women with cognitive disabilities have high rates of osteopenia and osteoporosis, likely partially due to high rates of anticonvulsant medication use. Women with Down syndrome are at especially high risk of osteopenia and osteoporosis, possibly because of lower peak bone density levels. Prevention of osteoporosis and related fractures in this population includes population-based measures, such as calcium and vitamin D supplementation and risk-based screening procedures. Primary care providers and specialists need to prioritize osteoporosis prevention strategies when taking care of women with disabilities. Future research is needed to determine optimal screening and prevention strategies in this very high risk population.     

Exercise and physical activities for the prevention of osteoporotic fractures: a review of the evidence

According that osteoporosis is the common condition in an aging society such as in Japan, much progress has been made in understanding the treatment and prevention of osteoporosis. Among potential risk factors, exercise and physical activities have been recognized as lifestyle factors that might influence the risk of osteoporosis and osteoporotic fractures. To assess the relationship between exercises including physical activities and the risk for low bone mass and osteoporosis-related fractures, a literature search over past 13 years was conducted. Accumulating evidence indicates that exercises decrease the risk for hip fractures among middle aged and older men and women. Exercises also help to maintain muscle strength, muscle volume, balance, and joint flexibility, which might prevent falls and fall-related fractures. One randomized controlled trial showed back-stretching exercise reduced the risk for vertebral fractures. The literature search also indicates that high-impact and/or weight-bearing exercise might increase the bone density in the elderly and the peak bone mass among young women, while there is no association between moderate or lower-impact exercise and bone mineral density. Future research should be required to evaluate the types and quantity of physical activity needed for the prevention of osteoporosis.     

浅谈绝经后骨质疏松症的临床特点、预防及护理

女性绝经后卵巢功能减退,雌激素分泌减少,骨骼中钙丢失加速,常引起骨质疏松症,表现为渐进性的腰背四肢关节酸痛、乏力、走路不稳,易于骨折而导致肺炎、心血管疾病等并发症,严重影响着绝经后女性的健康和生活质量.对绝经后女性实施正确的骨质疏松症防治和护理措施,可预防骨质疏松症的发生,提高绝经后骨质疏松症患者生活质量.     

African-American women and abortion: a neglected history.

The history of African-American women's efforts to control their fertility is largely unknown. From slavery to the present, the growth rate of the African-American population has been cut in half. Demographers and historians frequently attribute this change to external factors such as poverty, disease, and coerced birth control, rather than the deliberate agency of African-American women. This essay assembles a brief historical record of the ways African-American women have sought to control their fertility through the use of abortion and birth control. It also examines the activism of African-American women in the establishment of family planning clinics and in defense of abortion rights.     

Brittle bones, pain and fractures--lay constructions of osteoporosis among Norwegian women attending the Nord-Trøndelag Health Study (HUNT)

Osteoporosis has been labelled the disease of the 21st century. Over the past couple of centuries there have been various notions of this disease in medicine. In the present medical discourse, the emphasis is on prevention rather than treatment, making osteoporosis into a major risk factor for bone fractures. In Norway, osteoporosis is a particularly prevalent condition, leading to bone mass measurements being included in several large health surveys. In a follow-up study of the second round of the Nord-Trøndelag Health Study (HUNT), women aged 55–75 years were invited to participate in focus groups to talk about their experiences in relation to their bone density measurements. Findings from these focus groups show that osteoporosis is perceived as a disease characterized by brittle bones, pain and fractures. The physical appearance of a hunchbacked old woman is a dominant way of portraying the disease. It is mainly perceived as prevalent among women, but evidence that men can get it is provided through the example of a famous male athlete who became osteoporotic. Causal explanations for the disease are dominated by culturally shaped anecdotal evidence wherein medical knowledge has been included. Limits to lay constructions of osteoporosis based on such evidence are discussed. Talking about osteoporosis across generations the women applied different explanations for the condition over time. In doing so, they also showed that they have adopted the morality of the new public health where the individual has control over her health through self-governance. Whereas this was no option for their grandmothers, their grandchildren's generation was seen as one failing to meet their obligations to become healthy citizens. The lay construction of osteoporosis can thus be seen as one that has developed from a situation where osteoporotic persons were perceived as victims of harsh circumstances to one of individual responsibility.     

Developing profiles of postmenopausal women being prescribed estrogen therapy to prevent osteoporosis

Postmenopausal women with estrogen deficiency are at high risk for osteoporosis. Estrogen therapy has been shown to be effective in preventing postmenopausal bone loss and maintaining bone mineral density. The increasing number of women at risk for osteoporosis and the high cost of treating this condition emphasizes the importance of preventing osteoporosis. This study was designed to identify trends and predictors of estrogen use for osteoporosis prevention among postmenopausal women. A retrospective, cross-sectional study was conducted using Behavioral Risk Factor Surveillance System data (1997–1999). Women 35 years and older who had passed menopause or were currently going through menopause were identified from the states including the BRFSS module that asked questions about estrogen use. Results showed an increasing prevalence in estrogen use from 1997 to 1999 for osteoporosis prevention. In 1999, almost a third of the postmenopausal women surveyed used estrogen to prevent osteoporosis. Prevalence was higher among women 45–64 years of age, whites, and those with higher education levels. Physician counseling on the benefits and risks of estrogen therapy was the strongest predictor of estrogen use for prevention of osteoporosis. Insurance coverage and compliance with other preventive behaviors such as mammograms and Pap smears were also strongly associated with greater estrogen use. However, women who were at risk for acute drinking, not married, overweight or obese, and diabetic were all less likely to receive estrogen therapy for osteoporosis prevention. The relationships demonstrated between estrogen use and demographic characteristics, lifestyle behaviors and health care access and utilization factors underline the importance of targeting specific groups of women for promoting its protective effect against osteoporosis.     

The association between blood lead levels and osteoporosis among adults--results from the third national health and nutrition examination survey (NHANES III)

BACKGROUND: Osteoporosis is a reduction in bone mass sufficient to increase the risk of fracture. Lead exposure during childhood may be a risk factor for low bone mineral density (BMD). Basic-science research demonstrates that lead exposure is associated with a decrease in BMD in animals. However, human studies are limited. OBJECTIVE: Our objective was to conduct a secondary analysis of a national database to explore the association between lead exposure and osteoporosis in adult humans. METHODS: In this study we used data from the Third National Health and Nutrition Examination Survey (NHANES III). We analyzed subjects who were >/= 50 years of age. A concurrent venous blood lead level defined lead exposure. The primary outcome variable was the BMD of the total hip. We conducted analyses on four groups: non-Hispanic white men, non-Hispanic white women, African-American men, and African-American women. We conducted bivariate analyses between covariates known to be associated with bone density (i.e., age, body mass index, calcium intake, ethanol/tobacco consumption, physical activity, socioeconomic status) and the total hip BMD. The significant covariates were introduced into analysis of covariance to determine the association between BMD and blood lead level tercile. RESULTS: The adjusted mean total hip BMD among non-Hispanic white males with a blood lead level in the lowest tercile versus the highest tercile was 0.961 g/cm(2) and 0.934 g/cm(2), respectively (p < 0.05). We also found a similar association among white females, but the difference was marginally significant (0.05 < p < 0.10). CONCLUSIONS: We found a significant inverse association between lead exposure and BMD, but only among white subjects. However, because of the cross-sectional design of NHANES, we cannot make inferences about the temporal sequence of this association. With the large number of adults who had lead exposure in the past and the morbidity associated with osteoporosis, further inquiry is necessary on the possible casusal association between lead exposure and osteoporosis in humans.     

Prevention and Treatment of Osteoporosis in Postmenopausal Women

Postmenopausal osteoporosis is characterized by an increased rate of bone turnover accompanied by a reduction in bone mineral density (BMD) that results in an increased risk of fracture, especially of the vertebrae, hip, or wrist. Alendronate (Fosamax®, Fosamax Once-Weekly®), an oral bisphosphonate that inhibits osteoclast-mediated bone resorption and modulates bone metabolism, is a first-line therapy for the management of postmenopausal women with, or at risk of developing, osteoporosis.Alendronate produces sustained increases in BMD and reductions in bone turnover from baseline, and reduces the risk of vertebral, hip, wrist, and other fractures in women with postmenopausal osteoporosis. It also prevents bone loss, and reduces the risk of radiographic or clinical vertebral fracture in postmenopausal osteopenia. Provided administration instructions are followed, alendronate is generally well tolerated. Adverse events are usually transient and are associated with the upper gastrointestinal tract (abdominal pain, nausea, acid regurgitation, dyspepsia); moreover, the incidence of these adverse events with alendronate was similar to those with placebo. More serious events (esophagitis, gastric or duodenal ulceration or bleeding) are uncommon. Once-weekly formulations are as effective and as well tolerated as once-daily alendronate in postmenopausal women.Pharmacoeconomic evaluations suggest that alendronate is a viable treatment option in postmenopausal osteoporosis. The reduction in fracture-related healthcare utilization seen with alendronate results in decreased direct costs, including inpatient or long-term care. Markov state-transition models suggest that this could at least partially offset costs incurred with alendronate therapy. Treatment of women with osteoporosis aged 65 years and older, and postmenopausal women with a previous osteoporotic fracture, are cost-effective strategies. Alendronate is also likely to increase quality-adjusted life-years in any postmenopausal women with osteoporosis.In conclusion, clinical and economic data support the use of alendronate in postmenopausal osteoporosis. It effectively reduces bone turnover, increases BMD, and reduces the risk of osteoporotic fracture in postmenopausal women with established osteoporosis, especially older women with a higher risk of fracture. Although its cost effectiveness in postmenopausal women with osteopenia is not clearly established, alendronate is clinically effective in these patients. In addition, it is generally well tolerated when taken as recommended. Consequently, alendronate should be considered a therapy of choice in the prevention and treatment of osteoporosis in postmenopausal women.     

Worry regarding major diseases among older African-American,Native-American,and Caucasian women

This study examined worry regarding seven major diseases and their correlates in a sample of African-American (n = 57), Native-American (n = 50), and Caucasian (n = 53) women ages 36 to 91 years. African-American and Native-American women were most worried about developing cancer (44% and 50%, respectively) while Caucasian women were most worried about osteoporosis (37%) and cancer (33%). Women from each ethnic group were more worried about developing cancer than cardiovascular diseases and conditions. African-American and Native-American women were more worried than Caucasian women about developing diabetes and high cholesterol. Body mass index (BMI) was a consistent correlate of worry: heavier women were more worried about developing diseases than were leaner women. Other risk factors (e.g., physical activity, blood pressure), however, were generally not associated with disease worry. In fact, age was inversely associated with worry regarding diabetes, cancer, and osteoporosis. Although women who were more worried about developing cancer were more likely to perform monthly breast self-exams, worry regarding other diseases was not associated with preventive actions. These results are generally consistent with other studies that indicate women are more concerned about cancer than cardiovascular diseases.     

Management of Postmenopausal Osteoporosis

Postmenopausal osteoporosis is a very common disease, and approximately half of all women aged >50 years will experience an osteoporotic fracture during the remainder of their lifetime. The predominant cause of postmenopausal osteoporosis is the decline in estrogen levels, which causes an increase in bone turnover, and results in a loss of bone mass throughout the entire skeleton. Fragility fractures, either vertebral or nonvertebral, have a considerable adverse effect on quality of life in women with osteoporosis and place a significant burden on society in terms of healthcare costs.Management of postmenopausal osteoporosis includes alteration of modifiable risk factors (e.g. lifestyle and propensity to fall), ensuring adequate calcium and vitamin D intake, and pharmacological treatment to decrease fracture risk by slowing or preventing bone loss and preserving bone strength. Raloxifene (Evista®), a selective estrogen receptor modulator that partially mimics the effects of estrogen on bone and lipid metabolism and acts as an antiestrogen in the breast and endometrium, is indicated for the prevention and treatment of postmenopausal osteoporosis. Raloxifene increases bone mineral density at vertebral and nonvertebral sites, and decreases the risk of vertebral fracture to a similar extent to the bisphosphonates alendronate and risedronate. However, effects on nonvertebral fracture risk, including the risk of hip fracture, have not been observed.Raloxifene appears to reduce breast cancer risk (in women at average risk) and cardiovascular risk (in women at increased risk) without stimulating the endometrium, and does not cause vaginal bleeding or breast pain. However, the drug causes hot flashes in some women, and increases the risk of venous thromboembolic events by about the same amount as hormone replacement therapy (HRT).In economic models, raloxifene is cost effective compared with no treatment, HRT, calcitonin, or alendronate for the prevention or treatment of postmenopausal osteoporosis.In conclusion, raloxifene is a valuable and cost-effective therapy for preventing the progression of osteoporosis and for reducing vertebral fracture risk in osteoporotic postmenopausal women. The tendency for raloxifene to cause hot flashes, and its apparent lack of effect on hip fracture risk, may preclude its use in women with vasomotor symptoms and in patients at high risk for hip fracture. Results from large ongoing trials are needed to confirm the effects of raloxifene on breast cancer and cardiovascular disease. However, the effects of raloxifene on breast cancer and cardiovascular risk without stimulating the endometrium make the drug an attractive therapy for the prevention and treatment of postmenopausal osteoporosis.     

Alendronate in the treatment of osteoporosis: a review of the clinical trials

Osteoporosis is a highly prevalent disease. More than half of postmenopausal women will experience fractures. Women at high risk (osteoporosis as measured by bone density, low trauma fractures of any type, or certain other risk factors) often require pharmacological therapy. However, surveys show that most women who have recently had fractures are currently not being treated. Recent results from the first megatrial of osteoporosis with >6400 participants, the Fracture Intervention Trial (FIT), have provided important advances in our understanding of osteoporosis and the efficacy of alendronate. The FIT study and other large clinical trials show that alendronate effectively increases bone density, reduces the risk of hip and vertebral fractures by approximately half within the first 12-18 months, and, most importantly, reduces the health consequences of fractures. Alendronate is also effective for preventing bone loss in early postmenopausal women. Thus, alendronate represents an important option for preventing and treating this common and debilitating disease. This article summarizes the wealth of data from FIT and other studies of alendronate in the context of the burden of illness associated with osteoporosis.     

Statins, bone formation and osteoporosis: hope or hype?

Osteoporosis is a major health problem affecting both men and women. Statins, besides their action as lipid-lowering agents, seem to have additional pleiotropic properties, among them a beneficial effect on bone mineral density. The entirety of experimental and the majority of clinical studies as well as the only relevant meta-analysis suggest that statins have an anabolic effect on bone metabolism. Statins, osteoporosis and adipogenesis share the same pathway, RANKL/OPG. It would appear that an imbalance in this pathway could be responsible for the manifestation of some metabolic disorders such as diabetes mellitus, atherogenesis, multiple myeloma, osteoporosis. Possibly in the future, drugs which can intervene in this biochemical and pathophysiological cascade, like statins, in a variety of doses, could be used for the management of ectopic ossification syndromes and other bone disorders, even as an additive treatment. Until then, further large longitudinal randomized controlled studies for each statin separately are required to confirm this hypothesis.     

Osteoporosis for the home care physician. Part 1: etiology and current diagnostic strategies

Osteoporosis affects over 20 million individuals in North America and is responsible for over 1.5 million fractures in the US. Although most cases of osteoporosis are primary, in 20% of older women and 40% of older men presenting with vertebral fractures, a secondary cause can be identified. The WHO based the diagnosis of postmenopausal osteoporosis on the presence of BMD T-score that is 2.5 standard deviations or greater below the mean for young women. The International Society of Clinical Densitometry defined male osteoporosis as BMD T-score of 2.5 or greater below the mean for young men. BMD assessment at the hip and spine by DXA is the standard procedure to assess bone density. Laboratory testing in patients with low BMD is performed to exclude other conditions that could cause low BMD such as multiple myeloma, endocrinopathies and osteomalacia. Bone turnover marker levels currently do not predict bone mass or fracture risk and are only weakly associated with changes in bone mass. Subsequently, they are of limited use in the clinical evaluation of bone density changes.     

珠海地区575名女性骨密度测定及骨质疏松症危险因素初析

目的了解珠海地区女性骨密度和骨量分布情况以及影响骨质疏松症(OP)的危险因素。方法采用双能X线骨密度仪对珠海地区的575例女性进行骨密度检测,并对个人疾病史、生活习性及月经史进行调查,根据OP发生与否,进行单因素和多因素分析。结果女性骨密度和骨量呈现年龄分布趋势;单因素分析结果显示年龄、绝经年限、体重指数(BMI)、糖尿病、骨折以及慢性病对OP存在影响;多因素分析结果显示年龄和慢性病是OP发病的危险因素,而BMI是OP的保护因素。结论女性骨密度随年龄的增长、绝经年限的增加而逐步下降,而保持一定体型及体重,有利于骨密度的维持及提高;及时发现、治疗糖尿病、慢性病(如甲亢、风湿)等,对防治骨质疏松有积极作用。     

Association of Dietary Total Antioxidant Capacity with Bone Mass and Osteoporosis Risk in Korean Women: Analysis of the Korea National Health and Nutrition Examination Survey 2008–2011

Antioxidant intake has been suggested to be associated with a reduced osteoporosis risk, but the effect of dietary total antioxidant capacity (TAC) on bone health and the risk of osteoporosis remains unclear. We aimed to assess the hypothesis that dietary TAC is positively associated with bone mass and negatively related to the risk of osteoporosis in Korean women. This cross-sectional study was performed using data from the Korea National Health and Nutrition Examination Survey. Dietary TAC was estimated using task automation and an algorithm with 24-h recall data. In total, 8230 pre- and postmenopausal women were divided into four groups according to quartiles of dietary TAC. Dietary TAC was negatively associated with the risk of osteoporosis (odds ratio, 0.73; 95% confidence interval, 0.54–0.99; p-value = 0.045) in postmenopausal women, but not in premenopausal women. Dietary TAC was positively associated with bone mineral content (BMC) and bone mineral density of the femoral neck and lumbar spine in postmenopausal women and BMC of the total femur and lumbar spine in premenopausal women. Our study suggests that dietary TAC is inversely associated with the risk of osteoporosis in postmenopausal women and positively associated with bone mass in both pre- and postmenopausal women.     

Early menopause, number of reproductive years, and bone mineral density in postmenopausal women.

OBJECTIVES. Previous studies have reported positive associations of age at menopause with bone density and inverse associations of age at menarche with bone density. This study examined the relationships of early age at menopause and number of reproductive years (defined as age at menopause minus age at menarche) with bone density in postmenopausal women. METHODS. The subjects were 555 women aged 60 to 89 years who had had either natural menopause (n = 391) or hysterectomy with bilateral oophorectomy (n = 164). Bone density was measured at the ultradistal wrist, midshaft radius, lumbar spine, and hip. RESULTS. Women who had had early menopause and those with the fewest reproductive years had significantly lower bone density at all sites. After adjustment for covariates, both age at menopause and number of reproductive years had significant positive associations with bone density at every site, and total number of reproductive years explained more of the variance in bone mineral density than did either age at menarche or age at menopause. CONCLUSIONS. Elderly women reporting early menopause or fewer reproductive years have more osteoporosis. The number of reproductive years may be more helpful than age at menopause in identifying women at increased risk of osteoporosis.