Abstract
Osteoporosis is a major health problem. Little is known about the risk factors in premenopause. Sixty 40-50-year old patients with regular menses were studied cross-sectionally. None of the patients were on drugs known to interfere with bone mass. Patients answered a dietary inquiry and had their bone mineral density (BMD) measured. The Z scores were used for the comparisons. A blood sample was taken for the determination of FSH, SHBG, estradiol, testosterone, calcium and alkaline phosphatase. Calcium and creatinine were measured in 24-h urine. A Z score less than -1 was observed for the lumbar spine of 14 patients (23.3%), and for the femur of 24 patients (40%). Patients with a Z score less than -1 for the lumbar spine were older than patients with a Z score > or = -1 (45.7 vs 43.8 years) and presented higher values of alkaline phosphatase (71.1 +/- 18.2 vs 57.1 +/- 14.3 IU/l). Multiple regression analysis showed that a lower lumbar spine BMD was associated with higher values of alkaline phosphatase, lower calcium ingestion, a smaller body mass index (BMI), less frequent exercising, and older age. The patients with a Z score less than -1 for the femur were shorter than patients with a Z score > or = -1 (158.2 vs 161.3 cm). Multiple regression analysis showed that a lower femoral BMD was associated with lower BMI, higher alkaline phosphatase and caffeine intake, and less frequent exercising. A lower than expected BMD was observed in a significant proportion of premenopausal women and was associated with lower calcium intake, relatively lower physical activity and lower BMI. We conclude that the classical risk factors for osteoporosis may be present before ovarian failure, and their effect may be partly independent of estrogen levels.
Highlights
Osteoporosis is a major health problem because it is associated with an increase in fracture rate [1,2]
The role of oral contraceptives in bone mineral density (BMD) could not be evaluated because the majority of patients in this sample had used these preparations in intermittent or not recollectable patterns
body mass index (BMI) was higher in patients with a higher BMD; alkaline phosphatase, in the normal range, was higher in patients with greater bone loss
Summary
Osteoporosis is a major health problem because it is associated with an increase in fracture rate [1,2]. The disorder affects mainly women after 50 years of age. From the onset of ovarian failure a woman loses 3 to 5% of her bone mass per year [3]. After the detection of osteoporosis, the therapeutic options are limited, costly and imply some risk. It is important to detect risk factors for the development of osteoporosis as early as possible [6,7,8] so that preventive measures can be adopted. A decrease of 1 SD in BMD significantly increases the risk of fractures by 50%, irrespective of the site where the measurement was taken [9]
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