Annual Rate Of Bone Loss Research Articles

Effects of menopause on age-dependent bone loss in the axial and appendicular skeletons in healthy Japanese women.

To determine the effects of menopause on bone loss in different parts of the skeleton, bone mineral density (BMD) values were measured longitudinally in 85 healthy women. BMD values included the lumbar spine measured by dual-energy X-ray absorptiometry (DXA) and quantitative CT (QCT) and the distal and midradius measured by DXA obtained over 5 years. BMD at the calcaneus was measured using DXA for 3 years, and the BMD values of the distal metaphyses and diaphyses of radius and tibia were measured using peripheral QCT (pQCT) for 4 years. The subjects were 19 premenopausal, 17 perimenopausal, 12 early postmenopausal and 38 late postmenopausal women with the respective average ages of 39.1 +/- 7.1 (SD), 51.9 +/- 2.9, 55.8 +/- 1.8 and 61.9 +/- 3.9 years at the start of measurement. Average years since menopause were 1.4 +/- 1.8, 3.3 +/- 1.3 and 12.7 +/- 5.3 years, respectively. In the perimenopausal group, the annual rate of bone loss for lumbar trabecular bone measured by QCT, and for the calcaneus, and metaphyseal trabecular bone at the radius and tibia by pQCT were higher than the respective values in the premenopausal group. These values in the late postmenopausal group became significantly lower compared with those in the perimenopausal group, coming down to the level of the premenopausal group. While the annual rates of bone loss at the tibial diaphysis in the perimenopausal group were also higher than those in the premenopausal group, the values at the radial diaphysis by DXA or pQCT did not differ significantly. The reductions in the annual rates of bone loss with the passage of time after menopause were not marked in these cortical bone dominated sites. These data indicated that the annual rates of bone loss at trabecular bone dominated sites were accelerated in both axial and appendicular skeletons. Diaphyseal cortical bone, however, seemed to be less sensitive to estrogen withdrawal. Other factors, such as genetics and calcium/vitamin D metabolism, would also affect the age-dependent bone loss at the cortical bone dominated sites after menopause.

Early and late postmenopausal bone loss is associated with BsmI vitamin D receptor gene polymorphism in Japanese women.

To determine whether vitamin D receptor (VDR) gene polymorphisms are associated with bone mineral density (BMD) and bone loss in the Japanese population, VDR BsmI RFLPs were analyzed in 191 postmenopausal Japanese women by comparing B allele and b allele DNA sequences, and a point mutation was confirmed. We examined VDR BsmI restriction fragment length polymorphism (RFLP) with an amplification refractory mutation system (ARMS) using this point of mutation. The frequency of VDR BsmI alleles in the Japanese population was significantly different from that in whites. The bb genotype was identified in 79.6%, of the subjects, the Bb genotype in 19.3%, and the BB genotype was in only 1.1%. We find no significant differences in lumbar spine baseline BMD between the bb genotype and the Bb genotype. In both early and late postmenopausal periods, serial measurements of vertebral BMD revealed that subjects with the Bb genotype lost BMD faster than those with the bb genotype (P = 0.001). We conclude that there is a significant relationship between RFLPs of BsmI VDR and the annual rates of bone loss during early and late postmenopausal periods in the Japanese population.

Bone loss in Great Britain and Japan: a comparative longitudinal study

Hip fracture incidence is lower in Japan than in the West. Although differences have been found in peak bone mass and hip geometry between white and Japanese populations, these do not fully explain the difference in hip fracture rates. Variation in the rates of involutional bone loss may be an additional contributing factor. We address this issue in a prospective epidemiological study comparing bone loss rate among elderly people in Britain and Japan. Two population-based studies of bone loss rate in a British and a Japanese cohort were performed. Annual bone loss rates were obtained for 172 Hertfordshire men and 143 Hertfordshire women of mean age 66 years, and a questionnaire administered to obtain information on known confounding lifestyle factors. Eighty-six Japanese men and 90 Japanese women of mean age 69 years completed a similar study in Taiji, Japan. British men and women were heavier than Japanese men and women. Differences in lifestyle were also evident; the British men were less likely to smoke and the women more likely to consume alcohol than their Japanese counterparts. The British population also spent more time walking outdoors. Statistically significant differences between the two populations were apparent in baseline bone mineral density at lumbar spine ( p < 0.05) and trochanter ( p < 0.001) in men and women with Japanese subjects having lower values. There were also significant differences in bone density at the femoral neck ( p < 0.001) between British and Japanese males. Men gained bone at the lumbar spine over the follow-up period in both populations. Bone loss rates were generally greater in the British female population than in Japanese women: the difference was statistically significant at the femoral neck ( p < 0.05) and femoral trochanter ( p < 0.001). These differences all remained significant after adjustment for differences in age between the two populations. Japanese subjects appear to have lower peak bone mass, but slower bone loss rates in later life than their European counterparts. These differences in bone loss rate help to explain the relatively low hip fracture rates found in Japan.

Bone mineral measurement in Japan.

Various methods for evaluating bone mineral in appendicular, and axial bone or in the whole skeleton have recently become available. As bone mineral is one of the major determinants of bone strength, its exact measurement should be useful for the diagnosis of osteoporosis, as well as for the prediction of fracture risk and monitoring of therapeutical response. The aims of this paper are to review the fundamental performance of bone mineral measurements, the improvements in DXA systems, and the progress in site-specific bone mineral instruments for the radius and calcaneus used in Japan, and to introduce diagnostic criteria for primary osteoporosis, and report on annual rates of bone loss in Japanese females.

Age-related cortical bone loss at the metacarpal.

In order to evaluate in vivo the entity of endosteal and periosteal changes with age in the two sexes, and their relative contribution to age-related cortical bone loss, we undertook a cross-sectional study on a population of normal Caucasian subjects. The group included 189 women and 107 men who were studied by photodensitometry and radiogrammetry of the second metacarpal bone, derived from the same standard hand X-ray. Of the subjects, 134 were 65 years of age or older (75 women and 59 men). Metacarpal bone mineral density (BMD) correlated with age in both sexes, with an annual bone loss rate of 0.5% in women and 0.15% in men. In the over 65 group, correlation was significant only in women, who underwent an acceleration in the rate of bone loss (1% per year). Marrow cavity width (M), cortical index at the second metacarpal shaft (MI) and external width (W) all correlated with age in both sexes, although generally better in the female than in the male sex. M almost doubled from the fourth to the ninth decade in women and increased 50% in men. In the same age interval, MI showed an annual decrease of 0.49% in females and 0.33% in males. In the over 65 group, cortical thinning rate was significant in women (0.39% per annum) but not in men (0.14% per annum), whereas correlation of W was not significant in either sex. Finally, MI correlated with BMD in the whole study population and in the over 65, with a female prevalence in correlation strength maintained throughout life. The following conclusions can be derived for metacarpal aging: (1) an acceleration in cortical bone loss occurs in females after age 65; (2) age-related growth in periosteal diameter, although significant in the whole population, is negligible in the elderly of both sexes; (3) age-related cortical bone loss is generally more dependent on cortical thinning in women than in men.

Vertebral postmenopausal bone loss is reduced in overweight women: a longitudinal study in 155 early postmenopausal women.

To study the influence of excess body weight on vertebral postmenopausal bone loss, 155 healthy early postmenopausal women were divided into 2 groups according to their body mass index (BMI = weight/height2) and prospectively followed over a mean 31-month period. Spinal (L2-L4) bone mineral density was measured by dual photon absorptiometry. The annual rate of vertebral bone loss (percentage) was significantly reduced (-0.54 +/- 1.1% vs. -1.46 +/- 1.6%; P < 0.05) in the overweight group (BMI, > or = 25; n = 40) compared to that in the normal weight group (BMI, < 25; n = 115). At baseline, a significant decrease in the urinary calcium/creatinine ratio was observed in the overweight group, which suggested a decrease in bone turnover. A significant correlation was found between the annual rate of bone loss and the BMI (r = 0.21; P < 0.05), but not the body weight. The positive correlation between vertebral postmenopausal rate of bone loss and BMI was confirmed after adjustment for age and time since menopause. Moreover, plasma dehydroepiandrosterone sulfate levels were higher in the high BMI group than in the normal BMI group (P < 0.05). We conclude that within the first years after menopause, moderate excess body weight significantly reduces vertebral postmenopausal bone loss. This effect is probably related to excess adipose tissue through increased conversion of estrogen from adrenal precursors and/or increased production of adrenal androgens.

Longitudinal study of cortical bone loss in patients with inflammatory bowel disease.

Bone mineral density of the radius was measured by single-photon absorptiometry in 50 patients with inflammatory bowel disease. Thirty-three had Crohn's disease and 17 ulcerative colitis; 25 were women. The mean age was 45 years (range, 18-70 years). Measurements were repeated in 39 of them after a mean follow-up period of 7.9 years (range, 7.1-8.2 years). In female patients the mean (95% confidence interval) annual change in radial bone mineral density was -0.74% (-1.34% to -0.14%) (P = 0.022), the greatest bone loss occurring in postmenopausal women (mean, -1.16% (-2.01% to -0.30%)). In male patients the mean annual rate of bone loss was -0.07% (-0.41% to 0.28%) (P = NS). Patients with abnormally low values at the first measurement remained osteopenic at the second measurement, whilst some others with normal values initially showed increased rates of bone loss and had a subnormal bone mineral density after the follow-up period. These results show increased rates of cortical bone loss in some patients with inflammatory bowel disease and emphasize the need to monitor bone mass in these patients so that prophylactic measures can be instituted.

Age-related changes in bone mass among Japanese-American men

Bone mass and appendicular bone loss rates were examined in a cohort of Japanese-American men. Across their age range (ages 61 to 82 years) bone mass steadily declined at the proximal and distal radius, and at the calcaneus. The cross-sectional reduction in bone mass was 3.5–6.3% per decade at the various sites. Longitudinal measurements of the same cohort indicated greater losses than suggested by the cross-sectional data, yet still less than 10% per decade. Linear trends of increasing loss rates with aging were significant at the calcaneus, and marginally significant at the radius sites. However, the oldest men in the cohort strongly influenced these trends. Men under age 75 had essentially constant annual rates of bone loss. The most elderly men had both the lowest bone mass and the greatest bone loss rates.

Quantification of bone mineral contents using dual photon absorptiometry in a normal Japanese population — total body bone mineral

We established reference values for total body bone mineral of normal Japanese subjects utilizing dual photon absorptiometry. The index of measurement, total body bone mineral content (TBBM) divided by lean body mass (LBM), might be suitable for the evaluation of total body bone mineral. TBBM/LBM did not correlate with age in male subjects; however, reduced bone mineral was noted in female subjects after fifth decade. The rate of change in bone after the fifth decade was 0.82% per year. The bone mineral density (BMD) of each region including total body also showed a significant decrease with aging in women after the age of 40. Again no significant age-related changes were obtained in male BMD of any region (head, trunk, pelvis, legs, arms). The annual loss in women after the bone loss began was 0.72% in total body BMD. The rate of BMD change in each region of bone after 40 years of age ranged from 0.91% (trunk) to 0.51% (arms) per year. The bone mineral content (BMC) in “trunk” portion of TBBM decreased significantly with aging, while BMC of other portions did not show a significant age-related change. These results differ slightly from results which we have already reported for lumbar spine BMD, in which case average annual rates of bone loss once begun, were 0.32% for male and 0.97% for female.

Alveolar Bone Loss in Patients with Long‐Term Supportive Care

Radiographic record audits were conducted on 63 patients diagnosed as having periodontitis who had been treated and maintained for 10 years or longer in dental school clinics. Acceptable bite-wing radiographs were available for 50 of these patients. Bite-wing radiographs taken 8 to 34 years apart (mean 14.9 years) were assessed for bone loss. Recall maintenance had been accomplished for 60% of these patients at 6 to 9 month intervals, while 24% had been seen more frequently. The mean annual rate of bone loss was 0.037 mm (range of -0.19 to 0.20). There were no significant differences in bone loss between maxillary/mandibular, molar/premolar, or mesial/distal sites respectively. Alveolar bone loss in this dental school population compares well with other reported studies. Progression of disease as assessed by radiographic bone loss in treated and maintained periodontitis patients is minimal.

A 10-year retrospective study of periodontal disease progression.

The purpose of this study was to record the rate of periodontal disease progression over a 10-year period with respect to individual subject, age and tooth type. 283 subjects, who had undergone a full-mouth radiographic examination in 1974-76 and at that time were 25-70 years old, were randomly selected from a larger patient sample for a new radiographic examination in 1985-86. 201 subjects (71%) agreed to participate. For each respondent, tooth loss over the 10-year period was calculated. The radiographic bone height at the mesial and distal aspect of all teeth was assessed by measuring the distance between the cemento-enamel junction and the bone crest. Difference in periodontal bone height between the 2 examinations was calculated for each tooth site. The results revealed that the mean number of teeth lost over the 10-year period was 3.8 (SD 4.6). Tooth mortality, expressed as a % of the no. of teeth present at the initial examination, increased with age and varied between 2.9%-28.5%. In all age groups, molars had the highest and canines the lowest rate of tooth mortality. The frequency of subjects with loss of greater than 10 teeth was highest for the initially 45-year old individuals (20%). 7 individuals (3%) had become edentulous. The mean annual reduction of alveolar bone height varied between 0.07-0.14 mm in the age groups 25-65 years. The initially 70-year old subjects showed a statistically significant higher annual rate of bone loss (0.28 mm).(ABSTRACT TRUNCATED AT 250 WORDS)

Bone loss in rheumatoid arthritis and primary generalized osteoarthrosis: effects of corticosteroids, suppressive antirheumatic drugs and calcium supplements.

The annual rate of bone loss in rheumatoid arthritis (RA) and primary generalized osteoarthrosis (PGOA) was determined by measurement of total body calcium (TBCa). The mean annual rate of bone loss in 24 patients with RA treated with nonsteroidal anti-inflammatory drugs (NSAIDs) alone was 3.4%. This rate of bone loss was not reduced in ten RA patients responding to suppressive antirheumatic drugs (4.3%) or seven patients receiving oral calcium supplements (4.5%). The mean annual rate of loss of TBCa in 19 patients with PGOA was 1.6%, a figure which probably represents age-associated bone loss. The rate of bone loss in PGOA was significantly less than that in RA patients not receiving corticosteroids. The mean annual rate of change of TBCa in 30 RA patients receiving corticosteroids (+0.7%) was significantly less than that in any of the other RA groups despite an initial normalized bone mass which was significantly less than in those RA patients receiving NSAIDs alone. The data supported the hypothesis that bone loss occurred early in the course of corticosteroid therapy and thereafter the drugs might have a protective effect on the loss of bone in RA.

BONE MASS IN POSTMENOPAUSAL WOMEN AFTER WITHDRAWAL OF OESTROGEN/GESTAGEN REPLACEMENT THERAPY

The effect on forearm bone mineral content (BMC) of initiation and withdrawal of oestrogen/gestagen treatment was studied in a randomised trial in 94 healthy female volunteers six months to three years after the menopause. BMC was measured every three months for three years. BMC increased by 3·7% (p<0·001) during three years' hormone treatment and decreased by 5·7% (p<0·001) during three years' placebo treatment. The annual rate of bone loss after discontinuation of hormone therapy was identical with the bone loss in the placebo group. The present study indicates that even temporary hormone replacement therapy after the menopause will have a lasting beneficial effect on bone mass.

Loss of metacarpal and iliac bone in chronic renal failure: influence of haemodialysis, parathyroid activity, type of renal disease, physical activity and heparin consumption.

1. Bone loss was assessed by measurement of cortical thickness of metacarpal bone by X-ray and of trabecular bone area in serial bone biopsies in 49 patients with chronic renal failure, six before and 45 during maintenance haemodialysis treatment. 2. Metacarpal cortical measurements (MCM) were very reproducible (coefficient of variation 1·95%), whereas bone area measurements by histology showed great variability. There was no correlation between rates of change of MCM and bone area over the same period, although both tended to fall with time. 3. The mean annual rate of bone loss measured by MCM for patients on dialysis was 2·08 ± 0·32 mm/year (mean ±1 sem) and this rate was not significantly different from the mean rate of loss of 2·49 ± 0·78 mm/year for the six patients who were not on maintenance haemodialysis. 61% of all patients showed a significant decrease during the period of study (1–6 years), but none had symptoms attributable to bone loss. 4. The loss tended to be greatest in women over the age of 40 years. The initial amount of bone and the rate of loss measured by MCM or bone histology were not influenced significantly by the presence or absence of histological or radiological evidence of parathyroid overactivity or of osteomalacia, nor by differences in the causes of renal disease. 5. Loss of metacarpal cortical bone correlated with heparin consumption during haemodialysis in men but not in women. The amount of bone and its rate of loss was not influenced by the presence of an arteriovenous shunt in one arm compared with the other. In neither sex did bone loss correlate with physical activity. 6. A relative deficiency of calcium due to a low dietary calcium intake and intestinal malabsorption of calcium, together with a dialysate calcium of only 1·5 mmol/l, may be more important causes of bone loss in patients in this study.