Decline In BMD Research Articles

Lifestyle influences on 9-year changes in BMD in young women.

The effects of dietary calcium intake and physical activity on longitudinal changes in BMD over a mean of 9.4 years were examined in 62 healthy young women. Proximal femur BMD declined, lumbar spine BMD increased, and physical activity was associated with BMD change at intertrochanter and total hip sites. Maximizing premenopausal BMD is an important strategy for the prevention of osteoporosis and resultant fractures later in life. Young women who previously participated in a placebo-controlled 2-year calcium intervention study at a mean age of 18.5 +/- 0.3 years were remeasured at 27.8 +/- 1.0 years of age. DXA (Hologic QDR 1000W) was used to measure changes in BMD, and lifestyle factors were ascertained by questionnaire. Early decline in BMD at the neck of femur (-3.3%/decade) and the converse gain in BMD at the lumbar spine (+4.3%/decade) and intertrochanter (+1.9%/decade) suggest site-specific changes in BMD in young premenopausal women. No effect of previous calcium supplementation was seen on current BMD or changes in BMD (p > 0.10). Lifestyle predictors of change in BMD were determined using hierarchical regression analysis after forced correction for the covariates baseline BMD and previous calcium supplementation. Physical activity was positively associated with change in BMD at total hip and intertrochanter sites (beta-coefficients, beta = 0.26 and 0.26 respectively; p < 0.05). Calcium intake was negatively associated with change in BMD at the lumbar spine (beta = -0.27, p < 0.05). Parity was negatively associated with change in BMD at all sites (beta = -0.40 to -0.26, p < 0.05). These data show that BMD is already declining at the proximal femur in these healthy young women. Physical activity assists in maintenance of BMD at some sites and thus may contribute to lifelong fracture prevention. There was no positive association between calcium intake and change in BMD.

Improvement of risk factors for hip fracture by exercise intervention in elderly women

The purpose of this study was to investigate whether a 36-week complex exercise program helps to improve the risk factors for fall and hip fracture. Participant group for this study was 47 women in the range of age 65-68. The exercise program was conducted three times per week for 36 weeks. This study proved that the complex exercise program with weight bearing exercise at a moderate intensity and the gait training were highly effective in offsetting the decline in BMD, hormone metabolic substrate in elderly women. In addition, this exercise program had a positive effect on their postural stability.

A RANDOMIZED TRIAL TO EXAMINE EFFECTS OF EXERCISE ON BONE DENSITY IN CANCER PATIENTS RECEIVING CHEMOTHERAPY AND CATABOLIC STEROIDS

Muscle wasting and declines in bone density are commonly observed in patients receiving high dose catabolic steroids, drugs commonly included in cancer treatment protocols. The combination of catabolic steroids, and chemotherapy increase the potential for significant physical debilitation, and predispose patients to osteoporosis. The purpose of the preliminary analysis is to examine differences in functional ability, strength, and bone density (BMD) in cancer patients actively receiving chemotherapy and catabolic steroids. Thirty-six newly diagnosed cancer patients beginning chemotherapy regimens with catabolic steroids were randomized to aerobic exercise (AE) (N = 11), resistance exercise (RE) (N = 10), or usual care (CG) (N = 15). Exercising subjects followed a home-based program 4 days/wk. All subjects returned for exercise follow-up at 3 months intervals and had dexa scans of the L-spine at baseline and 6 months. The AE and RE groups both demonstrated increases of functional ability 16% and 4% respectively. The CG group showed a 10% decline in functional ability. Upper and lower body muscle strength increased in both the AE and RE groups. CG demonstrated significant declines in muscle stregth of the lower extremities. Only 3 subjects demonstrated stable or improved BMD (M = 2.04 SD = .96). The average decline in BMD was −6.5% (SD = 4.9, range = 1.4 to −16.4). AE demonstrated less declines in BMD than RE or CG. These preliminary data suggest that 1) AE and RE may improve functional ability and muscle strength, 2) substantial declines in BMD are observed over a short period during chemotherapy, and 3) more time is needed to determine effects of exercise on BMD. Supported by NIH NR 05084

Peripheral volumetric bone mineral density in pre- and postmenopausal Chinese women in Hong Kong.

The aim of this cross-sectional study was to use a newly available precise and multislice pQCT (Densiscan 2000) for establishing reference data of volumetric bone mineral density (vBMD) of the distal radius. vBMD of the nondominant wrist was measured in 118 healthy Hong Kong Chinese women aged 41-60. Anthropometric parameters, menstrual status, and handgrip strength were also measured. Results showed that there was a significant age-related decline in trabecular BMD (tBMD), integral BMD (iBMD), and cortical BMD (cBMD), with correlation coefficients ranging from -0.401 to -0.547 (P < 0.001). The annual decline of vBMD was 2.22%, 1.79%, and 0.88% in tBMD, iBMD, and cBMD, respectively. When subjects were divided into premenopausal and postmenopausal groups, we found an age-related decline in tBMD and iBMD, but not in cBMD in both groups. The vBMD values interpreted in mg/cm3 in premenopausal women were 238.4 +/- 57.2 in tBMD, 604.6 +/- 82.9 in iBMD, 1415.5 +/- 129.9 in cBMD, and declined significantly (all P < 0.001) to 193.7 +/-54.7 in tBMD, 500.0 +/- 90.3 in iBMD, and 1306.7 +/- 153.5 in cBMD in the postmenopausal women. On average, 16.7% of the subjects showed their vBMDs to be below-1 SD and only 1.7% of them lower than -2 SD. Linear regression showed that the annual decline of vBMD was faster in postmenopausal women with 2.42% in tBMD, 1.90% in iBMD, and 0.88% in cBMD compared with 1.91% in tBMD, 0.98% in iBMD, and 0.55% in cBMD in the premenopausal women. After adjustment for age, only the iBMD with dominant trabecular elements showed a significantly accelerated decrease after the onset of menopause (P = 0.008). Weak or no association was found among vBMDs with anthropometric parameters, years since menopause, or handgrip strength. In conclusion, we found a significant age-related decline of vBMDs in Hong Kong Chinese women aged 41-60 years, characterized by the early reduction of metabolically active trabecular bone after entering the fourth decade of life, with an accelerated decline after the onset of menopause.

Treatment options for osteoporosis in chronic liver disease patients requiring liver transplantation.

As patient life expectancy rises after liver transplantation, osteoporosis becomes a significant contributor to morbidity and mortality. Patients who undergo liver transplant have an increased risk of bone fractures secondary to osteoporosis, relative to the general population. Risk factors (pre- and posttransplant) include treatment with steroids, alcohol abuse, smoking, poor nutritional status, immobility, reduced muscle mass, menopause, and hypogonadism. The role of cholestatic liver disease is well recognized, but as of yet, the underlying etiology is unknown. The role of immunosuppressants is also evident, but their exact contribution remains to be established. Currently, there are no established therapies for osteoporosis secondary to liver transplantation. Most of the therapeutic options have been extrapolated from usual treatment options for osteoporosis in the general population. It is reasonable to attempt to lower steroid dosages, especially with the availability of new and more potent immunosuppressants such as mycophenolate mofetil and tacrolimus. Potentially, high-risk patients could be identified early with BMD screening. Preventive measures could be instituted and patients could be monitored more closely for objective signs of osteoporosis, such as decline in BMD and early fractures. Calcium and vitamin D supplementation may be helpful in those with deficiencies or poor nutritional intake, as well as in women older than 25 years. The role of bisphosphonates and hormone replacement therapy remains equivocal as studies in transplant patients are currently lacking. Risk versus benefit must be weighed on an individual basis. Lifestyle measures should be instituted in all patients if possible.

Bone density and body composition in Japanese women.

Total body bone mineral content (BMCTB in g) and density (BMDTB in g/cm2) and body composition were measured in 1006 healthy Japanese women aged 20-79 years using dual X-ray absorptiometry. Peak BMDTB was 1.11 +/- 0.05 g/cm2 in women 20-49 years, and mean BMDTB was 1. 019 g/cm2 in the 6th decade, 0.956 g/cm2 in the 7th decade, and 0. 900 g/cm2 in the 8th decade. BMDTB declined by 0.007 g/cm2/year in women after age 50. This age-related decline in BMD showed a similar pattern to that seen for the lumbar spine and femoral neck, but the actual rate of loss was lower for BMDTB than for these other measurement sites. There was no significant difference between a eumenorrheic premenopausal group and a group with irregular menses. BMCTB and BMDTB were associated with body build, lean tissue mass, and fat mass (r = 0.29 approximately 0.65 and 0.26 approximately 0.41, respectively). Bone mass and density decreased significantly in older women of all body builds. Premenopausal Japanese women had a 5% lower BMDTB than U.S. and European whites, but the difference was several times greater in postmenopausal than in premenopausal women.

Bone loss and turnover after cardiac transplantation.

Cardiac transplantation is associated with increased prevalence and incidence of fracture, and rapid bone loss has been reported during the first posttransplant year. To define further the pattern and etiology of bone loss after cardiac transplantation, we enrolled 70 patients (52 men and 18 women) in a prospective 3-yr study. Bone densitometry (BMD) and biochemical indexes of mineral metabolism were performed before and at defined times after transplantation. Despite supplementation with elemental calcium (1000 mg/day) and vitamin D (400 IU/day), the mean rate of bone loss during the first year was 7.3 +/- 0.9% (+/- SEM) at the lumbar spine and 10.5 +/- 1.1% at the femoral neck. The rate of bone loss slowed (P < 0.001 compared to year 1) at both sites (0.9 +/- 0.9% and 0.1 +/- 1.0%, respectively) during the second year. During the third year, lumbar spine BMD increased at a rate of 2.4 +/- 0.8%/yr (P < 0.02 compared to year 2), but femoral neck BMD did not change. At the radius, the rate of decline in BMD was negligible during the first year (0.9 +/- 0.5%), but was significant during the second (2.1 +/- 0.6%; P < 0.01) and third (2.9 +/- 0.8%; P < 0.03) years. Evaluation of the pattern of bone loss during the first year demonstrated that mean lumbar spine BMD decreased rapidly during the first 6 months, after which there was no further decline. In contrast, femoral neck BMD continued to fall at an annualized rate of 8.2 +/- 1.3% during the second half of the year. The pattern and rates of bone loss were similar in men and women. Biochemistries revealed decreases in serum testosterone and osteocalcin and increases in all bone resorption markers 1 and 3 months after transplantation, with a return to baseline by 6 months. Higher rates of bone loss were associated with greater exposure to prednisone, lower serum concentrations of vitamin D metabolites, greater suppression of osteocalcin, higher levels of bone resorption markers, and, in men, lower serum testosterone concentrations. We conclude that rapid bone loss is primarily confined to the initial year after transplantation. During the first 6 months, bone loss is accompanied by alterations in markers of bone turnover consistent with biochemical uncoupling of bone formation and resorption. Greater exposure to glucocorticoids, lower serum concentrations of vitamin D metabolites and testosterone, and higher bone turnover were associated with more rapid bone loss.

Seven years of cyclical etidronate: Continued improvement in spine bmd and progressive decline in vertebral fracture incidence

Seven years of cyclical etidronate: Continued improvement in spine bmd and progressive decline in vertebral fracture incidence

Age-related changes in female femoral neck geometry: implications for bone strength.

Bone strength is a function of both bone mass and its geometric distribution, a factor that is obscured in the conventional bone mineral analysis. Structural geometry is particularly important in areas such as the femoral neck that are exposed to bending loads in vivo. Here we present results of a study examining age changes in the structural geometry of the female femoral neck derived from dual photon absorptiometry (DPA) data. In a previous study, differences in the aging patterns of males and females over the entire adult age range were demonstrated. In that study, only males showed "compensatory" geometric restructuring of the femoral neck which tended to offset loss of bone mineral with age. In the present study, femoral neck structural properties from 1044 women were examined for aging trends before and after the approximate age of menopause (50 years). Women in the premenopausal age range showed a 4% decline per decade in femoral neck BMD, but no change in the femoral neck cross-sectional moment of inertia (CSMI). This aging pattern is similar to that of males in our earlier study, and in both cases resulted in little or no increase in femoral neck bending stresses. After age 50, however, women show a more rapid decline in femoral neck BMD (7% per decade) accompanied by a decline in CSMI of 5% per decade. These changes result in increases in femoral neck stresses of 4-12% per decade due to the apparent lack of compensatory restructuring to offset the loss of bone mineral.(ABSTRACT TRUNCATED AT 250 WORDS)

A Potential Primate Model for Bone Loss Resulting from Medical Oophorectomy or Menopause*

This study examined the potential use of the GnRH agonist-treated female monkey as a model for bone loss after medical oophorectomy or the onset of menopause in women. Three female rhesus monkeys (13-16 yr of age) were treated continuously for 10 months with 25 micrograms/day GnRH agonist using osmotic minipumps. All three animals exhibited normal menstrual cycles before treatment. Within 5 weeks of the beginning of GnRH agonist treatment, serum progesterone and estradiol concentrations had fallen to low values and did not rise significantly during the remaining treatment period. The decline in ovarian steroidogenesis was correlated with a reduction in bone mineral density (BMD; bone mineral content/bone width) of the caudal vertebrae and humerus. The reduction of BMD of the caudal vertebrae occurred gradually. The downward trend was evident during the first 3 treatment months, but did not fall significantly below pretreatment levels until 9 months of GnRN agonist treatment. The overall decline in BMD for the caudal vertebrae was approximately 14% after 9 months of GnRH agonist treatment. The measured decline in BMD of the humorous was 11%. Serum osteocalcin levels rose more than 10-fold above pretreatment values between 4 and 7 months of GnRH agonist treatment before declining to levels that approached pretreatment concentrations between 8 and 10 months of treatment. Menstrual cycles were reinitiated within 4 weeks after the termination of treatment, as shown by luteal phase increases in serum progesterone concentrations. BMD of the humerus and caudal vertebrae remained subnormal 2 months posttreatment, but by 5 months had recovered to near-pretreatment values. These data suggest that ovarian hormone deprivation induced by GnRH agonist administration is associated with a decline in BMD in female monkeys, and that this animal model may be an excellent model for postmenopausal bone loss or bone reduction resulting from medical oophorectomy. The GnRH agonist-treated monkey also has the potential to be developed as a model for type I postmenopausal osteoporosis.