Family History Of Fracture Research Articles

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Patient Assessment in the Diagnosis, Prevention, and Treatment of Osteoporosis

Assessment of the patient with osteoporosis includes history and physical examination, laboratory testing, and imaging studies. Information gathered during this assessment assists clinicians in targeting strategies to prevent fractures. The medical history should contain items such as personal and family history of fractures, lifestyle, intake of substances such as vitamin D, calcium, corticosteroids, and other medications. The physical examination can reveal relevant information such as height loss and risk of falls. Bone mineral density (BMD), most commonly determined by dual-energy x-ray absorptiometry, best predicts fracture risk in patients without previous fracture. BMD testing is most efficient in women over 65 years old but is also helpful for men and women with risk factors. Serial BMD tests can identify individuals losing bone mass, but clinicians should be aware of what constitutes a significant change. Laboratory testing can detect other risk factors and can provide clues to etiology. Selection of laboratory tests should be individualized, as there is no consensus regarding which tests are optimal. Biochemical markers of bone turnover have a potential role in fracture risk assessment and in gauging response to therapy, but are not widely used at present. Clinicians should be aware of problems with vitamin D measurement, including seasonal variation, variability among laboratories, and the desirable therapeutic range. Careful assessment of the osteoporotic patient is essential in developing a comprehensive plan that reduces fracture risk and improves quality of life.

Epidemiological multicenter study on osteoporosis: the EDMUSTO study

To the Editor Osteoporosis (OP) has been recognized as a worldwide major public health problem. Several risk factors have been identiWed to play a role in OP and the relevant literature comprises some descriptive studies within several countries [1–9]; however to our best knowledge, epidemiological diVerences among speciWc countries have not been fully reported hitherto. EDMUSTO was primarily conducted to provide an insight into understanding the epidemiological comparisons among three countries—namely Turkey, Iran and Poland—with regard to OP. The results with speciWc remark on eye and hair colors are presented in this paper. Six hundred and thirty-four postmenopausal women (461 from Turkey, 101 from Iran and 72 from Poland) with a diagnosis of OP were enrolled in the EDMUSTO study. During patient registration and data recording, a common style was utilized by all of the physicians in each country. Then, the forms were gathered and analyzed by the Turkish team. Demographical parameters included age, body weight and height, eye and hair color, education level, age and type of menopause, duration of OP, history of fracture, family history of OP and fractures, physical activity, high alcohol intake, heavy smoking, heavy caVeine intake and daily calcium intake. BMD evaluations were carried out by using DEXA of lumbar and femoral regions. Current treatments were also recorded. Descriptive statistics and Chi-square tests were performed for the comparison of three countries. Analysis of variance, Kruskal–Wallis analysis of variance and multiple comparisons were used to evaluate post hoc diVerences. Student’s t test and Mann–Whitney U test were performed to test the diVerences between two groups. The Statistical Package for Social Sciences (SPSS) was used for all calculations and statistical signiWcance was set at P < 0.05. When compared among the countries; the mean age values of Turkey (62.73 § 9.62) and Iran (63.85 § 9.80) were indiVerent, but that of Poland (68.10 § 7.84) was higher (P = 0.00). We have found signiWcant diVerences between the countries as far as BMI, age of menopause, eye/hair color, educational level, fracture history, family history of fracture, heavy smoking, daily Ca intake and physical activity, treatment alternatives and BMD values were concerned (all P values < 0.05) (Fig. 1, 2, 3). Furthermore, when all the results were recruited as a single data, we have Y. Gokce-Kutsal · L. Ozcakar (&) Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey e-mail: lozcakar@yahoo.com

Of mice and men: pathophysiology of male osteoporosis

In both old and young men osteoporosis is a severe but frequently neglected condition. This review deals with the multifactorial pathogenesis of impaired bone strength in men. Male bones are not only influenced by androgens, but, somewhat surprisingly – according to the current state of knowledge –female sex hormones may be the major players in calcified tissue remodelling. As a matter of principle, gender shapes bone geometry on a life-long basis. In men, age-dependant bone loss is outweighed by increased periosteal apposition. Contrary to women, the male gender-specific resorption pattern is mainly based on trabecular thinning. Therefore the connectivity remains rather intact, which again positively influences the biomechanical tissue properties and the resistance to fractures. Since affected patients often present with a family history of fractures or low bone density, the genetics of male osteoporosis is one of the main fields of interest in current bone research. Several gene polymorphisms involving the α1 chain of type 1 collagen (COLIA-1), aromatase, vitamin D receptor (VDR), low-density lipoprotein receptor-related protein 5 (LPR5) and the lactase phlorizin hydrolase (LCT) have recently been described. But apart from such exciting research novelties, the classical every-day violaters of both male and female bone health (vitamin D deficiency, low calcium intake and inadequate life-style) must still be taken into account.

Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound

The relationship between osteoporosis risk factors, bone quantitative ultrasound (QUS) and non-spinal fracture risk was estimated in a cohort of 5,201 postmenopausal women from Spain who were prospectively evaluated during three years. Several clinical risk factors and low heel QUS values were independently associated with non-spinal fracture risk. Low-trauma, non-spinal fractures are a growing source of morbidity and mortality in the elderly. The aim of the present study was to examine the association of heel quantitative ultrasound (QUS) and a series of osteoporosis and fracture risk factors, with incident low energy non-spinal fractures in a population of elderly women, and to incorporate them into fracture prediction models. 5,201 women aged 65 or older were enrolled in a three-year cohort study. Participants completed an osteoporosis and fracture risk factors questionnaire. QUS was measured at the heel with a gel-coupled device. Cox-proportional hazard analyses were performed to evaluate the association with the first incident low-trauma non-spinal fracture. Three hundred and eleven women (6.0%) sustained a total of 363 low-trauma fractures, including 133 forearm/wrist, 54 hip, 50 humerus, 37 leg and 17 pelvic fractures. For every standard deviation decrease in the quantitative ultrasound index, the adjusted hazard ratios (95% CI) for any non-vertebral, hip, forearm/wrist, and humerus fractures were 1.31 (1.15-1.49), 1.40 (1.01-1.95), 1.50 (1.19-1.89) and 1.35 (0.97-1.87), respectively. Similar results were observed with other QUS variables. The best predictive models indicated that age, a history of falls, a previous low-trauma fracture, a family history of fracture, a calcium intake from dairy products of less than 250 mg/day, and lower values of QUS parameters were independently associated with the risk of non-spinal fractures. Both clinical risk factors and QUS are independent predictors of risk of fragility non-spinal fractures. A prediction algorithm using these variables was developed to estimate the absolute risk of non-spinal fractures in elderly women in Spain.

Epidemiology, etiology, and diagnosis of osteoporosis

Osteoporosis, a major public health problem, is becoming increasingly prevalent with the aging of the world population. Osteoporosis is a skeletal disorder characterized by compromised bone strength, which predisposes the individual to an increased risk of fractures of the hip, spine, and other skeletal sites. The clinical consequences and economic burden of this disease call for measures to assess individuals who are at high risk to allow for appropriate intervention. Many risk factors are associated with osteoporotic fracture, including low peak bone mass, hormonal factors, the use of certain drugs (eg, glucocorticoids), cigarette smoking, low physical activity, low intake of calcium and vitamin D, race, small body size, and a personal or a family history of fracture. All of these factors should be taken into account when assessing the risk of fracture and determining whether further treatment is required. Because osteoporotic fracture risk is higher in older women than in older men, all postmenopausal women should be evaluated for signs of osteoporosis during routine physical examinations. Radiologic laboratory assessments of bone mineral density generally should be reserved for patients at highest risk, including all women over the age of 65, younger postmenopausal women with risk factors, and all postmenopausal women with a history of fractures. The evaluation of biochemical markers of bone turnover has been useful in clinical research. However, the predictive factor of these measurements is not defined clearly, and these findings should not be used as a replacement for bone density testing. Together, clinical assessment of osteoporotic risk factors and objective measures of bone mineral density can help to identify patients who will benefit from intervention and, thus, can potentially reduce the morbidity and mortality associated with osteoporosis-associated fractures in this population.

A method for determining the grade of osteoporosis based on risk factors in postmenopausal women

The aim of this study was to determine whether the probability of osteoporosis and osteopenia was affected by the risk factors, physical examination findings, or radiological investigations such as spinal X-rays in postmenopausal women. We assessed risk factors such as use of hormone replacement therapy, physical activity level, calcium intake, smoking, caffeine consumption, long-term immobilization, previous history of fracture, family history of fracture, presence of certain systemic diseases (hyperthyroidism or hyperparathyroidism), or use of medications (corticosteroids or others), physical examinations, and presence of vertebral fractures on spinal X-rays. Patients' bone mineral density (BMD) was evaluated using dual energy X-ray absorptiometry (DXA) in the lumbar spine, and we compared the risk factors between osteopenic and osteoporotic women according to DXA. We evaluated 235 postmenopausal women who attended our osteoporosis outpatient clinic. Those patients were divided into two groups as either osteopenic (n = 67, mean age: 63.1 years) or osteoporotic (n = 168, mean age: 66.2 years) according to WHO criteria. The lumbar spinal (L1-L2) T-score values were -1.5 +/- 0.6 and -3.1 +/- 0.6 in osteopenic and osteoporotic groups, respectively. There were significant differences between the two groups in terms of mean age and lumbar BMD (p = 0.009 and p < 0.001, respectively). We also observed that vertebral tenderness on palpation, back pain, and existing vertebral fracture (fx) were significantly different between the osteopenic and osteoporotic groups (p < 0.05). As a result of the statistical analysis, we found an equation to determine osteopenic and osteoporotic women by using those four factors (age, vertebral tenderness on palpation, back pain, and existing vertebral fx) in multivariate stepwise logistic regression. The equation is as follows: Y (DXA) = -2.9024 + 0.044 (age in year) + 0.819 (vertebral fx) + 0.877 (pain) + 1.136 (vertebral tenderness). We can estimate whether a postmenopausal woman is osteopenic or osteoporotic based on these risk factors by using the stepwise logistic regression equation.

A family history of fracture and fracture risk: a meta-analysis

The aims of the present study were to determine whether a parental history of any fracture or hip fracture specifically are significant risk factors for future fracture in an international setting, and to explore the effects of age, sex and bone mineral density (BMD) on this risk. We studied 34,928 men and women from seven prospectively studied cohorts followed for 134,374 person-years. The cohorts comprised the EPOS/EVOS study, CaMos, the Rotterdam Study, DOES and cohorts at Sheffield, Rochester and Gothenburg. The effect of family history of osteoporotic fracture or of hip fracture in first-degree relatives, BMD and age on all clinical fracture, osteoporotic fracture and hip fracture risk alone was examined using Poisson regression in each cohort and for each sex. The results of the different studies were merged from the weighted β coefficients. A parental history of fracture was associated with a modest but significantly increased risk of any fracture, osteoporotic fracture and hip fracture in men and women combined. The risk ratio (RR) for any fracture was 1.17 (95% CI = 1.07–1.28), for any osteoporotic fracture was 1.18 (95% CI = 1.06–1.31), and for hip fracture was 1.49 (95% CI = 1.17–1.89). The risk ratio was higher at younger ages but not significantly so. No significant difference in risk was seen between men and women with a parental history for any fracture (RR = 1.17 and 1.17, respectively) or for an osteoporotic fracture (RR = 1.17 and 1.18, respectively). For hip fracture, the risk ratios were somewhat higher, but not significantly higher, in men than in women (RR = 2.02 and 1.38, respectively). A family history of hip fracture in parents was associated with a significant risk both of all osteoporotic fracture (RR 1.54; 95CI = 1.25–1.88) and of hip fracture (RR = 2.27; 95% CI = 1.47–3.49). The risk was not significantly changed when BMD was added to the model. We conclude that a parental history of fracture (particularly a family history of hip fracture) confers an increased risk of fracture that is independent of BMD. Its identification on an international basis supports the use of this risk factor in case-finding strategies.

Maternal History of Osteoporosis and Femur Geometry

Most studies that have examined the role of skeletal factors in the relationship between an individual's family history of fracture or osteoporosis and their fracture risk have focused on bone density. In this study, we expanded the scope of skeletal factors to include geometric properties (subperiosteal width, section modulus, cortical thickness, and buckling ratio) in addition to areal bone mineral density (BMD). We compared these skeletal factors at the femur neck and shaft by self-reported maternal history of osteoporosis (OP HX) from 5334 non-Hispanic whites, ages > or =20 years in the Third National Health and Nutrition Examination Survey (NHANES III, 1988-94). A total of 213 men and 315 women reported a positive OP HX (e.g., their biological mother had sustained a hip fracture after age 50 years or had a physician's diagnosis of osteoporosis). Differences in bone density and geometry by OP HX were examined after adjusting for potential confounding variables. Several bone parameters differed significantly by OP HX in both sexes at the femur neck, but none differed at the femur shaft. At the neck, those with a positive OP HX had values that differed by approximately 3% to 4% (lower for BMD, bone mineral content (BMC), cross-sectional area, and cortical thickness; higher for buckling ratios) from those with a negative OP HX (P < 0.05). The magnitude of these relationships was similar in both sexes, but differences were greater in younger versus older adults. In conclusion, both men and women with a positive maternal history of osteoporosis may be at greater risk of femur neck fracture owing to thinner cortices and lower BMC, which in turn results in potentially greater cortical instability (buckling ratio) at this skeletal site.

Discriminative capacity of calcaneal quantitative ultrasound and of osteoporosis and fracture risk factors in postmenopausal women with osteoporotic fractures.

Bone fragility fractures constitute the principal complication of osteoporosis. The identification of individuals at high risk of sustaining osteoporotic fractures is important for implementing preventive measures. The purpose of this study is to analyze the discriminative capacity of a series of osteoporosis and fracture risk factors, and of calcaneal quantitative ultrasound (QUS), in a population of postmenopausal women with a history of osteoporotic fracture. A cross-sectional analysis was made of a cohort of 5195 women aged 65 or older (mean +/- SD: 72.3 +/- 5.4 years) seen in 58 primary care centers in Spain. A total of 1042 women (20.1%) presented with a history of osteoporotic fracture. Most fractures (93%) were non-vertebral. Age-adjusted odds ratios corresponding to each decrease in one standard deviation of the different QUS parameters ranged from 1.47 to 1.55 (P < 0.001) for fractures. The age-adjusted multivariate analysis yielded the following risk factors independently associated with a history of osteoporotic fracture: number of fertile years, a family history of fracture, falls in the previous year, a history of chronic obstructive airway disease, the use of antiarrhythmic drugs, and a low value for any of the QUS parameters. The area under the receiver operating characteristic curve of the best model was 0.656. In summary, a series of easily assessable osteoporotic fracture risk factors has been identified. QUS was shown to discriminate between women with and without a history of fracture, and constitutes a useful tool for assessing fracture risk. Various of the vertebral and hip fracture risk factors frequently cited in North American and British populations showed no discriminative capacity in our series--thus suggesting that such factors may not be fully applicable to our population and/or to the predominant type of fractures included in the present study.

Independent predictors of all osteoporosis-related fractures in healthy postmenopausal women: The OFELY Study

Several epidemiological studies have identified clinical factors that predict the risk of hip fractures in elderly women independently of the level of bone mineral density (BMD), such as low body weight, history of fractures, and clinical risk factors for falls. Their relevance in predicting all fragility fractures in all postmenopausal women, including younger ones, is unknown. The objective of this study was to identify independent predictors of all osteoporosis-related fractures in healthy postmenopausal women. We prospectively followed for 5.3 ± 1.1 years a cohort of 672 healthy postmenopausal women (mean age 59.1 ± 9.8 years). Information on social and professional conditions, demographic data, current and past medical history, fracture history, medication use, alcohol consumption, caffeine consumption, daily calcium intake, cigarette smoking, family history of fracture, and past and recent physical activity was obtained. Anthropometric and total hip bone mineral density measurements were made. Incident falls and fractures were ascertained every year. We observed 81 osteoporotic fractures (annual incidence, 21 per 1000 women/year). The final model consisted of seven independent predictors of incident osteoporotic fractures: age ≥ 65 years, odds ratio estimate (OR), 1.90 [95% confidence interval (CI) 1.04–3.46], past falls, OR, 1.76 (CI 1.00–3.09), total hip bone mineral density (BMD) ≤ 0.736 g/cm 2, OR, 3.15 (CI 1.75–5.66), left grip strength ≤ 0.60 bar, OR, 2.05 (CI 1.15–3.64), maternal history of fracture, OR, 1.77 (CI 1.01–3.09), low physical activity, OR, 2.08 (CI 1.17–3.69), and personal history of fragility fracture, OR, 3.33 (CI 1.75–5.66). In contrast, body weight, weight loss, height loss, smoking, neuromuscular coordination assessed by three tests, and hormone replacement therapy were not independent predictors of all fragility fractures after adjustment for all variables. We found that some—but not all—previously reported clinical risk factors for skeletal fragility predicted all fragility fractures independently of BMD in healthy postmenopausal women, although they differed somewhat from those predicting specifically hip fractures in elderly women. These risk factors appear to reflect quality of bone structure (previous fragility fracture), lifestyle habits (physical activity), muscle function and health status (grip strength), heredity (maternal history of fracture), falls, and aging. Measurements of these variables should be included in the clinical assessment of the risk of osteoporotic fractures in postmenopausal women.

Bone Densitometry: Applications and Limitations

Osteoporosis is clinically diagnosed in its advanced stages, usually following a fracture. Accurate, precise, and noninvasive skeletal assessment is now possible for early detection of osteoporosis at a preclinical stage. Currently, the gold standard in bone mass measurement and fracture prediction is dual energy X-ray absorptiometry (DEXA) of the hip and spine. Exponential increases in fracture risk have been observed with small decreases in bone mineral density. Bone mineral density BMD should be considered in conjunction with independent clinical risk factors for fracture, including: low body weight, history of postmenopausal fracture, family history of fracture, and poor neuromuscular function. The World Health Organization (WHO) diagnostic criteria for osteoporosis and osteopenia are appropriate for postmenopausal Caucasian women and are applicable to DEXA assessments at the hip, spine, or forearm. This review explores the relationship between BMD and fracture risk, the principles of bone densitometry interpretation, and the applications as well as the limitations of DEXA technology, and presents cases illustrating common errors seen in the interpretation of DEXA studies.

Identification and fracture outcomes of undiagnosed low bone mineral density in postmenopausal women: results from the National Osteoporosis Risk Assessment.

Large segments of the population at risk for osteoporosis and fracture have not been evaluated, and the usefulness of peripheral measurements for short-term prediction of fracture risk is uncertain. To describe the occurrence of low bone mineral density (BMD) in postmenopausal women, its risk factors, and fracture incidence during short-term follow-up. The National Osteoporosis Risk Assessment, a longitudinal observational study initiated September 1997 to March 1999, with approximately 12 months of subsequent follow-up. A total of 200 160 ambulatory postmenopausal women aged 50 years or older with no previous osteoporosis diagnosis, derived from 4236 primary care practices in 34 states. Baseline BMD T scores, obtained from peripheral bone densitometry performed at the heel, finger, or forearm; risk factors for low BMD, derived from questionnaire responses; and clinical fracture rates at 12-month follow-up. Using World Health Organization criteria, 39.6% had osteopenia (T score of -1 to -2.49) and 7.2% had osteoporosis (T score </=-2.5). Age, personal or family history of fracture, Asian or Hispanic heritage, smoking, and cortisone use were associated with significantly increased likelihood of osteoporosis; higher body mass index, African American heritage, estrogen or diuretic use, exercise, and alcohol consumption significantly decreased the likelihood. Among the 163 979 participants with follow-up information, osteoporosis was associated with a fracture rate approximately 4 times that of normal BMD (rate ratio, 4.03; 95% confidence interval [CI], 3.59-4.53) and osteopenia was associated with a 1.8-fold higher rate (95% CI, 1.49-2.18). Almost half of this population had previously undetected low BMD, including 7% with osteoporosis. Peripheral BMD results were highly predictive of fracture risk. Given the economic and social costs of osteoporotic fractures, strategies to identify and manage osteoporosis in the primary care setting need to be established and implemented.

Prevalence of hip fracture risk factors in women aged 70 years and over.

We estimated the prevalence of common risk factors for hip fracture and the numbers needed to treat (NNT) to prevent a hip fracture in various high-risk population groups, using a postal risk factor survey of women aged 70 years and above from General Practices in Grampian and Yorkshire. Recorded risk factors included prior fracture of any type; low body weight; smoking; and family history of fracture. The prevalence rates of hip fracture risk factors were 34%, 7% and 11% for previous fracture, maternal hip fracture and smoking, respectively for the Grampian practices (low body weight being defined as falling in the lowest quartile) and 34%, 7% and 7% for a single practice in the York area. Applying previously published estimates of risk, NNT analysis produced a value of about 300 for women with no risk factors, whilst for women with three risk factors it was between 32 and 71, depending on which risk factors were present and assuming intervention reduced fracture rates by 30% or 50%. Groups of women at high risk of hip fracture can easily be identified in primary care and offered treatment, with realistic prospects of hip fracture prevention.

Epidemiology of Fractures and Assessment of Fracture Risk

Osteoporosis is a common condition that is clinically important because of its association with fracture. Fracture risk is ultimately determined by the relation between bone strength and propensity to trauma. Bone density is a key determinant of bone strength, and depends on the bone gained during growth and consolidation, and the subsequent rate of bone loss. Many factors (both genetic and environmental) influence the risk of future fracture through effects on these key intermediary mechanisms. Fracture risk increases greatly with age and is generally higher in women than in men and in whites than in other races. Around 30% to 40% of the variance in peak bone mass is genetically determined, and polymorphisms for several candidate genes are currently being identified. Sex hormone deficiency after the menopause is a key factor in the pathogenesis of osteoporosis in women. In addition, however, there are environmental influences that affect bone density, such as cigarette smoking, alcohol consumption, physical inactivity, and nutrition. Using age, BMD, and other risk factors, it is now possible to identify populations at high risk of osteoporotic fractures. Such populations will potentially derive maximal benefit from therapies and other strategies that reduce fracture risk.

The relationship between spinal and appendicular bone mass modified by physical, historical, and lifestyle factors.

Spinal, radial, and calcaneal bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and calcaneal bone mass measured by quantitative ultrasound densitometry (QUS) were compared in 83 healthy Japanese female volunteers. A significant and strong correlation was found within the same methods (r = 0.619 for lumbar spine and radius by DXA, r = 0.760 for lumbar spine and calcaneus by DXA, and r = 0.644 for calcaneus and radius by DXA), and within the same site (r = 0.758 for calcaneus by DXA and QUS). A lesser correlation was found when both the method and site were different (r = 0.521 for radius by DXA and calcaneus by QUS, and r = 0.583 for lumbar spine by DXA and calcaneus by QUS). Relations of spinal and appendicular bone mass were examined together with physical, historical, and lifestyle factors. Multiple correlation coefficients between bone mass at the lumbar spine and appendicular bone were 0.754 to 0.782, and all these increased after modification by physical, historical, and lifestyle factors in whichever appendicular bone. In the correlation between lumbar spine and radial BMD, past weight-bearing activity, age at menarche, family history of fractures, and body weight were chosen. Menstrual status, body weight, past weight-bearing activity, and present arm-using activity were chosen to determine the correlation between lumbar spine BMD and calcaneal bone mass by QUS. These results suggest that the incorporation of those factors improved the correlation between lumbar spine BMD and appendicular bone mass, especially in cases of lumbar spine BMD versus radial BMD or calcaneal bone mass by QUS.

Association between a family history of fractures and bone mineral density in early postmenopausal women

The aim of this analysis was to measure the strength of the association between a family history of fractures and bone mineral density (BMD), and to determine what definition of family fracture history best predicts BMD. Five hundred and eighty postmenopausal women aged 45–59 at recruitment completed a risk factor questionnaire. Women were asked to recall details of fractures sustained by any female relative. BMD measurements taken at five sites were used. The data were analysed using linear regression, adjusting for age. Two hundred and ninety-seven (52.8%) women reported a family history of fractures, and they had a significantly lower BMD at two of the sites measured ( p < 0.05). The associations with BMD were most significant when only counting fractures that occurred in the subject’s mother or a sister as a result of low trauma, with no restrictions made on age at the time of fracture and site of fracture ( p < 0.01 at three sites; 0.01 < p < 0.05 at two sites). Women with a family history according to this definition had a 4.6% reduction in BMD at the femoral neck. When T scores were used to categorize women as either osteopenic/osteoporotic ( T < −1) or normal at the femoral neck, the sensitivity of using this definition was 39% and the specificity was 74%. The small group of women that reported a low-trauma hip fracture in a mother or sister (n = 23) had a mean femoral neck BMD which was 8.9% lower than that of the remainder of the sample, although this difference was less statistically significant than when low trauma fractures at any site were counted. Of these 23 women, 70% were osteopenic or osteoporotic, compared with 57% of those reporting a low-trauma fracture at any site and 47% of the sample as a whole. The sensitivity of this definition, however, was low (6%). From these analyses it can be concluded that the definition of family fracture history that best predicts BMD in postmenopausal women is a fracture at any age in a mother or sister resulting from low trauma, although the sensitivity and specificity of using a family history of fractures by itself to screen for low BMD were poor.

Fracture rates and risk factors for fractures in patients with spinal cord injury.

To study fracture rates and risk factors for fractures in patients with spinal cord injuries. A self-administered questionnaire was mailed to 646 members of the Danish Paraplegic Association and 1000 randomly selected normal controls. 438 patients (309 males, 129 females, 67.8%) and 654 controls (332 males, 322 females, 65.4%) returned the questionnaire. Median age in patients was 42, range 10-80 years, and in controls 43, range 19-93 years (2p = 0.25). The crude fracture rate was 2% per year in patients and 1% per year in controls (RR = 2.0, P < 0.001). Low-energy fractures were much more prominent in patients (19.0% of all fractures) than in controls (1.4%, P < 0.001). The fracture rate did not differ before the injury but increased after the injury to a constant level from the third year and forward. Fractures of the lower extremities were more prominent in patients than controls (femurs: RR = 23.4, P < 0.001, lower legs: RR = 5.2, P < 0.001, feet/toes: RR = 2.4, P = 0.006) while fractures of the forearms (P < 0.001) and clavicles (P = 0.03) were absent among patients. Fractures were more frequent in female patients (RR = 1.6, P = 0.008) and in male patients with a family history of fractures (RR = 2.0, P = 0.004). Low-energy fractures especially of the lower extremities are frequent in spinal cord injury patients and especially among female patients. The forearms seem protected from fractures.

Bone mass and risk factors for bone loss in perimenopausal Danish women.

To determine risk factors for low bone mass at menopause and risk factors for subsequent bone loss in the following period. A cross-sectional study and a 2-year prospective follow-up. The catchment area of Sundby Hospital in Copenhagen. Four hundred and thirty-three women aged 45-58 years, with amenorrhea for 3-24 months, of whom 87 were followed for a 2-year period. Registration of life-style and anthropometric variables, reproductive history, and family history of fractures. Total body bone mineral content (BMC) was measured with dual energy X-ray absorptiometry. By means of multiple regression analysis height, body weight, and length of reproductive period were found to be positively related to whole body BMC (P < 0.001), whilst a negative relationship was found to age (P < 0.001), smoking (P < 0.001), and family history of fractures (P < 0.005). In the longitudinal study, only body weight at the inclusion (P = 0.005) and subsequent changes in body weight and fat mass (P < 0.001) were related to the changes in bone mass. The most significant predictors for bone loss were changes in body weight and fat mass. Hence, weight loss is a risk factor for bone loss in the early postmenopausal period, whereas weight gain seems to preserve bone.

Risk Factors of Osteoporosis: Results of EVOS in Germany

As a part of the European Vertebral Osteoporosis Study (EVOS) eight German centres – Bochum, Heidelberg, Lubeck, Berlin-Steglitz, Berlin-Charit, Potsdam, Jena, Erfurt – among 36 centres in Europe participate. Throughout Europe 16000 probands have been examined, stratified into sexes, 6 age groups – in Germany 1951 women and 2109 men.Besides an extensive interview regarding socio demographic data, personal history, gynaecological history, physical activity, diet with calcium intake, smoking, alcohol consumption, family history of fractures and past medical history were documented in addition to height, weight, grip strength, and a x-ray in lateral projection of the thoracic and lumbar spine were taken. The analysis of the x-rays was realized centrally in Berlin by Dr. Felsenberg in a semiautomatic process with differentThe analysis of risk factors was mainly obtained by logistic regression usually separated by sexes. There are important differences between the three methods of x-ray estimation, which need ...