Family History Of Hip Fracture Research Articles

Reducing the risk of bone loss associated with breast cancer treatment

Women with breast cancer experience more fractures than their healthy peers. Fracture risk factors that are frequently observed in healthy postmenopausal women may already be present when breast cancer is diagnosed. Although low bone mineral density (BMD) significantly increases fracture risk, additional clinical risk factors that are independent of BMD, including age, previous fragility fracture, premature menopause, family history of hip fracture, use of corticosteroids, and low body mass index, also increase fracture risk. Additionally, cancer therapies can further increase fracture risk. Most notably, gonadotropin-releasing hormone analogues and aromatase inhibitor (AI) therapy increase bone loss and fracture incidence. Therefore, patients receiving AIs require a comprehensive fracture risk assessment including all risk factors and BMD when available. Zoledronic acid is an effective therapy for the prevention of AI-associated bone loss and, when combined with AI therapy, may provide the greatest clinical benefit without increasing fracture risk.

Prevalence and risk factors for osteopenia/osteoporosis in an HIV-infected male population

The objective of our investigation was to estimate the prevalence of osteopenia/osteoporosis in men with HIV/AIDS and evaluate the role of antiretroviral treatment (ART), HIV and other risk factors in reducing bone mineral density (BMD). All known Slovenian HIV-infected ART-naïve and treated males (infected or treated > 12 months) were invited to participate in a cross-sectional study. Data were collected on age, BMI, waist-hip ratio, family history of hip fracture, duration of infection, duration of ART, smoking, alcohol, exercise, viral load and CD4+ cells. BMD was measured using dual X-ray absorptiometry. A total of 96 patients (out of 133 who fulfilled the inclusion criteria) were assessed and allocated into three groups: group A (n = 24), ART-naïve; group B1 (n = 37), treated with non-protease-inhibitor (PI) containing ART; and group B2 (n = 35), treated with PI-containing ART. The prevalence of osteopenia/osteoporosis was 57/96 (59%): osteopenia 45/96 (47%) and osteoporosis 12/96 (12%). Significantly lower BMD was detected in group A (P = 0.020). Multiple logistic regression analysis showed ART to be an independent negative predictor for reduced BMD (P = 0.037; OR = 0.29, 95%CI 0.09-0.93). Vitamin D(3) deficiency was detected in 79 (82%) of the patients. The study group represented 72% of the national HIV-infected male population; this proportion being higher than in any other study reported to date. The prevalence of reduced BMD was notably higher than the national prevalence among men of comparable age. There was no association between reduced BMD and any specific ART. According to our results, absence of ART was confirmed as an independent predictor of osteopenia/osteoporosis. Targeted screening and early treatment present a reasonable strategy for preventing reduced BMD in HIV-infected patients, but correcting vitamin D(3) levels could also be an important component.

Aromatase Inhibitor-associated Bone Loss in Breast Cancer

In 2006, breast cancer was the most commonly diagnosed cancer among women, comprising approximately 31% of new cancer cases, and resulting in 15% of all cancer-related deaths in the US. 1 In a large proportion of the newly diagnosed breast cancer cases, breast cancer tumors are hormone-responsive; therefore, estrogen and its receptor have become the targets of choice for therapeutic intervention. Estrogen suppression prevents or reduces growth of estrogen receptor-positive (ER+) tumors, and can be achieved through surgical or targeted therapeutic modalities. Early surgical and radiological ovarian ablation strategies have given way to more targeted therapies involving the detection of ER status and compounds such as tamoxifen that block tumor-cell growth at the ER level. Tamoxifen was the therapy of choice for hormone-responsive breast cancer and is still commonly prescribed. However, many patients still experience disease recurrence despite ongoing tamoxifen therapy. Furthermore, tamoxifen is associated with serious adverse events, most notably thromboembolism (blood clots) and endometrial cancer, and therapy is limited to five years. Therefore, alternative approaches with improved efficacy to target ER+ breast cancer tumors have been developed. Aromatase inhibitors (AIs) block estrogen production in the peripheral tissues by preventing the last step in estrogen biosynthesis. The superior efficacy and more favorable side-effect profile demonstrated by AIs have allowed them to begin to replace tamoxifen as the adjuvant therapy of choice for post-menopausal women with ER+ breast cancer. 2‐5 However, one caveat of AI therapy is accelerated bone loss and increased fracture risk in a population of women that may already be at risk for fracture related to chemotherapy, low bone mineral density (BMD), age, history of fragility fracture after the age of 50, family history of hip fracture, or treatment history. 4‐8 The goal of adjuvant hormonal therapy for early breast cancer is to prevent local or distant disease recurrence or prolong disease-free survival (DFS) or overall survival (OS). Recent head-to-head clinical trials demonstrate that AI treatment is superior to tamoxifen for achieving this goal. To this end, maximum clinical benefit may be achieved by combining AI therapy with bisphosphonates in patients at risk for fracture to ensure optimal breast cancer management and prevent bone loss. 9,10 This review briefly summarizes the available data regarding aromatase inhibitor-associated bone loss (AIBL) and provides insight into ongoing trials for the prevention of AIBL with bisphosphonates.

Determinants of bone mineral density in Chinese-American women

Few data are available regarding bone mineral density (BMD) and its determinants among Chinese Americans. We identified determinants of BMD among 359 Chinese-American women in order to identify risk factors for low BMD in this burgeoning population. BMD in Chinese-American women is influenced by a number of factors, including immigration. Osteoporosis and low BMD are common among Chinese women, including Chinese Americans, who are a growing population at risk for osteoporosis in the US. Few data are available regarding BMD and its determinants among Chinese-American women. In this study, we examined predictors of BMD in 359 ambulatory Chinese-American women, ages 20-90, using stepwise multiple regression analysis. Variables in the model included age, weight, height, menarche age, years since menopause, immigration age, years in US, percentage of life in US, number of pregnancies, oral contraceptive use, family history of osteoporosis, family history of hip fracture, daily calcium intake, exercise, time outdoors, alcohol consumption and tobacco use. Among premenopausal women, weight was the strongest predictor of BMD, accounting for 10.5% of the variance at the lumbar spine (LS), 15.2% at the total hip (TH) and 16.6% at the femoral neck (FN). Time outdoors was also a positive predictor of BMD (1.4% at LS, 2.8% at TH and 1.6% at FN), while family history of osteoporosis (1.4% at TH) and age (3.7% at FN) were negative predictors. Among postmenopausal women, greater BMD at the LS and TH was associated with greater weight and earlier immigration age. Weight accounted for 16.4% of the variance at the LS and 19.8% at the TH; immigration age accounted for 3.1% of the variance at the LS and 4.1% at the TH. At the FN, years since menopause and weight were predictors of BMD, accounting for 14.4% and 8.7% of the variance, respectively. While older age at immigration had a negative effect on BMD, years in and proportion of life in the United States were not significant predictors of BMD. Bone mineral density in Chinese-American women is influenced by a number of biological and lifestyle factors, including immigration. The results of this study provide new insights into risk factors for low bone density as they relate to environmental determinants in the growing population of Chinese-American women.

Who is at risk of osteoporosis?

This contribution assesses who is at risk of osteoporosis, by delineating the key risk factors involved in the condition. Osteoporosis represents a major public health problem through its association with fragility fractures, primarily of the hip, spine and distal forearm. Some risk factors for fragility fracture act through bone mineral density (BMD), for example female gender, asian or Caucasian race, premature menopause, primary or secondary amenorrhoea, primary and secondary hypogonadism in men, prolongued immobilisation, low dietary calcium intake, vitamin D deficiency. However, a number of others contribute significantly to fracture risk over and above their association with BMD (age, high bone turnover, poor visual acuity, neuromuscular disorders, previous fragility fracture, glucocorticoid therapy, family history of hip fracture, low body weight, cigarette smoking, excess alcohol consumption).

Bone mass in young adults: relationship with gender, weight and genetic factors

To determine the relationship of the bone mass attained in young adults with anthropometric and genetic factors. Cross-sectional study of normal individuals. We studied 341 healthy subjects between 22 and 45 years of age. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA) and correlated with body weight, height and nine polymorphisms in six genes involved in sex steroid metabolism (17-hydroxylase, aromatase and 5-reductase) and activity (oestrogen receptors (ER)-alpha and -beta, and androgen receptor). The BMD was higher in men than in women (spine: 1.048 +/- 0.120 vs. 1.034 +/- 0.112; hip: 0.907 +/- 0.131 vs. 0.822 +/- 0.104 g cm(-2), P < 0.001). However, the difference was due, at least in part, to the larger body size in men and diminished markedly after height adjustment. There was a negative correlation between age and hip BMD. Body weight was the single most influential factor on spine and hip BMD in both sexes, explaining 8-9% of BMD variance. Amongst the genetic factors studied, a common CA repeat polymorphism in ER-beta showed a significant association with BMD in women (P = 0.03 at the spine, and 0.008 at the hip). The relationship between ER-beta genotype and BMD persisted after adjustment by body weight and age, explaining a further 2-3% of BMD variance. Allelic variants of other genes studied were not related with BMD. Body weight and allelic variants of ER-beta are associated with BMD in young adults.

Determinants of incidence of osteoporotic fractures in the female Spanish population older than 50

It is well known that the adoption of preventive measures for osteoporosis may contribute to minimizing its impact as a result of bone fractures. However, there are well-recognized risk factors involved in the onset of osteoporosis that are not possible to modify. Better knowledge of these non-modifiable factors could aid prevention in subjects at high risk of fractures. The aim of this study was to evaluate the likely association between gynecological, reproductive and family history of hip fracture with the incidence of vertebral and nonvertebral osteoporotic fractures in women older than 50. We studied 255 women aged 50 and over, randomly selected from a Spanish population that had participated in a study of prevalence of vertebral fractures (EVOS study). This cohort was prospectively followed for 8 years by means of four postal questionnaires, in order to find out the incidence of nonvertebral fractures. Concerning the incidence of vertebral fractures, participants were invited to repeat the lumbar spine X-rays 4 years after the initial study. A total of 31 women had incident osteoporotic fractures. The analysis of gynecological variables showed that an increase in the age at menarche was a risk factor for all incident osteoporotic fractures [OR=1.57 (1.04-2.37)]. The presence of amenorrhea at any age during the fertile period was associated with higher incidence of all osteoporotic fractures [OR=6.30 (1.61-24.70)]. Among all the reproductive variables analyzed (pregnancy, number of live births and breast-feeding) only pregnancy was an important protective factor in preventing incident Colles fracture [OR=0.15 (0.03-0.62)]. A family history of hip fracture was associated with a higher incidence of all osteoporotic fractures [OR=3.59 (1.01-12.79)]. In summary, a late age at menarche, the presence of amenorrhea and having close relatives with hip fracture were all risk factors which, independently of bone mineral density (BMD) and age, were associated with higher incidence of all osteoporotic fractures. Pregnancy was an important protective factor for the incidence of Colles fractures.

Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care

Objective To assess whether supplementation with calcium and cholecaliferol (vitamin D3) reduces the risk of fracture in women with one or more risk factors for fracture of the hip.Design Pragmatic...

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.

The health economics of calcium and vitamin D3 for the prevention of osteoporotic hip fractures in Sweden.

The objective of this study was to examine the economics of administering calcium and vitamin D3 to post-menopausal women in Sweden. We focus primarily on the cost-effectiveness of treating older women for whom clear evidence of efficacy is available. We supplement this information, however, with estimates of the cost-effectiveness of treating certain high-risk groups of younger women, while acknowledging the greater uncertainty involved. We developed a Markov model for analyzing the occurrence and timing of hip fractures, based almost entirely on peer-reviewed data from Sweden. In a 3-year randomized clinical trial, the combination of calcium and vitamin D3 was shown to reduce the risk of hip fractures by 27%. Costs for treating hip fractures were based on 1,080 women who were hospitalized in Stockholm. Treatment of 70-year-old women was cost saving at efficacy as low as two-thirds that seen in the clinical trials, and upwards. Even at modest rates of efficacy, treatment of the high-risk 50- and 60-year-old cohorts was generally cost-effective and in some cases even cost saving. Particularly cost-effective was treatment of women with identified osteoporosis or a maternal family history of hip fracture. Simulation results suggest a role for lifetime treatment of older women with calcium and vitamin D3 in Sweden. While there is more uncertainty underlying the treatment of younger women, our simulation results suggest that treatment may also be cost saving or at least cost-effective for many cohorts of high-risk 50- and particularly 60-year-old women, in particular those with osteoporosis or a maternal family history of hip fracture.

Family history and risk of osteoporotic fracture. Study of Osteoporotic Fractures Research Group.

The importance of family history of fractures as a risk factor for fractures is unclear. The aim of this study was to test the hypothesis that family history of fracture increased a woman's risk of hip, wrist and other osteoporotic fracture and determine whether the influence of family history is independent of low bone density. We tested this hypothesis in a prospective study of 9704 Caucasian women, age 65 years or older, by assessing family history and bone density of the radius and calcaneus at baseline; 7963 women had femoral bone density measurements two years later. Fractures occurring during an average of 7.1 years of follow-up since baseline and 5.2 years since the second examination were confirmed by radiographic report. After adjusting for age, risk of hip fracture was increased in those with a maternal (1.48; 95% CI = 1.03-2.11); sister's (1.83; 1.20-2.80) or brother's history of hip fracture (2.26; 1.16-4.42). Risk of wrist fracture was increased by maternal (1.52; 1.10-2.11) and paternal (2.41; 1.14-5.07) history of wrist fracture. Adjustment for bone density did not consistently and substantially affect the strength of the associations. Family history of hip fracture was not associated with an increased risk of wrist fracture and family history of wrist fracture did not increase the risk of hip fracture. We conclude that family history is an important risk factor for fracture that may act, at least in part, through means besides bone density. Furthermore, the effect of family history is not a general but site-specific predisposition to fracture.

The influence of family history of hip fracture on the risk of verterbral deformity in men and women: The European vertebral osteoporosis study

There are few data exploring clustering of osteoporotic fractures within families. The aim of this study was to determine on influence of maternal and paternal history of hip fracture on the risk of vertebral deformity. 12,816 men and women aged 50 to 75 years were recruited from population based sampling frames across Europe. Subjects were invited to attend by letter of invitation for an interviewer administered questionnaire and lateral spinal radiographs. Vertebral deformity was defined morphometrically using the McCloskey-Kanis method. 6.4% of men and 7.1% of women reported that their mother had suffered a hip fracture, while 1.7% of both men and women reported that their father had suffered a hip fracture. A maternal history of hip fracture was associated with a modest increased risk of vertebral deformity in men [odds ratio (OR) 1.3, 95% confidence interval (CI) 1.0–1.8], the risk being greater among those aged 65 years and over (OR = 1.5; 95% CI 1.0–2.4) and in those from low prevalence areas. There was no increased risk in women. Paternal history of hip fracture was not associated with vertebral deformity in either sex. In conclusion, maternal history of hip fracture appears to be a risk factor for vertebral deformity, particularly in men.

Family history of hip fracture or spinal deformity as a predictor of bone density

Family history of hip fracture or spinal deformity as a predictor of bone density