Fracture Risk In Elderly Women Research Articles

Decline in Muscle Strength and Performance Predicts Fracture Risk in Elderly Women and Men.

Muscle strength and performance are associated with fractures. However, the contribution of their rate of decline is unclear. To assess the independent contribution of the rate of decline in muscle strength and performance to fracture risk. Community-dwelling women (n = 811) and men (n = 440) aged 60 years or older from the prospective Dubbo Osteoporosis Epidemiology Study followed from 2000 to 2018 for incident fracture. Clinical data, appendicular lean mass/height2 (ht)2, bone mineral density, quadricep strength/ht (QS), timed get-up-and-go (TGUG), 5 times repeated sit-to-stand (5xSTS), and gait speed (GS) measured biennially. Rates of decline in muscle parameters were calculated using ordinary least squares regression and fracture risk was assessed using Cox's models. Incident low-trauma fracture ascertained by x-ray report. Apart from lean mass in women, all muscle parameters declined over time. Greater rates of decline in physical performance were associated with increased fracture risk in women (Hazard ratios [HRs] ranging from 2.1 (95% CI: 1.5-2.9) for GS to 2.7 (95% CI: 1.9-3.6) for 5xSTS, while in men only the decline in GS was associated with fracture risk (HR: 3.4 [95% CI: 1.8-6.3]). Baseline performance and strength were also associated with increased fracture risk in men (HRs ranging from 1.8 (95% CI: 1.1-3.0) for QS to 2.5 (95% CI: 1.5-4.1) for TGUG, but not in women. Rate of decline in physical performance in both genders, and baseline strength and performance in men, contributed independently to fracture risk. Sit-to-stand and GS were the tests most consistently associated with fractures. Further studies are required to determine whether muscle strength and/or performance improve the predictive accuracy of fracture prediction models.

Testing a theoretical model of imminent fracture risk in elderly women: an observational cohort analysis of the Canadian Multicentre Osteoporosis Study.

This study aimed to examine direct and indirect effects of several factors on imminent (1year) fracture risk. Data from women age 65 and older from population-based Canadian Multicentre Osteoporosis Study were used. Predictors were identified from study years 5 and 10, and imminent fracture data (1-year fracture) came from years 6 and 11 (year 5 predicts year 6, year 10 predicts year 11). A structural equation model (SEM) was used to test the theoretical construct. General health and physical functioning were measured as latent variables using items from the 36-Item Short Form Health Survey (SF-36) and bone mineral density (BMD) T-score was a latent variable based on observed site-specific BMD data (spine L1-L4, femoral neck, total hip). Observed variables were fractures and falls. Model fit was evaluated using root mean square error of approximation (RMSEA), Tucker Lewis index (TLI), and comparative fit index (CFI). The analysis included 3298 women. Model fit tests showed that the SEM fit the data well; χ2(172) = 1122.10 < .001, RMSEA = .03, TLI = .99, CFI = .99. Results suggested that having past year fracture, worse past year general health, worse past year physical functioning, and lower past year BMD T-score directly predicted higher risk of fracture in the subsequent year (p < .001). Past year falls had a statistically significant but indirect effect on imminent fracture risk through physical functioning and general health (p < .001). We found several direct and indirect pathways that predicted imminent fracture risk in elderly women. Future studies should extend this work by developing risk scoring methods and defining imminent risk thresholds.

Executive functions and bone health: a focus on cognitive impulsivity and bone mineral density

Background : It is known that cognitive impairment is associated with low bone mineral density (BMD) and that low BMD is also observed in elderly people with neurodegenerative diseases, in which executive functions (EF) could be decreased. A limited number of studies investigated the association between EF with BMD and fracture risk in elderly women. Aims : The aim of this study was to explore the association between cognitive impulsivity, BMD and fall risk in a sample of postmenopausal women evaluated for osteoporosis. Methods : We consecutively recruited women who obtained a score ≥ 24 at the Mini Mental State Examination (MMSE). Cognitive impulsivity was evaluated by the Stroop Colour and Word Test (SCWT). BMD was detected by dual-energy X-ray absorptiometry at lumbar spine and femoral neck. Results: Cognitive impulsivity, as evidenced by the greater number of errors at the SCWT, was significantly related with BMD values at lumbar spine and femoral neck (r= -0.39, p= 0.01 and r= -0.43, p= 0.008; respectively), suggesting a neuropsychological impairment in patients assessed for osteoporosis. Moreover, interference effect on response time was significantly associated with higher prevalence of falls (r= 0.342; p= 0.031). Discussion and Conclusions : Our findings suggested a potential involvement of cognitive impulsivity on BMD and risk of fall. This is a relevant issue in clinical practice for both clinical psychologists and physicians who evaluate postmenopausal women, to eventually predict risk of fracture.

Smoking, smoking cessation, and fracture risk in elderly women followed for 10 years.

This study examines the impact of smoking and smoking cessation on fracture risk in 75-year-old women followed for 10 years. Smoking increased fracture risk, especially for vertebral fractures. Smoking cessation decreased the risk for vertebral fractures but not for other fracture types. The purpose of this study was to examine effects of smoking and smoking cessation on fracture risk. This prospective observational population-based study followed 1033 women during 10 years from age 75. Data regarding smoking were collected at age 75. Hazard ratios (HRs) and 95 % confidence intervals for fracture were calculated using competing risks proportional hazards regression. Both former smokers and current smokers had an increased risk for any fracture (HR 1.30; 1.03-1.66, and HR 1.32; 1.01-1.73, respectively) and any osteoporotic fracture (hip, proximal humerus, distal radius, vertebra) (HR 1.31; 1.01-1.70 and HR 1.49; 1.11-1.98, respectively) compared to non-smokers. Former smokers had an increased risk for proximal humerus fractures (HR 2.23; 1.35-3.70), and current smokers had an increased risk for vertebral fractures (HR 2.30; 1.57-3.38) compared to non-smokers. After adjustment for weight, previous fractures, alcohol habits, bone mineral density (BMD), use of corticoids, vitamin D, bisphosphonates, and previous falls, former smokers had an increased risk for proximal humerus fracture (HR 2.07; 1.19-3.57) and current smokers had an increased risk for osteoporotic (HR 1.47; 1.05-2.05) and vertebral fractures (HR 2.50; 1.58-3.95) compared to non-smokers. Former smokers had a decreased risk for vertebral fractures, but not for other types of fractures, compared to current smokers. Smoking increased the risk for fracture among elderly women, especially vertebral fractures. Smoking cessation decreased the risk for vertebral fractures but not for other types of fractures.

Age-related trends in vertebral dimensions.

Several studies have demonstrated age-related changes in vertebral dimensions. Vertebral size has been reported to increase among elderly adults, with periosteal apposition resulting in increased cross-sectional area (CSA) of the vertebral corpus combined with reduction in bone mineral density. These changes in CSA are observed to be sex-specific, as the pronounced increase of vertebral CSA is found only in elderly males. However, the reduction in bone mineral density in old age is apparent within both sexes. It is thus hypothesized that higher fracture risk in elderly women is a result of their incapacity to increase vertebral size and thus adapt to bone mineral reduction. In this study, our aim was to explore whether the onset of these changes could be ascribed to specific age intervals and whether the proposed differences between the sexes are as great as previously suggested. To conduct this study we utilized two large early 20th century skeletal collections known as Terry and Bass (n = 181). We also utilized data from two lumbar spine magnetic resonance imaging samples as a modern-day reference (n = 497). Age, sex and ethnicity of all individuals were known. Vertebral CSA was determined by measuring three width and length dimensions from the corpus of the fourth lumbar vertebra (L4). Our results indicate only a moderate association between age and vertebral CSA. This association was observed to be relatively similar in both sexes, and we thus conclude that there is no clear sex-specific compensatory mechanism for age-related bone loss in vertebral size.

Long-term proton pump inhibitor therapy and falls and fractures in elderly women: a prospective cohort study.

Proton pump inhibitors (PPIs) are widely used in the elderly. Recent studies have suggested that long-term PPI therapy is associated with fractures in the elderly, however the mechanism remains unknown. We investigated the association between long-term PPI therapy ≥1 year and fracture risk factors including bone structure, falls, and balance-related function in a post hoc analysis of a longitudinal population-based prospective cohort of elderly postmenopausal women and replicated the findings in a second prospective study of falling in elderly postmenopausal women. Long-term PPI therapy was associated with increased risk of falls and fracture-related hospitalizations; adjusted odds ratio (AOR) 2.17; 95% CI, 1.25-3.77; p = 0.006 and 1.95; 95% CI, 1.20-3.16; p = 0.007, respectively. In the replication study, long-term PPI use was associated with an increased risk of self-reported falling; AOR, 1.51; 95% CI, 1.00-2.27; p = 0.049. No association of long-term PPI therapy with bone structure was observed; however, questionnaire-assessed falls-associated metrics such as limiting outdoor activity (p = 0.002) and indoor activity (p = 0.001) due to fear of falling, dizziness (p < 0.001) and numbness of feet (p = 0.017) and objective clinical measurement such as Timed Up and Go (p = 0.002) and Romberg eyes closed (p = 0.025) tests were all significantly impaired in long-term PPI users. Long-term PPI users were also more likely to have low vitamin B12 levels than non-users (50% versus 21%, p = 0.003). In conclusion, similar to previous studies, we identified an increased fracture risk in subjects on long-term PPI therapy. This increase in fracture risk in elderly women, already at high risk of fracture, appears to be mediated via increased falls risk and falling rather than impaired bone structure and should be carefully considered when prescribing long-term PPI therapy.

CIITA: A Master Regulator of Adaptive Immunity Shows Its Innate Side in the Bone

CIITA (the Major Histocompatibility Class (MHC) II transactivator) has long been known as the master regulator of MHC Class II genes, which are critical for normal immune function (reviewed in (1, 2)). CIITA is a non-DNA binding co-activator that specifically regulates expression of Major Histocompatibility Class II molecules, with CIITA deficiency leading to the rare human immunodeficiency disease termed Bare Lymphocyte Syndrome (3). CIITA also regulates expression of genes encoding accessory proteins required for MHCII-restricted antigen presentation, thus CIITA is central to controlling the response to foreign antigens and the maintenance of tolerance (1, 2). In this issue of the Journal of Bone and Mineral Research, Benasciutti and colleagues demonstrate that CIITA is also a major regulator of osteoclast differentiation and bone homeostasis (4).

Hip fracture prevention with a multifactorial educational program in elderly community-dwelling Finnish women

Guidelines suggest identification of women at fracture risk by bone density measurement and subsequently pharmacotherapy. However, most women who sustain a hip fracture do not have osteoporosis in terms of bone density. The present non-pharmacological intervention among elderly women unselected for osteoporosis reduced hip fracture risk by 55% providing an alternative approach to fracture prevention. Hip fractures are expensive for society and cause disability for those who sustain them. We studied whether a multifactorial non-pharmacological prevention program reduces hip fracture risk in elderly women. A controlled trial concerning 60- to 70-year-old community-dwelling Finnish women was undertaken. A random sample was drawn from the Population Information System and assigned into the intervention group (IG) and control group (CG). Of the 2,547 women who were invited to the IG, 1,004 (39%) and of the 2,120 invited to the CG, 1,174 (55%) participated. The IG participated in a fracture prevention program for 1week at a rehabilitation center followed by review days twice. The CG received no intervention. During the 10-year follow-up, both groups participated in survey questionnaire by mail. Outcome of interest was occurrence of hip fractures and changes in bone-health-related lifestyle. During the follow-up, 12 (1.2%) women in the IG and 29 (2.5%) in the CG sustained a hip fracture (P = 0.039). The determinants of hip fractures by stepwise logistic regression were baseline smoking (odds ratio (OR) 4.32 (95% confidence interval [CI] 2.14-8.71), age OR 1.15/year (95% CI 1.03-1.28), fall history OR 2.7 (95% CI 1.24-5.9), stroke history OR 2.99 (95% CI 1.19-7.54) and participating in this program OR 0.45 (95% CI 0.22-0.93). Starting vitamin D and calcium supplement use was more common in the IG compared with the CG. The results suggest that this non-pharmacological fracture prevention program may reduce the risk of hip fractures in elderly Finnish women.

Dietary B vitamin intake and risk of hip fracture: the Singapore Chinese Health Study

This prospective cohort study that comprehensively examined effects of different B vitamins in an Asian population showed an inverse relationship between dietary intake of pyridoxine and hip fracture risk in elderly women. These findings suggest that maintaining sufficient pyridoxine intake may be beneficial in preserving bone health in postmenopausal women. B vitamins have recently been investigated for their possible roles in maintaining bone health. Incidence of osteoporotic hip fracture has been rising in Asia, but epidemiological data on dietary B vitamins and risk of osteoporotic fractures are sparse. We aimed to examine the association between dietary intakes of B vitamins (thiamin, riboflavin, niacin, pyridoxine, folate, and cobalamin) and hip fracture risk among elderly Chinese in Singapore. The current study was conducted in the Singapore Chinese Health Study, which is a population-based cohort prospective study that enrolled a total of 63,257 men and women aged 45-74 years between 1993 and 1998. Dietary intakes of B vitamins were derived from a validated food frequency questionnaire and the Singapore Food Composition Database. After a mean follow-up period of 13.8 years, 1,630 hip fracture incident cases were identified. A statistically significant inverse relationship between dietary pyridoxine intake and hip fracture risk was observed among women (p for trend = 0.002) but not among men. Compared to women in the lowest quartile intake (0.37-0.61 mg/1,000 kcal/day), women in the highest quartile intake (0.78-1.76 mg/1,000 kcal/day) had a 22 % reduction in hip fracture risk (hazard ratio 0.78, 95 % confidence interval 0.66-0.93). Dietary intakes of the other B vitamins of interest were not related to hip fracture risk. Our findings suggest that maintaining adequate intake of pyridoxine may prevent osteoporotic fractures among elderly women.

Absolute Fracture-Risk Prediction by a Combination of Calcaneal Quantitative Ultrasound and Bone Mineral Density

Quantitative ultrasound measurement (QUS) and bone mineral density (BMD) have each been shown to predict fracture risk in women. The present study examined whether a combination of QUS and BMD could improve the predictive accuracy of fracture risk. This is a population-based prospective study which involved 454 women and 445 men aged 62-89years. Femoral neck BMD (FNBMD) was measured by DXA and calcaneal QUS was measured as broadband ultrasound attenuation (BUA) by a CUBA sonometer. Fragility fracture was ascertained by X-ray reports during the follow-up period, which took place between mid-1989 and 2009. During the follow-up period (median 13years, range 11-15), 75 men and 154 women sustained a fragility fracture. In women, the model with FNBMD and BUA had a higher AUC compared to that without BUA (0.73 vs. 0.71 for any fracture, 0.81 vs. 0.77 for hip fracture, and 0.72 vs. 0.70 for vertebral fracture). Reclassification analysis yielded a total net reclassification improvement of 7.3%, 11.1%, and 5.2% for any, hip, and vertebral fractures, respectively. For men, the addition of BUA to FNBMD did not improve the predictive power for any, hip, or vertebral fracture. These results suggest that calcaneal QUS is an independent predictor of fracture risk and that a combination of QUS and BMD measurement could improve the predictive accuracy of fracture risk in elderly women.

Relation Among Fractures, Body Mass Index And Physical Activity In Elderly Women

There are many factors which affect the fracture risk in elderly women. Among them we stress low bone mass, increased occurrence of falls, and anthropometric characteristics and physical activity. Low bone mass in postmenopausal women may come from genetic and environmental factors. The non-modifiable factors are gender and age. The modifiable ones are related to change of habits, including a sedentary lifestyle. Low bone mass is prevalent in women and the problem worsens with aging. Fractures represent a high cost in hospitalization, rehabilitation, morbidity and mortality. PURPOSE: The aim was to analyze the correlation among the history of fractures over the age of 50, physical activity and body mass index (BMI) in elderly women. METHODS: The study was approved by the Research Ethics Committee of PUCRS, Letter No. 05029/35, and the sample consisted of 284 elderly from 60 to 94 years with an average of 71.2 ± 7.8 years, who had or had not done physical activity for at least 3 months on a regular and systematic basis, with a BMI between 14.3 and 44.8. Data were analyzed using descriptive and inferential statistics (chi-square test). RESULTS: Among the 284 elderly women, 76 had a history of fractures over the age of 50, 28 of these were physically active e the other 48 were not. Also, among the 97 physically active ones, 28 women (28.9%) had fractures, 11.1% with BMI ≤ 22, 28.2% with BMI 22-27, and 32.7% with BMI ≥ 27. Among the 187 non-physically active ones, 48 women (25.7%) had a history of fractures, 22.7% of those with BMI ≤ 22, 28.3% with BMI between 22-27 and 24.8% with BMI ≥ 27. CONCLUSION: Physical activity plays a fundamental role in increasing bone mass during childhood and adolescence, and it's a necessary stimulus for one to reach his/her peak bone mass in adulthood. Some studies in postmenopausal women are inconclusive on the association between physical activity and bone mass maintenance, and others, point out that only exercise or calcium supplementation alone can not compensate for the loss of bone mass and suggest that the benefits of exercise on low bone mass works if there is a high calcium and D vitamin intake, suggesting that physical activity, D vitamin and calcium would act synergistically. This leads to the need of correlating variables related to physical activity.

The effects of homocysteine and MTHFR genotype on hip bone loss and fracture risk in elderly women

Few studies have evaluated the effects of homocysteine and methylenetetrahydrofolate reductase (MTHFR) genotype on age-related bone loss. In our 5-year cohort study with 1,213 women aged 70-85 years, high homocysteine is associated with greater hip bone loss but not fracture risk. The effect of MTHFR genotype on bone density and fracture is weak. Previous studies on the effects of homocysteine and MTHFR genotype on bone mineral density (BMD) and osteoporotic fracture risk have shown inconsistent results. Few studies have evaluated their effects on age-related bone loss. We evaluated the effects of homocysteine and MTHFR genotype variation on hip BMD and fracture risk over 5 years in a cohort of 1,213 community-dwelling women aged 70-85 years. Nutritional intake and prevalent fracture status were assessed at baseline, plasma homocysteine was measured at year 1, and hip dual-energy X-ray absorptiometry (DXA) BMD was measured at years 1 and 5. Clinical incident osteoporotic fractures confirmed by radiographic report were collected throughout the study and the MTHFR gene C677T and A1298C polymorphisms genotyped. Data were analyzed using analysis of covariance and Cox proportional hazard regression. The highest tertile of homocysteine was associated with a greater hip BMD loss over 4 years (-2.8%) compared to the middle (-1.6%) and lowest tertiles (-1.2%) (P < 0.001). This effect remained after adjustment for covariates. There was no effect of homocysteine on fracture prevalence or incidence. MTHFR gene variation was only weakly related to one of the bone outcome measures. In this study population, high homocysteine is associated with greater hip bone loss but not fracture risk.

Genetic variation in the GDF5 region is associated with osteoarthritis, height, hip axis length and fracture risk: the Rotterdam study

Background:A polymorphism (rs143383; T to C) near the GDF5 gene has been associated with height and osteoarthritis (OA), but debate exists about whether its primary biological action is directed to...

Osteoporotic Fracture Risk in Elderly Women: Estimation with Quantitative Heel US and Clinical Risk Factors

To derive a prediction rule by using prospectively obtained clinical and bone ultrasonographic (US) data to identify elderly women at risk for osteoporotic fractures. The study was approved by the Swiss Ethics Committee. A prediction rule was computed by using data from a 3-year prospective multicenter study to assess the predictive value of heel-bone quantitative US in 6174 Swiss women aged 70-85 years. A quantitative US device to calculate the stiffness index at the heel was used. Baseline characteristics, known risk factors for osteoporosis and fall, and the quantitative US stiffness index were used to elaborate a predictive rule for osteoporotic fracture. Predictive values were determined by using a univariate Cox model and were adjusted with multivariate analysis. There were five risk factors for the incidence of osteoporotic fracture: older age (>75 years) (P < .001), low heel quantitative US stiffness index (<78%) (P < .001), history of fracture (P = .001), recent fall (P = .001), and a failed chair test (P = .029). The score points assigned to these risk factors were as follows: age, 2 (3 if age > 80 years); low quantitative US stiffness index, 5 (7.5 if stiffness index < 60%); history of fracture, 1; recent fall, 1.5; and failed chair test, 1. The cutoff value to obtain a high sensitivity (90%) was 4.5. With this cutoff, 1464 women were at lower risk (score, <4.5) and 4710 were at higher risk (score, >or=4.5) for fracture. Among the higher-risk women, 6.1% had an osteoporotic fracture, versus 1.8% of women at lower risk. Among the women who had a hip fracture, 90% were in the higher-risk group. A prediction rule obtained by using quantitative US stiffness index and four clinical risk factors helped discriminate, with high sensitivity, women at higher versus those at lower risk for osteoporotic fracture.

Hip structural geometry in old and old-old age: Similarities and differences between men and women

Introduction Changes in hip structure and geometry during aging contribute to decreased bone strength. Little is known, however, about these characteristics at advanced age, when fragility fractures are common. We examined hip structural geometry in men and women of old age (72–84 years) and old-old age (85–96 years) to determine (1) gender differences; (2) whether or not these differences are consistent with the increased occurrence of hip fracture in elderly women, compared to men; and (3) whether or not gender-specific changes are consistent with the increased occurrence of fragility fractures after age 80 in both men and women. Methods We used Hip Structure Analysis (HSA) software to analyze bone densitometry scans from 916 community-dwelling men and women aged 72–96 years. We examined gender differences in hip geometry by age group (72–74, 75–79, 80–84, and ≥ 85 years) and between gender-specific age groups using multivariable linear regression. Results At the femoral narrow neck, there was no gender difference at age 72–74 in bone mineral density (BMD), cortical thickness (CT), and buckling ratio (BR). In contrast, at age 85 or older women had 13% less BMD and CT than men and 8% higher BR. At the intertrochanteric region, women ≥ 85 years had 25–31% less BMD, cross-sectional bone area (CSA), and CT than men of comparable age, and 38% higher BR. These gender differences were approximately 10–20% greater than those between men and women in their 70s. In gender-specific comparisons, women showed increasing change in structural geometry with increasing age. At both narrow neck and trochanteric regions, women ≥ 85 years had nearly 35% higher BR, 15% less BMD and CT, and 10% less CSA than women aged 72–74 years. At the narrow neck, they also had 6% greater outer diameter than the youngest women and 8% lower section modulus (Z), an index of bending strength. In contrast, men showed significant age differences only at the narrow neck region, and only at 85 years or older, including 22% higher BR, 10% less BMD and CT, and 5% greater outer diameter, compared to men in their early 70s. Unlike women, men showed no age-associated decline in section modulus. Conclusions Gender differences in hip geometry consistent with increased fragility and fracture risk in elderly women, compared to men, continue into old-old age. Both men and women 85 or older show the most unfavorable features, suggesting a structural basis for the increased occurrence of hip fracture in both sexes at advanced age.

Associations Between Homocysteine, Bone Turnover, BMD, Mortality, and Fracture Risk in Elderly Women

Homocysteine has been suggested to be a risk factor for fracture, but the causal relationship is not clear. In 996 women from the OPRA study, high homocysteine level was associated with high bone marker levels and low BMD at baseline. During a mean 7-year follow-up, high homocysteine level was associated with mortality, but no clear association to fracture risk existed. Recently, the association between high serum homocysteine (Hcy) levels and an increased risk of fracture has been described. Hcy levels were measured at baseline in 996 women, all 75 years old. Vitamin B(12), folate, serum cross-linking telopeptide of type I collagen (CTX), serum TRACP5b, serum osteocalcin, urine deoxypyridinoline, PTH, areal BMD (aBMD), calcaneal quantitative ultrasound (QUS), and physical performance were assessed at baseline. Fractures and mortality were recorded during a mean follow-up of 7.0 years. Bone marker levels were higher in women with Hcy in the highest quartile compared with all other women (p < 0.05). The most evident correlation between Hcy and a bone marker was seen with CTX (r = 0.19, p < 0.001). aBMD (hip) was 4% lower, QUS was up to 2% lower, and gait speed was 11% slower among women with Hcy in the highest quartile compared with the other women (p < 0.05). During the follow-up, 267 women sustained at least one low-energy fracture (including 69 hip fractures). When women in the highest Hcy quartile were compared with all other women, the hazard ratios (HRs) for sustaining any type of fracture was 1.18 (95% CI, 0.89-1.36) and for hip fracture was 1.50 (95% CI, 0.91-1.94). For the same group of women, the mortality risk was 2.16 (95% CI, 1.58-2.55). Adjustments for confounders did not substantially change these associations. Adjustment for PTH increased the HR for hip fracture to 1.67 (95% CI, 1.01-2.17). Low vitamin B(12) or folate was not associated with increased fracture risk or mortality. High Hcy levels were associated with higher bone turnover, poor physical performance, and lower BMD. There was no clear association to fracture risk. The increased mortality among women with high Hcy levels indicates that a high Hcy level may be a marker of frailty.

High-sensitivity C-reactive protein test results predict fracture risk in elderly women

High-sensitivity C-reactive protein test results predict fracture risk in elderly women

High-Sensitivity C-Reactive Protein and Fracture Risk in Elderly Women

High-Sensitivity C-Reactive Protein and Fracture Risk in Elderly Women

Effects of Calcium Supplementation on Clinical Fracture and Bone Structure

Increased dietary calcium intake has been proposed as a population-based public health intervention to prevent osteoporotic fractures. We have examined whether calcium supplementation decreases clinical fracture risk in elderly women and its mechanism of action. Five-year, double-blind, placebo-controlled study of 1460 women recruited from the population and older than 70 years (mean age, 75 years) who were randomized to receive calcium carbonate, 600 mg twice per day, or identical placebo. The primary end points included clinical incident osteoporotic fractures, vertebral deformity, and adverse events ascertained in 5 years. Bone structure was also measured using dual x-ray absorptiometry of the hip and whole body, quantitative ultrasonography of the heel, and peripheral quantitative computed tomography of the distal radius. Among our patients, 16.1% sustained 1 or more clinical osteoporotic fractures. In the intention-to-treat analysis, calcium supplementation did not significantly reduce fracture risk (hazard ratio, 0.87; 95% confidence interval, 0.67-1.12). However, 830 patients (56.8%) who took 80% or more of their tablets (calcium or placebo) per year had reduced fracture incidence in the calcium compared with the placebo groups (10.2% vs 15.4%; hazard ratio, 0.66; 95% confidence interval, 0.45-0.97). Calcium-treated patients had improved quantitative ultrasonography findings of the heel, femoral neck and whole-body dual x-ray absorptiometry data, and bone strength compared with placebo-treated patients. Of the 92 000 adverse events recorded, constipation was the only event increased by the treatment (calcium group, 13.4%; placebo group, 9.1%). Supplementation with calcium carbonate tablets supplying 1200 mg/d is ineffective as a public health intervention in preventing clinical fractures in the ambulatory elderly population owing to poor long-term compliance, but it is effective in those patients who are compliant.

Femoral Neck Bone Loss Predicts Fracture Risk Independent of Baseline BMD

Whereas low BMD is known to be a risk factor for fracture, it is not clear whether loss of BMD is also a risk factor. In elderly women, greater loss of BMD at the femoral neck was associated with increased risk of fracture, independent of baseline BMD and age. Baseline measurement of BMD predicts fracture risk. However, it is not clear whether short-term bone loss is an independent risk factor for fractures. This study was designed to investigate the relationship between changes in BMD and fracture risk in elderly women in the general population. A total of 966 women > or = 60 years of age (mean, 70 +/- 6.7 [SD] years), who had been followed for an average of 10.7 years, were studied. Atraumatic fracture of the proximal femur (hip), symptomatic vertebral fracture, and other major fractures, excluding pathological fractures or those resulting from severe trauma, were recorded and confirmed by radiographs. Femoral neck and lumbar spine BMD was measured by DXA. During the follow-up period, 224 had sustained a fracture (including 43 hip, 71 symptomatic vertebrae, 37 proximal humerus, 46 forearm and wrist, and 27 rib and pelvis fractures). The annual rate of change in BMD in fracture women (-2.1 +/- 4.2%) was significantly higher than that in nonfracture women (-0.8 +/- 2.8%; p = 0.005). In the multivariable Cox's proportional hazards analysis, the following factors were significant predictors of fracture risk: femoral neck bone loss (relative hazard [RH], 1.4; 95% CI, 1.1-1.8 per 5% loss), baseline femoral neck BMD (RH, 2.0; 95% CI, 1.7-2.7 per SD), and advancing age (RH, 1.2; 95% CI, 1.1-1.4). The proportion of fractures attributable to the three factors was 45%. For hip fracture, the attributable risk fraction was approximately 90%. Bone loss at the femoral neck is a predictor of fracture risk in elderly women, independent of baseline BMD and age.