Fractures In Postmenopausal Women Research Articles

Efficacy of a single 5mg zoledronic acid infusion in preventing bone loss and fracture in postmenopausal women with breast cancer.

Chemotherapy-induced bone loss (CTIBL) is common among breast cancer patients, requiring comprehensive assessment and intervention. Zoledronic acid, a strong inhibitor of bone resorption, is effective in CTIBL management, though information on dosing and intervals, particularly the efficacy of the 5mg annual dose for osteoporosis in breast cancer patients, is limited. In this 12-month prospective observational study, 85 breast cancer patients were divided into three groups: 17 received no treatment, 17 received tamoxifen, and 51 received anastrozole or letrozole (AI). Post-surgery, patients were administered a single 5mg dose of zoledronic acid and monitored over 12months for changes in bone mineral density (BMD), fracture rates, and biochemical markers. Initially, the AI group was the oldest, averaging 59.1 ± 8.7years. At baseline, no significant differences in variables, except age, were observed. After 12months, BMD increased in all groups following a single zoledronic acid dose, with the smallest increase in the AI group at the lumbar spine: no treatment (2.4% ± 6.1%), tamoxifen (2.6% ± 3.4%), AI (0.6% ± 14.5%) (p = 0.778). CTx and P1NP levels were consistently suppressed up to 12months post-treatment, with smaller reductions in the AI group. There were no significant differences in fracture or bone metastasis rates among groups. A single infusion of 5mg zoledronic acid was effective in increasing bone density in breast cancer patients. However, AI-treated patients showed less improvement in vertebral bone mineral density and biochemical markers. Further long-term studies with larger cohorts are needed.

Bone Loss and Fractures in Post-Menopausal Women Living with HIV: A Narrative Review.

Post-menopausal women living with Human Immunodeficiency Virus (WLHIV) face an increased risk of bone fractures due to the relationship between HIV-related factors and menopause. This narrative review aims to summarise the current knowledge about fracture risk among post-menopausal WLHIV in particular looking at hormonal changes, combined antiretroviral therapy (cART), lifestyle factors, and psychosocial implications. We also profiled a summary of the significant, recent studies of post-menopausal WLHIV residing in low-income countries (LIC). A thorough search of the literature was performed across PubMed, Medline, Scopus, and Google Scholar, focussing on studies published between 2000 and 2024. Inclusion criteria entailed original research, reviews, and meta-analyses addressing bone mineral density (BMD), fracture incidence, and related risk factors in post-menopausal WLHIV. The review identified 223 relevant studies. Post-menopausal WLHIV exhibit significantly lower BMD and higher fracture rates compared to both HIV-negative post-menopausal women and pre-menopausal WLHIV. cART, particularly tenofovir disoproxil fumarate (TDF), contributes to reduced BMD. Menopausal status exacerbates this risk through decreased oestrogen levels, leading to increased bone resorption. Moreover, lifestyle choices such as smoking, alcohol consumption, and low physical activity are more prevalent in PWHIV, which further elevates fracture risk. Different psychosocial factors may make WLWHIV more vulnerable at this stage of their life, such as depression, isolation, stigma, and housing and nutritional issues. Women living in LICs face a variety of challenges in accessing HIV care. There are gaps in research related to the prevalence of osteoporosis and bone loss in post-menopausal WLHIV in LICs. Post-menopausal women living with HIV face a significantly higher risk of bone loss and fractures due to the combined effects of HIV and menopause. Antiretroviral therapy (particularly TDF), lifestyle factors, and psychosocial challenges exacerbate this risk. There is a need for careful selection of cART, hormone replacement therapy (HRT), and emerging treatments such as Abaloparatide. A holistic approach including lifestyle changes and psychosocial support is crucial to reduce fracture risk in WLHIV, especially in low-income countries.

Elevated uric acid is associated with a low bone mineral density in pre- but not post-menopausal women with rheumatoid arthritis: a pilot study.

The role of uric acid (UA) on bone metabolism is controversially discussed. Higher UA levels have been associated with higher T-scores and a reduced incidence of fractures in postmenopausal women. However, in the context of rheumatoid arthritis (RA), the role of UA remains unclear. This pilot study aimed to investigate the association of UA levels with bone mineral density in RA female and male patients. This pilot study analyzed patients with RA to explore preliminary associations. We utilized data from the Rh-GIOP cohort, a prospective monocentric observational study focusing on bone health in chronic rheumatic diseases. To assess the association between UA levels and the lowest T-scores measured at the lumbar spine, hip, or femur, we used linear regression with adjustment for various confounders. An interaction term was included to evaluate differential associations in pre- and postmenopausal women. Data on dual X-ray absorptiometry (DXA) measurements and serum UA levels were analyzed in a total of 206 patients. Among the 167 women 16 were premenopausal (age 40 ± 8 years) and 149 postmenopausal (age 65 ± 10 years). As expected, postmenopausal had lower T-scores than premenopausal patients (-1.53 ± 1.01 versus - 0.41 ± 1.29, respectively). No association of UA levels with T-scores was found when analyzing the whole cohort (Slope β: -0.04; p = 0.45). However, a significant negative correlation of UA with T-scores in premenopausal (Slope β: -0.98; p = 0.014), but not postmenopausal (Slope β: -0.04; p > 0.05) women was found. Uric acid appears to be negatively associated with bone mineral density in premenopausal but not in postmenopausal women with RA. Thus, the impact of UA on bone health seems to depend on the hormonal status of women. Further investigations are required to validate these results in a larger cohort of patients and to investigate the underlying mechanisms.

The relationship of body composition with bone mineral density and 10-year probability of hip fracture in postmenopausal women

IntroductionPostmenopausal osteoporosis and fractures are widely prevalent. However, the relationship of body composition with bone health in this population remains unclear. The aim of this study was to investigate the association of body composition with bone mineral density (BMD) and 10-year probability of hip fracture in postmenopausal women. Materials and MethodsThis is a cross-sectional study. A total of 1285 subjects were included in our study. Body composition and BMD were assessed using dual-energy X-ray densitometry. The 10-year probability of hip fracture of participants was calculated. All participants were categorized into four groups: sarcopenic-obese (SO) group, sarcopenic-nonobese (S) group, nonsarcopenic-obese (O) group, or nonsarcopenic-nonobese control (C) group. Multivariate analyses and binary logistic regression were conducted to explore the relationship of body composition with BMD and 10-year probability of hip fracture. ResultsParticipants in S group were 2.8, 4.7 and 4.8 times more likely to develop osteoporosis in the lumbar spine, the total hip and femoral neck sites, respectively. Lean mass was positively correlated with BMD, wherein lumbar spine BMD was significantly affected by appendicular lean mass, while total hip BMD and femoral neck BMD were mainly influenced by trunk lean mass. Total fat mass was positively associated with total hip and femoral neck BMD, but not with lumbar spine BMD. A significant correlation was observed between lean mass and 10-year probability of hip fracture. ConclusionChanges in body composition in postmenopausal women could affect bone health. A decrease in regional lean mass may be associated with an increased risk of osteoporosis and fractures.

Effects of romosozumab on bone mineral density and fractures in postmenopausal women: a meta-analysis

Purpose: Romosozumab, a mono-clonal antibody has been approved for the treatment of postmenopausal women with osteoporosis and high fracture risk. This meta-analysis evaluated the effect of romosozumab on Bone Mineral Density (BMD) and fracture occurrence in postmenopausal women with osteoporosis.Methods: A systematic search was done adhered to the PRISMA guidelines in PubMed, Ovid and Clinicaltrials.gov and eligible studies were selected. The details related to study participants, changes in BMD at the lumber spine (LS), total hip (TH) and femoral neck (FN) and the occurrence of fractures during the period were extracted. The mean differences of BMDs between the two groups and odds ratios (OR) of fractures were considered as the outcome of the studies.Results: Of the 11 potentially eligible articles, only four studies fulfilled the selection criteria and they were included in the final analysis. Romosozumab therapy for 12 months increased mean BMD at the LS by 12.7% (95% CI, 9.7, 15.6), TH by 4.8% (95% CI, 3.3,6.3) and FN by 4.1% (95% CI, 3.1, 5.2). Treatment with romosozumab decreased the odds of new vertebral fractures and vertebral fractures by 58% (OR=0.42, CI, 0.23,0.91) and 25% (OR=0.75, CI, 0.53,1.06) respectively at the end of 12 months.Conclusion: Romosozumab significantly increases BMD at LS, TH and FN and reduces the risk of new vertebral and non-vertebral fractures in postmenopausal women with osteoporosis.

Evaluation of fragility fracture risk using deep learning based on ultrasound radio frequency signal.

It was essential to identify individuals at high risk of fragility fracture and prevented them due to the significant morbidity, mortality, and economic burden associated with fragility fracture. The quantitative ultrasound (QUS) showed promise in assessing bone structure characteristics and determining the risk of fragility fracture. To evaluate the performance of a multi-channel residual network (MResNet) based on ultrasonic radiofrequency (RF) signal to discriminate fragility fractures retrospectively in postmenopausal women, and compared it with the traditional parameter of QUS, speed of sound (SOS), and bone mineral density (BMD) acquired with dual X-ray absorptiometry (DXA). Using QUS, RF signal and SOS were acquired for 246 postmenopausal women. An MResNet was utilized, based on the RF signal, to categorize individuals with an elevated risk of fragility fracture. DXA was employed to obtain BMD at the lumbar, hip, and femoral neck. The fracture history of all adult subjects was gathered. Analyzing the odds ratios (OR) and the area under the receiver operator characteristic curves (AUC) was done to evaluate the effectiveness of various methods in discriminating fragility fracture. Among the 246 postmenopausal women, 170 belonged to the non-fracture group, 50 to the vertebral group, and 26 to the non-vertebral fracture group. MResNet was competent to discriminate any fragility fracture (OR = 2.64; AUC = 0.74), Vertebral fracture (OR = 3.02; AUC = 0.77), and non-vertebral fracture (OR = 2.01; AUC = 0.69). After being modified by clinical covariates, the efficiency of MResNet was further improved to OR = 3.31-4.08, AUC = 0.81-0.83 among all fracture groups, which significantly surpassed QUS-SOS (OR = 1.32-1.36; AUC = 0.60) and DXA-BMD (OR = 1.23-2.94; AUC = 0.63-0.76). This pilot cross-sectional study demonstrates that the MResNet model based on the ultrasonic RF signal shows promising performance in discriminating fragility fractures in postmenopausal women. When incorporating clinical covariates, the efficiency of the modified MResNet is further enhanced, surpassing the performance of QUS-SOS and DXA-BMD in terms of OR and AUC. These findings highlight the potential of the MResNet as a promising approach for fracture risk assessment. Future research should focus on larger and more diverse populations to validate these results and explore its clinical applications.

Low-dose glucocorticoid increase the risk of fracture in postmenopausal women with low bone mass: a retrospective cohort study.

The effect of low-dose glucocorticoid (GC) therapy on the fracture risk in postmenopausal women with low bone mass was investigated. 119,790 66-year-old postmenopausal women with low bone mass based on bone mineral density (BMD) results were included. GC group consisted of patients who had been prescribed oral GCs within 6months of BMD testing. In GC group, GCs dosage was calculated by a defined daily dose (DDD), and divided into five groups according to GC usage (Group 1[G1]; < 11.25 DDDs, G2; ≥ 11.25, < 22.5 DDDs, G3; ≥ 22.5, < 45 DDDs, G4; ≥ 45, < 90 DDDs, G5; ≥ 90 DDDs). The risk of major osteoporotic fractures (MOF) and non-MOF was analyzed and compared with that of the control group during the 1-year follow-up. The risk of total fracture was higher in G3-G5 than in the control group (G3, hazard ratio (HR) 1.25, 95% confidence interval [CI] 1.07-1.46; G4, 1.37 [1.13-1.66]; G5 1.45 [1.08-1.94]). The risk of MOF was higher in all groups except G2 than in the control group (G1, 1.23 [1.05-1.45]; G3, 1.37 [1.11-1.68]; G4, 1.41 [1.09-1.83]; G5, 1.66 [1.14-2.42]). The risk of spine fracture was significantly higher in all GC groups except G2 than in the control group. The risk of non-MOF was higher only in G4 than in the control group (G4, 1.48 [1.13-1.94]). Low-dose GC therapy can increase the risk of osteoporotic fractures, particularly spine fractures, in postmenopausal women with low bone mass.

The development and validation of a prediction model for imminent vertebral osteoporotic fracture in postmenopausal women

The development and validation of a prediction model for imminent vertebral osteoporotic fracture in postmenopausal women

A practical approach for anabolic treatment of bone fragility with romosozumab.

Romosozumab, a fully humanized anti-sclerostin-antibody, is a bone-builder stimulating osteoblasts and inhibiting osteoclast by activation of the canonical Wnt-beta catenin signaling. This unique mechanism of action has the potential to address unmet needs in osteoporosis management. The multifaceted practical clinical issues related to romosozumab are discussed, especially focusing on the rationale of employing a sclerostin inhibitor to target bone fragility as first line or second line treatment in post-menopausal osteoporosis and in males at increased risk of fractures. Four randomized clinical trials with several post-hoc analyses and more than ten observational studies have consistently demonstrated that romosozumab is effective in rapidly increasing bone mineral density (BMD) and decreasing risk of vertebral, non-vertebral and hip fractures in post-menopausal women at very-high risk of fractures. In male osteoporosis, only data on BMD are available. Noteworthy, romosozumab was shown to be more effective and rapid than teriparatide in improving BMD, bone structure and strength at the hip, especially in women already treated with anti-resorptive drugs. Interestingly, even if romosozumab displays best results in treatment-naïve patients, its favourable effects on BMD were observed even in women previously treated with teriparatide or denosumab, although to a lesser extent. Based on the available evidence, romosozumab could be proposed as ideal drug in several clinical settings, such as non-fractured post-menopausal women at very-high risk of fractures, patients with recent hip fracture, patients non responder to bisphosphonates and short-term denosumab therapy.

Association between reduced physical activity and 10-years risk of fracture in postmenopausal women with osteopenia/osteoporosis

Association between reduced physical activity and 10-years risk of fracture in postmenopausal women with osteopenia/osteoporosis

P043 The different roles of FRAX risk factors as predictors of fragility fractures in peri-menopausal vs post-menopausal patients: results from a large population-based cohort study

Abstract Background/Aims The marked rise in the prevalence of fragility fractures affecting both women undergoing the transition to menopause (i.e. peri-menopause), and post-menopausal women, confers a significant burden on patients’ health and quality of life. The risk factors for fractures in post-menopausal women have been previously well-explored, and tend to align with the FRAX variables. However, there is less consensus regarding the fracture risk factors in peri-menopausal women. We compare the association between FRAX risk factors and fractures across peri-menopausal and post-menopausal women, selected from the same large population-based cohort. Methods Female patients referred for a DXA scan at the Royal Lancaster Infirmary between 2004-2011 provided information relating to any previous fragility fracture(s), FRAX risk factors, and menopause status (i.e. not post-menopausal vs post-menopausal) through a questionnaire. Patients aged 41 to 51 (median menopause age in UK) who had not undergone the menopause, as per their questionnaire response, were categorised as ‘peri-menopausal’. Logistic regression modelling, which included adjustment for potential confounders, was performed using r(version 4.3.1). Results Our study included 23388 patients, including 3785 peri-menopausal patients and 20774 post-menopausal patients, with a mean age of 47.5 (SD:3.0) and 66.1 (SD:10.4) respectively. The prevalence of fragility fractures was greater in the post-menopausal than peri-menopausal cohort (42.8% vs 25.5% respectively; p &amp;lt; 0.001). Across post-menopausal patients, following adjustment for the other FRAX risk factors, significant predictors of increased fracture risk were age (odds ratio (OR): 1.04 (95% CI:1.03-1.04, p &amp;lt; 0.001), smoking (OR:1.16 (CI:1.09-1.23, p &amp;lt; 0.001), alcohol (OR:1.54, CI:1.36-1.74, p &amp;lt; 0.001), and a family history of fracture(s) (OR:1.21 (CI:1.13-1.29, p &amp;lt; 0.001). Comparatively, across peri-menopausal patients, only alcohol (OR:1.57, CI:1.08-2.26, p = 0.016) and smoking (OR:1.22 (CI:1.00-1.48, p = 0.045) positively predicted fracture risk. Corticosteroid use was associated with a reduced fracture risk across both post-menopausal (OR:0.84, CI:0.79-0.90, p &amp;lt; 0.001) and peri-menopausal (OR:0.79, CI: 0.64-0.97, p = 0.024) cohorts. Conclusion Different FRAX risk factors predict fracture occurrence across post-menopausal and peri-menopausal patients; notably, only smoking and alcohol consumption predict an increased fracture risk in the latter group. Interestingly, corticosteroids were associated with a reduced risk of fractures across both groups. This finding may be elucidated by the fact that low-dose corticosteroids can exert an anti-inflammatory effect, and may protect bone cells. However, our finding is limited by the fact that the indication, dose and duration of corticosteroids were unknown. More generally, our study is limited by the fact that patients’ peri-menopausal status was not clinically confirmed, but inferred based on patients’ age and self-reported menopause status. Our results suggest that the FRAX risk factors, which were derived from analysis of predominantly 50-80 year old patients, may require adjustment for peri-menopausal patients (many of whom are aged &amp;lt;50). Future studies should assess whether our conclusions apply to specific fracture sites, and are replicated across more demographically diverse patient populations. Disclosure K. Song: None. M. Bukhari: None.

Bisphosphonates for the prevention of osteoporotic fractures in postmenopausal women with osteopenia: a systematic review and meta-analysis

Bisphosphonates for the prevention of osteoporotic fractures in postmenopausal women with osteopenia: a systematic review and meta-analysis

Osteoporotic quality of life, self-efficacy, and fracture protection behaviors in postmenopausal women

SummaryIt is important for postmenopausal women to acquire bone health protective behaviors to protect them from fractures. For this reason, it is necessary to evaluate bone health during menopause and to inform women.PurposeThis study was conducted to examine osteoporotic fracture protection behaviors, quality of life, and self-efficacy in postmenopausal women.MethodsIn the study, the data were evaluated with the socio-demographic data form, Osteoporotic Fracture Protection Scale, Osteoporosis Self-Efficacy-Efficacy Scale, European Osteoporosis Foundation Quality of Life Questionnaire-41, which includes introductory information on socio-demographic characteristics.ResultsIt was determined that the postmenopausal women included in our study were between the ages of 45–92; more than half of them had chronic diseases; their average BMI was 29; and their DEXA score was − 3.00 ± 0.41. Among the people included in our study, those with a history of fractures had lower self-efficacy scores. It was determined that the fracture prevention scale scores of the participants were above the average, and the average of the osteoporosis-related quality of life score was high. In addition, it was determined that there was a strong positive correlation between self-efficacy and fracture prevention scale.ConclusionIt is important to determine behaviors to prevent osteoporotic fractures in postmenopausal women, to raise the necessary awareness and to inform patients about the precautions to be taken. It is thought that it will increase patients’ quality of life by increasing their disease-related self-efficacy. Therefore, there is a need for research on providing education to op patients and examining the results.

Summary of the 2023 Thai Menopause Society Clinical Practice Guideline on Menopausal Hormone Therapy.

The Thai Menopause Society is an academic organization consisting of healthcare professionals engaged in menopause medicine. The position statement was first issued in 1994 and updated in 2003 and 2023. Herein, we reviewed the important updates of the 2023 position statement on menopausal hormone therapy (MHT) as an international reference for healthcare professionals in Thailand. An advisory panel of clinicians and research experts in the field of menopause reviewed the recommendation of published International Consensus Statements and updated the evidence using the MEDLINE database through PubMed. The evidence-based information and relevant publications were assessed, and a consensus on recommendations was subsequently achieved using the level of evidence to determine the recommendation strength and evidence quality. MHT remains the most effective treatment for vasomotor symptoms and genitourinary syndromes of menopause even after 20 years. Additionally, it is effective in preventing bone loss and fractures in postmenopausal women. The cardiovascular risk of MHT increased in women who initiated MHT after 60 years of age. Hormone therapy should be individualized following the hormone type, dose, administration route, use duration, and progestogen inclusion. The necessary pretreatment evaluation and appropriate follow-up recommendations were added for improved MHT standard care. The updated 2023 Clinical Practice Guideline on MHT is useful for gynecologists, general physicians, endocrinologists, and other healthcare professionals in treating menopausal women receiving hormone therapy in Thailand.

Evaluation of Bone Density Changes Before and After One Year of Denosumab (Prolia) Administration in Osteoporosis Patients

Background: Osteoporosis, a widespread disease associated with aging, is characterized by a decrease in bone tissue density. With the global population aging, numerous studies aim to present methods for preventing or treating this disease to avoid pathological fractures by preserving bone density. Objectives: This study aimed to compare the changes in bone density in females with osteoporosis before and after receiving denosumab for at least one year. Methods: This clinical trial was conducted on 202 patients with osteoporosis who were referred to two private clinics in Tehran between 2019 and 2020. Each patient received two subcutaneous injections of 60 mg denosumab (Prolia) once every six months. Bone density was measured using the DXA method, and the T-score and the risk of bone fracture were calculated and compared using the FRAX instrument before drug administration and six months after the second dose injection. Results: The average age of the participants was 69.0 ± 8.0 years. Significant differences were observed in vertebral bone density (-2.55 ± 0.06 to -2.00 ± 0.07) and femur bone density (-2.10 ± 0.10 to -1.88 ± 0.06) before and after denosumab treatment (P &lt; 0.05). Furthermore, the risk of major fractures (23.0 ± 1.9 to 18.9 ± 1.5) and hip fractures (8.5 ± 1.3 to 5.7 ± 0.9) significantly decreased before and after treatment with denosumab (P &lt; 0.05). A significant improvement in bone density was observed across all age groups of patients before and after treatment with denosumab (P &lt; 0.05). Conclusions: Denosumab significantly reduces the risk of bone fractures and enhances bone density in postmenopausal women. It proves to be an effective medication for reducing the increased risk of fractures in postmenopausal women and for improving their bone density.

Physical function trajectory after wrist or lower arm fracture in postmenopausal women: results from the Women’s Health Initiative Study

SummaryLong-term physical functioning trajectories following distal forearm fracture are unknown. We found that women with versus those without distal forearm fracture were more likely to experience a 5-year decline in physical functioning, independent of initial physical functioning level. This association was most evident among women 80 years and older.IntroductionPhysical functioning trajectory following lower arm or wrist fracture is not well understood.PurposeThis study is to evaluate physical functioning trajectory before vs. after lower arm or wrist fracture, stratified by age.MethodsWe performed a nested case–control study of prospective data from the Women’s Health Initiative Study (n = 2097 cases with lower arm or wrist fracture, 20,970 controls). Self-reported fractures and the physical functioning subscale of the RAND 36-item Short-Form Health Survey were assessed annually. We examined three physical functioning trajectory groups: stable, improving, and declining.ResultsMean (SD) number of physical functioning measurements was 5.2 (1.5) for cases and 5.0 (1.4) for controls. Declining physical functioning was observed among 20.4% of cases and 16.0% of controls. Compared to women without lower arm or wrist fracture, women with lower arm or wrist fracture were 33% more likely to experience declining physical functioning (adjusted odds ratio [aOR] 1.33 95% confidence interval [CI] 1.19–1.49, reference group stable or improving physical functioning trajectory). Associations varied by age: age ≥ 80 years aOR 1.56 (95% CI 1.29–1.88); age 70–79 years aOR 1.29 (95% CI 1.09–1.52); age < 70 years aOR 1.15 (95% CI 0.86–1.53) (pinteraction = 0.06). Associations between lower arm or wrist fracture and odds of declining physical functioning did not vary by baseline physical functioning or physical activity level.ConclusionsWomen with lower arm or wrist fracture, particularly those aged 80 and older, were more likely to experience declines in physical functioning than women without such fractures, independent of baseline physical functioning level.

Plant-Based Diets and Risk of Hip Fracture in Postmenopausal Women

Previous research has found that vegetarian diets are associated with lower bone mineral density and higher risk of fractures, but these studies did not differentiate the quality of the plant-based foods. To examine the association between the quality of plant-based diets (not necessarily vegan but also omnivorous) and hip fracture risk among postmenopausal women in the Nurses' Health Study. This cohort study analyzed data from 70 285 postmenopausal women who participated in the US Nurses' Health Study from 1984 through 2014. Data were analyzed from January 1 to July 31, 2023. Hip fractures were self-reported on biennial questionnaires. Diet was assessed every 4 years using a validated semiquantitative food frequency questionnaire. Plant-based diet quality was assessed using 2 previously established indices: the healthful Plant-Based Diet Index (hPDI), for which healthy plant foods (whole grains, fruits, vegetables, nuts, legumes, vegetable oils, and tea or coffee) received positive scores, whereas less healthy plant foods (fruit juices, sweetened beverages, refined grains, potatoes, and sweets or desserts) and animal foods received reversed scores; and the unhealthful Plant-Based Diet Index (uPDI), for which positive scores were given to less healthy plant foods and reversed scores to healthy plant and animal foods. Quintile scores of 18 food groups were summed, with a theoretical range for both indices of 18 to 90 (highest adherence). Cox proportional hazards regression with time-varying covariates was used to compute hazard ratios (HRs) and 95% CIs for hip fracture. In total, 70 285 participants (mean [SD] age, 54.92 [4.48] years; 100% White women) were included, and 2038 cases of hip fracture were ascertained during the study and for up to 30 years of follow-up. Neither the hPDI (HR for highest vs lowest quintile, 0.97 [95% CI, 0.83-1.14]) nor the uPDI (HR for highest vs lowest quintile, 1.02 [95% CI, 0.87-1.20]) for long-term diet adherence was associated with hip fracture risk. However, when examining recent intake for the highest vs lowest quintiles, the hPDI was associated with 21% lower risk of hip fracture (HR, 0.79 [95% CI, 0.68-0.92]; P = .02 for trend), and the uPDI was associated with 28% higher risk (1.28 [95% CI, 1.09-1.51]; P = .008 for trend). Findings of this cohort study indicated that long-term adherence to healthful or unhealthful plant-based diets as assessed by hPDI and uPDI scores was not associated with hip fracture risk. Future research should clarify whether the associations observed with recent dietary intake are due to short-term effects of these dietary patterns, reverse causality, or both.

Comparative Study of Serum Calcium Level Between Postmenopausal and Premenopausal Women

In postmenopausal women, more significant bony consequences are associated with low blood calcium levels. A observational cross-sectional study was conducted in the Department of Biochemistry, Dhaka Medical College, Dhaka from July 2014 to June 2015. Serum calcium levels were compared between postmenopausal women as cases and premenopausal women as controls. The study sample size was 100 of which 50 were postmenopausal, and 50 were premenopausal. Mean (±SD) of serum calcium level was significantly higher in the premenopausal group than in the postmenopausal group. Serum calcium level was 8.66±0.43 mg/dL in postmenopausal women and 9.12±0.59mg/dL in premenopausal women. Both the values were within the normal reference range, but the difference was statistically significant with a p-value of 0.001. By this research work, it is observed that postmenopausal women are more prone to develop osteoporosis with a decreased serum calcium concentration. Routine check-up of this biochemical parameter may provide valuable information for preventing osteoporotic fractures in postmenopausal women.&#x0D; Bangladesh J Med Biochem 2019; 12(1): 1-5

Spinal osteoarthritis is a risk of vertebral fractures in postmenopausal women

Recent studies have revealed that despite high bone mineral density (BMD), osteoarthritis (OA) is a risk factor for osteoporotic fractures. However, the relationship between spinal OA and vertebral fractures has not yet been fully investigated. This longitudinal analysis used a subset of ongoing cohort study consist with Japanese postmenopausal women. The prevalence of spinal OA was determined using Kellgren–Lawrence grading method. The incidence of vertebral fractures were determined by semiquantitative analysis of spinal X-ray films. The relationship between the presence of spinal OA and incidence of vertebral fractures was evaluated using the Cox regression analysis. In total, 1480 women were followed up for 8.1 ± 6.4 years. Among them, 923 were diagnosed with spinal OA, and incident vertebral fractures were observed in 473 participants. After adjusting for confounding variables, the spinal OA (≥ grade 2) was a significant predictor of incident vertebral fractures (hazard ratio, 1.52; 95% confidence interval: 1.19–1.93, p = 0.001). Using ROC analysis, the thresholds of lumbar BMD for incident vertebral fractures were 0.952 g/cm2 for patients with spinal OA and 0.753 g/cm2 for patients without spinal OA. The presence of spinal OA is a risk factor for incident vertebral fractures despite high lumbar BMD.

The association between circulating irisin levels and osteoporosis in women: a systematic review and meta-analysis of observational studies.

This systematic review and meta-analysis aimed to investigate the association between circulating irisin levels and osteoporosis in women, exploring irisin's potential role in the pathophysiology and management of osteoporosis. We searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang, and VIP databases up to January 2023. The inclusion criteria were observational studies reporting on circulating irisin levels in women. The standardized mean difference (SMD) and correlation coefficients with a 95% confidence interval (CI) were used as the main effect measures under a random-effects model. Heterogeneity was evaluated using the Cochrane Q statistic and the I2 statistics. Subgroup analysis and univariate meta-regression analysis were performed to identify the sources of heterogeneity. The quality of the included study was assessed by the Newcastle-Ottawa Score. The quality of evidence was evaluated using the GRADE system. Publication bias was assessed using Begg's and Egger's test, and the trim-and-fill method. Sensitivity analysis was performed to assess the stability of the results. Fifteen studies with a total of 2856 participants met the criteria. The analysis showed significantly lower irisin levels in postmenopausal osteoporotic women compared to non-osteoporotic controls (SMD = -1.66, 95% CI: -2.43 to -0.89, P < 0.0001; I2 = 98%, P < 0.00001) and in postmenopausal individuals with osteoporotic fractures than in non-fractures controls (SMD = -1.25, 95% CI: -2.15 to -0.34, P = 0.007; I2 = 97%, P < 0.00001). Correlation analysis revealed that irisin levels positively correlated with lumbar spine BMD (r = 0.37, 95% CI: 0.18 to 0.54), femoral BMD (r = 0.30, 95% CI: 0.18 to 0.42), and femoral neck BMD (r = 0.31, 95% CI: 0.14 to 0.47) in women. Despite significant heterogeneity, the robustness of the results was supported by using the random effects model and sensitivity analysis. The current evidence suggests that lower irisin levels are significantly associated with osteoporosis and fracture in postmenopausal women, suggesting its utility as a potential biomarker for early detection of osteoporosis and therapeutic target. However, further high-quality prospective research controlling for confounding factors is needed to clarify the relationship between irisin levels and osteoporotic outcomes. https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023410264.