High Incidence Of Osteoporotic Fractures Research Articles

Proximity to major roads and the incidence of osteoporotic fractures in elderly women: The BONE study in Beijing.

There is growing evidence to suggest that living near major roads (and suffering from the air pollution of urban streets) can have an adverse effect on bone health. However, little is known about its relationship to fractures caused by osteoporosis. This study was designed to investigate the relationship between residents living near major roads and the incidence of osteoporotic fractures. A retrospective cohort of 529 subjects was established based on community populations in older women aged 65-91. All participants lived in Beijing between September 27, 2007 and September 26, 2017. The distance between the residential sites of the subjects and the main roads was determined by the authors. Osteoporotic fracture diagnosis was based on medical histories and imaging examinations (DXA and X-rays). The Cox proportional hazard model was used to assess the association between traffic proximity and osteoporotic fractures, with suitable adjustments for individual and background factors. The age range of all participants was 65-91 years, with an average age of 75.8 years (and a standard deviation 6.8 years). Of these, 19 (3.59%) suffered from diabetes, and 48 (9%) had hypertension; 85 (14%) families had annual incomes below US $30,000 and 402 (76%) had received a secondary school education or higher. Nearly 25% of people lived within 50 m of a main road, while 50% lived within 300 m. Between 2007 and 2017, a total of 96 osteoporotic fractures were observed. For people living <50 m from a main road, the adjusted hazard ratio (HR) for osteoporotic fractures was 2.509 (95% CI 1.345-4.680), while it was 1.830 (95% CI 1.029-3.255) for those living at a distance of 50-300 m from a main road vs. those living further than 300 m away. In this community-based cohort, living near a major road was associated with a higher incidence of osteoporotic fractures.

Risk of fractures at different anatomic sites in patients with irritable bowel syndrome: a nationwide population-based cohort study.

Patients with IBS might also be at increased risk of osteoporosis and osteoporotic fractures. Up to now, the association between IBS and the risk of fractures at different anatomic sites occurrences is not completely clear. We conducted a population-based cohort analysis to investigate the fracture risk of IBS in comparison with non-IBS group. We identified 29,505 adults aged ≥ 20years with newly diagnosed IBS using the Taiwan National Health Insurance Research Database in 2000-2012. A comparison group was constructed of patients without IBS who were matched according to gender and age. The occurrence of fracture was monitored until the end of 2013. We analyzed the risk of fracture events to occur in IBS by using Cox proportional hazards regression models. Patients with IBS had a higher incidence of osteoporotic fractures compared with the non-IBS group (12.34 versus 9.45 per 1000 person-years) and an increased risk of osteoporotic fractures (adjusted hazard ratio [aHR] = 1.27, 95% confidence interval [CI] = 1.20-1.35). Site-specific analysis showed that the IBS group had a higher risk of fractures for spine, forearm, hip, and hand than did the non-IBS group. With further stratification for gender and age, a higher aHR value for osteoporotic fractures in the IBS group was seen across all age groups in males, but seen in elderly females. In addition, female, elderly, low income, hypertension, coronary artery disease, cerebrovascular disease, and depressive disorders as independent osteoporotic fracture risk factors in IBS patients. The IBS is considered as a risk factor for osteoporotic fractures, particularly in female individuals and fracture sites located at the spine, forearm, hip, and hand.

TGF-β inhibits osteogenesis by upregulating the expression of ubiquitin ligase SMURF1 via MAPK-ERK signaling.

High incidence of osteoporotic fractures emphasizes the necessity of developing effective measures to promote osteogenesis. In our study, we investigated a possible role of MAPK-ERK signaling in the TGF-β-mediated osteoblastic differentiation. Our results indicated that TGF-β activated the MAPK-ERK pathway and inhibited osteogenesis in mesenchymal pluripotent cell line, C3H10T1/2, and preosteoblastic cell line, MC3T3 cells. And the downregulation of MAPK-ERK signaling using pharmacological inhibitor U0126 and RNA interference rescued osteoblast differentiation suppressed by TGF-β, which was confirmed by Alkaline phosphatase (ALP) staining and alizarrn red staining, and the enhanced expression of osteogenesic markers. Western blotting analysis indicated that TGF-β induced protein expression of E3 ubiquitin-protein ligase SMURF1, which contributed to the degradation of RUNX2 and SMAD1 as evidenced by SMURF1 inhibition using RNA interference and proteasome inhibitor MG132. Moreover, we observed that the expression of SMURF1 was decreased, while that of SMAD1 and RUNX2 increased by MAPK-ERK inhibitor U0126 in TGF-β-treated differentiating preosteoblasts, suggesting that MAPK-ERK regulated the transcription of osteogenesis-related genes. Furthermore, a synergistic effect between U0126 and bone morphogenic protein (BMP)-2 on osteoblast differentiation and bone formation was observed both in cell cultures and experimental animals. In conclusion, our results revealed that TGF-β inhibited osteoblastic differentiation by inducing the MAPK-ERK pathway which upregulated the expression of ubiquitin ligase SMURF1 and resulted in reduced presence of osteogenic proteins. In addition, the potentiation of BMP-2 on osteogenic activity by ERK1/2 inhibitor U0126 suggests that it may have potential clinical utility for promoting osteogenesis in bone fracture repair.

PTH-217 Spinal infections among patients with long term central venous catheters for home parenteral nutrition: a descriptive case series

<h3>Introduction</h3> Long-term central venous catheters for home parenteral nutrition (HPN) carry a risk of recurrent bacterial colonisation and catheter related sepsis (CRS).¹Spinal infections following an episode of CRS are uncommon but may be underreported or overlooked due to the high incidence of osteoporotic fractures in this cohort.²We aimed to determine the frequency and describe cases of spinal infections in HPN patients at our institution. <h3>Method</h3> We performed a retrospective review of all spinal infections presenting in our HPN patients between January 2010 and October 2013, a cohort of approximately 270 patients. Data were extracted on basic demographics, indication for and duration of HPN, means of venous access, history of presentation and management. <h3>Results</h3> The CRS rate was 0.9 per 1000 catheter days. Six patients were identified (mean age 65 years, 5 male) with spinal infection, a rate of 0.02 per 1000 catheter days. Duration with current CVC ranged from 5 months to 2 years. All patients presented with spinal pain; 5/6 cervical, 1/6 thoracic. All patients had a normal white cell count and differential, and in only 1 case was the CRP elevated. In 4 cases an organism was isolated at the time of presentation from blood cultures taken centrally and/or peripherally – commonly staphylococcal species. All patients had contrast-enhanced magnetic resonance imaging (MRI) with features compatible with spinal infection and in two patients a repeat MRI demonstrated resolution of changes. In three patients a disc biopsy was performed yielding one negative culture, one microbiological correlation with blood cultures and a single positive culture (unknown isolate). All patients received three months of intravenous antibiotic therapy augmented with surgery or conservative management on a case-by-case basis. The CVC was removed in 4/6 patients at presentation, with salvage in the remaining two. <h3>Conclusion</h3> Spinal infections associated with long-term CVC for HPN should be considered in patients presenting with spinal pain. They are often of insidious onset and may present with normal inflammatory markers which may contribute to delayed or missed diagnoses that together with differences in the definition of CRS¹may partially explain the poor representation in the current HPN-related literature.³Gold-standard imaging is with contrast-enhanced MRI with formal biopsy decided on an individual basis. Management should involve prolonged antibiotics and liaison with microbiology and neurosurgery. Multidisciplinary discussion on CVC salvage is important especially in cases of difficult vascular access. <h3>Disclosure of interest</h3> None Declared. <h3>References</h3> Reimund JM, <i>et al.</i><i>Clin Nutr.</i>2002;21(2):33–38 Haderslev KV, <i>et al.</i><i>JPEN</i>2004;28(5):289–294 Huard G, <i>et al.</i><i>J Clin Med Res.</i>2014;6(4):272–277

The puzzling world of vitamin D insufficiency

In the past decade, not only skeletal but also non-skeletal actions of vitamin D have been frequently reported—rickets, it seems, was merely the tip of the iceberg.1 Vitamin D deficiency might result in a higher incidence of osteoporotic fractures, cancer, cardiovascular diseases, diabetes, infections, neuropsychiatric disorders, and a higher risk of death.1,2 A mild form of vitamin D deficiency has also been introduced—referred to as vitamin D insufficiency.

A Case of Cushing Syndrome Diagnosed by Recurrent Pathologic Fractures in a Young Woman

Cushing's syndrome is characterized by central obesity, fatigability, weakness, amenorrhea, hirsutism, edema, hypertension, impaired glucose tolerance, and osteoporosis due to excessive production of steroids. Cushing's syndrome is an important cause of secondary osteoporosis. Patients with Cushing's syndrome have a high incidence of osteoporotic fractures. At least, 30-50% of patients with Cushing's syndrome experience fractures, particularly in the vertebral body. And it is consistent with the 50% prevalence of osteoporosis in patients with Cushing's syndrome. However, reports of multiple pathological fractures in young patients with Cushing's syndrome are rare. Thus, we describe the case of a 26-year-old woman with Cushing's syndrome accompanied with recurrent multiple osteoporotic fractures and being treated by parathyroid hormone. Careful consideration for the possibility of Cushing's syndrome will be necessary in case of young patients with a spontaneous multiple compression fractures in spine.

Assessing 5-year incidence rates and determinants of osteoporotic fractures in primary care

To assess the gender and age-related 5-year incidence rates of osteoporotic fractures, and their related predictors, in a primary care setting. We obtained information from the Health Search-CSD Longitudinal Patients Database (HSD). This is an Italian General Practice data repository which comprises information given by computer-based patient records of a selected group of over 900 Primary Care Physicians (PCPs). We selected all patients aged 50 to 85 years, who were actively included into the PCP's list at the beginning of the enrolment period (1st January 2002-31st December 2003). We excluded individuals who were registered in the PCPs' list for less than 1 year before the entry date (Index date) into the cohort, as well as those who were diagnosed with Paget disease or malignant neoplasm. Participants were followed up until the occurrence of osteoporotic fracture, one of the exclusion criteria, or the end of the study period. The 5-year rates (per 1000 person-years) of any osteoporotic fracture were 11.56 (95% C.I. 11.33 to 11.77) among females, and 4.91 (95% C.I. 4.75 to 5.07) among males. For hip fractures, the overall incidence rates were 3.23 (95% C.I. 3.11 to 3.34) among females and 1.21 (95% C.I. 1.12 to 1.28) among males, respectively. Advanced age, history of fracture, use of corticosteroids, rheumatoid arthritis, BMI<=20, presence of osteoporosis, gastrointestinal and chronic hepatic disease, depression, chronic obstructive pulmonary disease, use of anticonvulsants and a higher number of co-medications, increased the risk of any osteoporotic fractures. The use of primary care data confirms a higher incidence of osteoporotic fractures among females vs. males as well as in older individuals. Predictors of osteoporotic fractures were consistent with FRAX® algorithm. Given the clinical utility of a simple score for the assessment of absolute fracture risk among osteoporotic patients, its assessment and validation in the Italian HSD could potentially provide an applicable prediction tool.

Vitamin K and Osteoporosis

Vitamin K is involved in blood coagulation and in bone metabolism via the carboxylation of glutamate residues in (hepatic) blood coagulation factors and (osteoblastic) bone proteins. Although undercarboxylation of blood coagulation factors is very rare, undercarboxylated osteocalcin (bone Gla-protein) is frequently found in subject with osteoporosis. Osteoporosis, a systemic disease characterized by a low bone mass, is a major public health problem. It is a devastating disorder with significant physical, psychosocial, and financial problems because of the high incidence of fragility fractures, especially hip and vertebral fracture. The high incidence of osteoporotic fractures leads to considerable mortality, morbidity, reduced mobility and decreased quality of life. Hence one of the most important approaches to therapy is prevention. Supplementation of osteoporotic subjects with extra vitamin K causes the markers for bone formation to increase. In parallel, a decrease of the markers for bone resorption is frequently seen, Because of vitamin K can be decreased the risk of developing osteoporosis and its complications can be minimized. In this review summarizes with a theoretical knowledge about vitamin K and osteoporosis plus current reports regarding a possible role of vitamin K insufficiency in the pathogenesis of osteoporosis.

Epidemiology of osteoporosis-related fractures in France: A literature review

ObjectivesTo evaluate the health implications and economic burden on society of osteoporotic fractures as a major source of morbidity and mortality in the ageing population. MethodsWe have summarised the findings of a literature review of French studies published between 1960 and 2009, characterised the epidemiology of osteoporosis and osteoporotic fractures, and predicted future trends. ResultsPublished data for France supported the observation that osteoporosis is under-diagnosed in many countries. The incidence of fracture increased exponentially with age, alongside a concurrent decrease in bone mineral density, a risk factor for fracture. Combined with a projected rise in the French elderly population, this poses a significant burden for the future. The incidence of fracture was high in the osteopenic population; consequently, fragility fractures may be underestimated if reports focus on osteoporotic women only. As in many other countries, French data revealed that women have a higher incidence of osteoporotic fractures than men, although mortality from hip fracture was higher in men. DiscussionDue to ageing of the population, an increase in the number of people suffering from fractures is predicted over the next few decades unless preventative action is taken, highlighting the need for improved diagnosis and screening in postmenopausal women.

Effect of early menopause on bone mineral density and fractures

To review the data on the effect of early menopause on bone. Do women undergoing early menopause develop lower bone mineral density at an earlier age and do they have a higher incidence of osteoporotic fractures? Is there a difference on bone between women who undergo early natural menopause compared to women who have early menopause after oophorectomy? The earlier in life that menopause occurs, the lower the bone density will be later in life. Low bone density is associated with a higher fracture rate, and several studies show a relationship between early menopause, oophorectomy, and an increase in osteoporotic fractures. Early menopause is a risk factor for osteoporosis. Women with an early menopause should have bone density testing performed within 10 years of menopause so that osteopenia or osteoporosis will be diagnosed early and appropriate anti-resorptive therapy initiated.

Thiazolidinedione Treatment Decreases Bone Mineral Density in Type 2 Diabetic Men

Case-control studies of patients with fractures have found that subjects with diabetes have at least a twofold higher risk of fracture than subjects without diabetes (1), with an increased risk of hip, humerus, and foot fractures in elderly diabetic subjects (2–4). Risk factors that contribute to increased fracture in diabetic subjects include number of falls (5,6), insulin use (7,8), functional disability (9–11), diabetes duration (7,12), and poor vision (7). Recent studies report that older women and African Americans have higher incidence of osteoporotic fractures (13). In addition, lower bone strength (bone mineral density [BMD]) might be expected to increase risk for the development of osteoporosis and fracture. Type 2 diabetic patients are widely prescribed drugs called thiazolidinediones, which increase insulin sensitivity via activation of peroxisome proliferator–activated receptor (PPAR)-γ receptors. However, it is not known whether thiazolidinedione use has any effect on bone mass and thereby increases risk of fracture in type 2 diabetic patients. In animal studies, thiazolidinedione treatment was associated with bone loss in a mouse model (14,15), which was explained by possible imbalance in bone from increased apoptotic death of osteogenic cells and diminished bone formation (15), and also in ovariectomized rats (16). Other investigators did not find bone loss in troglitazone-treated mice (17). There is limited information on the effect of …

To Treat or Not To Treat, That Is the Question: Proceedings of the Quebec Symposium for the Treatment of Osteoporosis in Long-Term Care Institutions, Saint-Hyacinthe, Quebec, November 5, 2004

Patients in long-term care institutions (LTCI) are especially at risk for osteoporotic fractures owing to their lack of mobility, poor nutrition, and limited sun exposure. Previous reports have shown that osteoporosis is underdiagnosed and undertreated in LTCI despite the high incidence of osteoporotic fractures in these settings. This document has been developed to assist clinicians practicing in LTCI with the diagnosis and treatment of osteoporosis in their institutionalized patients. These proceedings offer an overview of the particular characteristics of patients at LTCI. Management strategies include both nonpharmacological and pharmacological interventions for the prevention and treatment of osteoporotic fractures in very frail older subjects. This guide is an edited review of presentations and discussions held by specialists in osteoporosis in the elderly together with physicians and pharmacists practicing in LTCI in the province of Quebec. This symposium was held in Saint-Hyacinthe, Quebec on November 5, 2004. The value of a given diagnostic test or treatment option was determined based on the clinical experiences and opinions of the participants and a review of the literature from an evidence-based perspective. All patients located at LTCI are at potential risk for osteoporotic fractures. Global interventions should include vitamin D, calcium, and a comprehensive exercise program. In patients who are at high risk for osteoporotic fractures or with previous fractures, pharmacological treatment should be started. These recommendations were approved during the final plenary of the symposium. All the prevailing opinions were summarized and included in this article.

To Treat or Not To Treat, That Is the Question: Proceedings of the Quebec Symposium for the Treatment of Osteoporosis in Long-Term Care Institutions, Saint-Hyacinthe, Quebec, November 5, 2004

Patients in long-term care institutions (LTCI) are especially at risk for osteoporotic fractures owing to their lack of mobility, poor nutrition, and limited sun exposure. Previous reports have shown that osteoporosis is underdiagnosed and undertreated in LTCI despite the high incidence of osteoporotic fractures in these settings. This document has been developed to assist clinicians practicing in LTCI with the diagnosis and treatment of osteoporosis in their institutionalized patients. These proceedings offer an overview of the particular characteristics of patients at LTCI. Management strategies include both nonpharmacological and pharmacological interventions for the prevention and treatment of osteoporotic fractures in very frail older subjects. This guide is an edited review of presentations and discussions held by specialists in osteoporosis in the elderly together with physicians and pharmacists practicing in LTCI in the province of Quebec. This symposium was held in Saint-Hyacinthe, Quebec on November 5, 2004. The value of a given diagnostic test or treatment option was determined based on the clinical experiences and opinions of the participants and a review of the literature from an evidence-based perspective. All patients located at LTCI are at potential risk for osteoporotic fractures. Global interventions should include vitamin D, calcium, and a comprehensive exercise program. In patients who are at high risk for osteoporotic fractures or with previous fractures, pharmacological treatment should be started. These recommendations were approved during the final plenary of the symposium. All the prevailing opinions were summarized and included in this article.

Epidemiology of the most frequent diseases in the European a-symptomatic post-menopausal women: Is there any difference between Ireland and the rest of Europe?

Osteoporosis, cardiovascular disease, breast cancer and genitourinary diseases are some of the most frequently diagnosed diseases in a-symptomatic post-menopausal women. There is a marked European geographic distribution of osteoporosis. Rates are higher in Scandinavia than in the Southern European countries. The possible reasons for this higher incidence of osteoporotic fractures in the Northern European countries is associated with the climate, which limits physical activity and exposure to sunlight and increases the risk of falls. During the next two decades, the number of hip fractures for European women over 65 years is expected to nearly double. Despite these figures, osteoporosis prevention has not yet been adopted in many European countries. There is a devastating impact and a huge financial burden on the European economy and health care system. Breast cancer is the most common cancer in females in Europe. The regions of highest incidence are Western and Northern Europe, while Southern and Eastern Europe have lower incidence rates. The causes of differences in breast cancer incidences between Northern and Southern Europe are not known, but the average 5-year survival of women with breast cancer has increased in Europe in the last three decades. Studies have revealed marked differences in cardiovascular diseases across Europe, showing cardiovascular death rates as highest among the Eastern and Central European countries and lowest in the Mediterranean countries. Cardiovascular disease is the major cause of mortality in European women. However, in North European countries, there are more ischaemic heart diseases in women than in Mediterranean countries. In Mediterranean countries, on the other hand, there are more strokes than in Northern Europe. These strokes events occur 10 years later than the ischaemic heart attacks.

Higher Bone Mineral Density in Rural Compared with Urban Dwellers: The NOREPOS Study

Norway has a very high incidence of osteoporotic fractures, with substantial regional differences in fracture incidence. The present study evaluated whether there are differences in bone mineral density (BMD) between regions in Norway with differences in fracture incidence. The authors used data collected in four large, population-based, multipurpose studies performed in four regions of Norway during 1994-2001. Distal forearm BMD was measured by single energy x-ray absorptiometry in 10,667 participants aged 40-75 years. Cross-calibration was performed by using the European Forearm Phantom. Mean distal forearm BMD was lower in the urban populations of Tromso, Oslo, and Bergen compared with the rural county of Nord-Trondelag, whereas there was no difference between the rural part of Tromso and Nord-Trondelag. For women, body mass index explained some of these differences. The prevalence of low BMD (z score < or = -1) in Oslo, Bergen, and urban Tromso, compared with Nord-Trondelag, was 1.6-1.7 times higher in men and 1.5-2.0 times higher in women, whereas no significant difference was found between rural Tromso and Nord-Trondelag. In this study, higher BMD was found in rural compared with urban areas of Norway, which might help explain the differences in fracture incidence. There was no apparent north-south gradient in BMD.

High-resolution magnetic resonance imaging to assess trabecular bone structure in patients after transplantation: a review.

After organ transplantation patients have a higher incidence of osteoporotic fractures. Bone mineral density (BMD) measurements to assess fracture risk are of limited value in these patients. On the other hand, structure-based techniques have shown promise. In this review, the use of high-resolution magnetic resonance imaging in the analysis of the trabecular bone structure in patients before and after renal and cardiac transplantation cross-sectionally is presented. The analyses of calcaneal trabecular structure were compared with BMD with regard to the prediction of therapy-induced bone loss and osteoporotic fracture status. Sagittal and axial T1-weighted spin-echo sequences with a voxel size of 0.2 x 0.2 x 1 mm were performed at 1.5 T and structure measures analogous to bone histomorphometry were calculated. In addition, fracture status of the spine and of the peripheral skeleton was assessed. Structure measures showed significant differences between healthy controls and patients before and after renal and cardiac transplantation (p < 0.01). Osteoporotic fractures were found in approximately 35% of the transplant patients; the percentage was higher in the cardiac transplants. Structure measures and BMD were lower in patients with fractures; differences were more significant in the cardiac transplant patients. Using receiver operating characteristic analyses the diagnostic performance in differentiating patients with and without fractures was highest when BMD and structure measures were combined. Structure measures performed better than BMD in the cardiac transplant patients, whereas results were comparable in the renal transplant patients. In conclusion, structure measures determined in high-resolution magnetic resonance images may be useful in assessing changes of trabecular bone after organ transplantation and may improve the prediction of fracture risk.

Calcium and vitamin D nutrition and bone disease of the elderly

Osteoporosis, a systemic skeletal disease characterized by a low bone mass, is a major public health problem in EC member states because of the high incidence of fragility fractures, especially hip and vertebral fracture. In EC member states the high incidence of osteoporotic fractures leads to considerable mortality, morbidity, reduced mobility and decreased quality of life. In 1995 the number of hip fractures in 15 countries of EC has been 382,000 and the estimated total care cost of about 9 billion of ECUs. Given the magnitude of the problem public health measures are important for preventive intervention. Skeletal bone mass is determined by a combination of endogenous (genetic, hormonal) and exogenous (nutritional, physical activity) factors. Nutrition plays an important role in bone health. The two nutrients essential for bone health are calcium and vitamin D. Reduced supplies of calcium are associated with a reduced bone mass and osteoporosis, whereas a chronic and severe vitamin D deficiency leads to osteomalacia, a metabolic bone disease characterized by a decreased mineralization of bone. Vitamin D insufficiency, the preclinical phase of vitamin D deficiency, is most commonly found in the elderly. The major causes of vitamin D deficiency and insufficiency are decreased renal hydroxylation of vitamin D, poor nutrition, scarce exposition to sunlight and a decline in the synthesis of vitamin D in the skin. The daily average calcium intake in Europe has been evaluated in the SENECA study concerning the diet of elderly people from 19 towns of 10 European countries. In about one third of subjects the dietary calcium intake results were very low, between 300 and 600 mg/day in women, and 350 and 700 mg/day in men. Calcium supplements reduce the rate of bone loss in osteoporotic patients. Some recent studies have reported a significant positive effect of calcium treatment not only on bone mass but also on fracture incidence. The SENECA study, has also shown that vitamin D insufficiency is frequent in elderly populations in Europe. There are a number of studies on the effects of vitamin D supplementation on bone loss in the elderly, showing that supplementations with daily doses of 400-800 IU of vitamin D, given alone or in combination with calcium, are able to reverse vitamin D insufficiency, to prevent bone loss and to improve bone density in the elderly. In recent years, there has been much uncertainty about the intake of calcium for various ages and physiological states. In 1998, the expert committee of the European Community in the Report on Osteoporosis-Action on prevention, has given the recommended daily dietary allowances (RDA) for calcium at all stage of life. For the elderly population, above age 65 the RDA is 700-800 mg/day. The main source of calcium in the diet are dairy products (milk, yoghurts and cheese) fish (sardines with bones), few vegetables and fruits. The optimal way to achieve adequate calcium intake is through the diet. However, when dietary sources are scarce or not well tolerated, calcium supplementation may be used. Calcium is generally well tolerated and reports of significant side-effects are rare. Adequate sunlight exposure may prevent and cure vitamin D insufficiency. However, the sunlight exposure or the ultraviolet irradiation are limited by concern about skin cancer and skin disease. The most rational approach to reducing vitamin D insufficiency is supplementation. In Europe, the RDA is 400-800 IU (10-20 microg) daily for people aged 65 years or over. This dose is safe and free of side effects. In conclusion, in Europe a low calcium intake and a suboptimal vitamin D status are very common in the elderly. Evidence supports routine supplementation for these people at risk of osteoporosis, by providing a daily intake of 700-800 mg of calcium and 400-800 IU of vitamin D. This is an effective, safe and cheap means of preventing osteoporotic fractures.

Osteoporosis and Lung Transplantation: A Prospective Study

Osteoporosis is a well-recognized complication of lung transplantation that may significantly impair the quality of life of transplant recipients. We performed a prospective study of bone mineral density (BMD) before and after transplantation to determine the degree of bone mass loss associated with lung transplantation Patients and design: We conducted a prospective study of BMD in 28 patients with various end-stage respiratory diseases pretransplantation and 6 to 12 months posttransplantation. The BMD of the lumbar spine (LS) and femoral neck (FN) were measured. All 28 patients were treated only with vitamin D and calcium supplementation posttransplant. The primary endpoint was the percentage change in BMD. The secondary endpoint was the incidence of fractures posttransplant. A univariate analysis was conducted to determine the various risk factors associated with bone mass loss pretransplant and posttransplant. Prior to transplantation, moderate to severe bone disease was evident. The mean (+/- SD) pretransplant T score (the number of SDs from the peak bone mass) and Z score (the number of SDs from the age-matched mean) for the LS were -1.72 +/- 1.37 and -1.44 +/- 1.31, respectively. The mean pretransplant T score and Z score for the FN were -2.65 +/- 1.01 and -1.5 +/- 1.43, respectively. Within 6 to 12 months posttransplant, the mean BMD for the LS decreased by 4.76% (p < 0.001), while the mean BMD for the FN decreased by 5.3% (p < 0.001). Five of the 28 patients (18%) suffered osteoporotic fractures posttransplant, while no fractures were documented pretransplant. The cumulative steroid dose posttransplant was associated with a drop in BMD for the LS and FN (r = 0.39, p = 0.039 and r = 0.63, p < 0.001, respectively), while a negative association was found between cumulative steroid use pretransplant and baseline LS and FN T scores (r = -0.4, p = 0. 02 and r = -0.43, p = 0.023, respectively). Within 6 to 12 months after lung transplantation, there is a significant decrease in BMD at both the LS and FN levels (approximately 5%) despite vitamin D and calcium supplementation. This drop in BMD is associated with a relatively high incidence of osteoporotic fractures posttransplant.

Age-dependence of bone material quality shown by the measurement of frequency of resonance in the ulna

In women before and after the age of peak bone mass, identical values of bone mineral density (BMD) can be obtained. However, there is a much higher incidence of osteoporotic fractures in older women. We investigated whether a deterioration of bone material quality with increasing age might contribute to this phenomenon. Material properties of bone tissue can be characterized by the modulus of elasticity, which is correlated to the square of sound transmission velocity. In this study, sound transmission velocity was determined in cortical bone by measuring the frequency of resonance in the ulna in the direction of the bone's longitudinal axis and correcting the values by multiplying by ulna length. Validation of this method indicated acceptable reproducibility: interobserver variability determined as the mean coefficient of variation was 1.82%. In a clinical study, 21 young women (22.5 +/- 1.2 years old) were compared with 21 middle-aged women (52.9 +/- 2.7 years old). Pairs were matched that had identical values of BMD in the nondominant forearm at a location representing mainly cortical bone (SPA). The product of ulna length and frequency of resonance in the ulna in the younger women was found to be 61.4 +/- 5.8 m/second, and in the middle-aged women 55.7 +/- 4.5 m/second. The difference was highly significant with P < 0.005. Our results confirm recent findings indicating a deterioration of bone material quality independent of BMD with increasing age.(ABSTRACT TRUNCATED AT 250 WORDS)

Menopause without symptoms: The endocrinology of menopause among rural Mayan Indians

Our purpose was to determine the characteristics of menopause among Mayan women who did not have menopausal symptoms. A cross-sectional study of Mayan women from Chichimila, Mexico, was performed. Demographic information, history and physical examination, hormone concentrations, and radial bone density measurement were obtained. Fifty-two postmenopausal women were compared with 26 premenopausal women. Menopause occurred at 44.3 +/- 4.4 years. None of the women admitted to hot flushes and did not recall significant menopausal symptoms. Hormone levels included elevated follicle-stimulating hormone (66.6 +/- 29 mlU/ml), low estradiol and estrone (9.4 +/- 8.3 and 13.3 +/- 7.8 pg/ml), estrone greater than estradiol levels, normal levels of testosterone and androstenedione (0.17 +/- 0.14 and 0.31 +/- 0.17 ng/ml). Bone mineral density declined with age, but height did not. Clinical evidence of osteoporosis was not detected. Lack of symptoms during the menopausal transition is not attributable to a difference in endocrinology. Postmenopausal Mayan women are estrogen deprived and experience age-related bone demineralization but do not have a high incidence of osteoporotic fractures.