Low Between Bone Mineral Density Research Articles

Relationship Between Low Bone Mineral Density and Exercise-Induced Myocardial Ischemia

To evaluate the relationship between bone mineral density (BMD) and ischemic heart disease and exercise capacity, as assessed by stress testing. We retrospectively reviewed entries in the echocardiography database for 28,048 consecutive patients who underwent exercise echocardiography for standard clinical indications between August 1, 1998, and October 1, 2003, to determine which of these patients had also undergone dual-energy x-ray absorptiometry to measure femoral neck BMD before the procedure. Of the 1194 patients meeting both criteria, 28 were excluded because of missing data and 24 because they were tested with an exercise protocol other than the Bruce protocol, leaving 1142 patients to be included. Of the included study patients, 643 (56%) had a T score of -1.0 or less (mean age +/- SD, 67 +/- 0 years; 87% women), and 499 (44%) had a T score greater than -1.0 (60 +/- 10 years; 90% women). For every 1-unit decrease in femoral neck T score, a 0.23 minute decrease in treadmill exercise duration was observed, once values had been adjusted for age and other patient characteristics (95% confidence interval [CI], 0.11-0.35; P<.001). Furthermore, for every 1-unit decrease in T score, there was a 22% increased risk of myocardial ischemia after adjustments (hazard ratio, 1.22; 95% CI, 1.06-1.41; P=.004). Overall, after adjustments, patients with a BMD of -1.0 or less who were referred for exercise echocardiography had a 43% greater risk of myocardial ischemia than did patients referred with normal BMD (hazard ratio, 1.43; 95% CI, 1.06-1.94; P=.02). Lower BMD is associated with myocardial ischemia and decreased exercise capacity during exercise echocardiography. Persons with low BMD who present with symptoms suggestive of cardiovascular disease are more likely to have myocardial ischemia than are those with normal BMD.

Low Bone Mineral Density and Fractures in Long-Term Hemodialysis Patients: A Meta-Analysis

The association between bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) and fracture in patients with stage 5 chronic kidney disease (CKD) is unclear. We performed a meta-analysis to determine whether BMD by DXA was associated with fractures. We included published reports of completed studies that enrolled patients with stage 5 CKD; measured BMD by DXA at the spine, femoral neck, or radius; and reported on fractures. To compare mean BMD values between the fracture and nonfracture groups, we used the standardized mean difference as an effect measure. We synthesized study results using a random-effects meta-analysis model and tested for heterogeneity using Cochran Q test. Our results are unadjusted for confounders. Our outcome was fractures, either morphometric spine or clinical nonspine fractures. We identified 1,774 potentially relevant articles, retrieved 105 reports for evaluation, and included 6 cross-sectional studies with 683 subjects. The studies reported on 75 morphometric spine fractures and 79 clinical fractures. BMD was measured at the spine, femoral neck, and ultradistal, one third, and midradius. Mean age ranged from 60.5 +/- 14.3 to 73.6 +/- 6.3 years, and mean duration of dialysis therapy ranged from 36.8 +/- 3.1 to 87.1 +/- 60.2 months. For all BMD sites except the femoral neck, subjects with fractures had significantly lower BMD than subjects without fractures. For example, the pooled standardized mean difference was -0.44 (95% confidence interval, -0.80 to -0.08) in the 5 studies that examined associations between spine BMD and fracture. There was important heterogeneity in the association between BMD and fractures. This was a meta-analysis of cross-sectional observational studies and reports an unadjusted association between BMD and fracture. Our meta-analysis suggests that BMD is lower in patients with stage 5 CKD who have fractures. Future studies need to determine whether this association is independent of confounding factors, measurement of BMD is useful for predicting future fracture risk, and fractures may be prevented by treatments that preserve BMD.

Low Femoral Bone Mineral Density and Quantitative Ultrasound Are Risk Factors for New Osteoporotic Fracture and Total and Cardiovascular Mortality: A 5-Year Population-Based Study of Brazilian Elderly Women

Prospective and cross-sectional studies have confirmed a significant association between bone mineral density (BMD) measurements and fracture risk. However, the relationship among incident fracture risk, mortality, BMD, and quantitative ultrasound is controversial and less studied. At baseline, 275 postmenopausal elderly women were evaluated by clinical questionnaire regarding fracture risk factors and had radiological analysis of the spine, spine and femur dual energy x-ray absorptiometry, and calcaneous quantitative ultrasound measurements. Five years later, 42 (15.3%) women had died, 25 (9.1%) were lost to follow-up, and 208 (75.6%) continued the study. Specific questionnaire items regarding fracture risk were reevaluated, and thoracic and lumbar spine x-rays were taken to identify new fractures. Causes of mortality in this population were also assessed. All reported deaths were confirmed by review of death certificates or hospital records and were classified according to International Classification of Diseases, 10th Revision (ICD-10) code. After adjustments for age, weight, body mass index, smoking status, previous fracture, physical activity, drug use, and presence of chronic diseases, each 1 standard deviation (SD) reduction in stiffness index (SI) at baseline was significantly associated with future fracture (hazard ratio [HR] = 2.23; 95% confidence interval [CI], 1.30-3.83) and total mortality 5 years later (HR = 1.57; 95% CI, 1.10-2.47). Femoral neck and trochanter BMD values at baseline were also related to new fracture (HR = 2.01; 95% CI, 1.27-3.18 and HR = 1.62; 95% CI, 1.08-2.42, respectively) and total mortality (HR = 1.44; 95% CI, 1.06-2.22 and HR = 1.59; 95% CI, 1.07-2.36, respectively). Cardiovascular mortality was associated with decreased baseline femur BMD (HR = 1.28; 95% CI, 1.08-2.26) and lower SI values (HR = 1.54; 95% CI, 1.08-2.79). Our results demonstrate that low femoral BMD and low SI are able to predict fracture risk and are related to non-cause-specific and cardiovascular mortality, independently of other factors associated with osteoporosis, death, or aging.

Association between bone mineral densities and serum lipid profiles of pre- and post-menopausal rural women in South Korea

The objectives of this population-based study were to investigate the potential association between bone mineral density (BMD) and serum lipid profiles and to compare the effects of serum lipids on BMD at various skeletal sites in pre- and post-menopausal women. In July and August of 2004, BMD was measured at a variety of skeletal sites [lumbar spine (L1-4), femoral neck, trochanter, Ward's triangle, shaft and proximal total hip] using the GE/Bravo Lunar DPX dual-energy X-ray absorptiometer in a South Korean population-based sample of 375 pre-menopausal and 355 post-menopausal rural women aged 19-80 years. The levels of serum total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) were inversely associated with BMD in both pre- and post-menopausal women. In the pre-menopausal women, correlations were shown only for lumbar 1-4 (TC: r=-0.12, P<0.05; LDL-C: r=-0.12, P<0.05), whereas in the post-menopausal women, no correlation was evident for the lumbar sites. In the post-menopausal subjects, the TC levels showed significant correlations with the BMD values at the trochanter (r=-0.15, P<0.01), shaft (r=-0.16, P<0.001) and proximal total hip (r=-0.15, P<0.01) sites, while the LDL-C levels showed significant correlations with the BMD values at the neck (r=-0.13, P<0.05), trochanter (r=-0.21, P<.001), shaft (r=-0.20, P<0.001) and proximal total hip (r=-0.20, P<0.001) sites. The levels of triglyceride (TG) were shown to have a significant positive correlation with BMD values at the trochanter site (r=0.11, P=0.05) in the post-menopausal women; by contrast, subjects in a higher quartile of TG levels show lower lumbar BMD values in the pre-menopausal women. The levels of high-density lipoprotein cholesterol (HDL-C) were not associated with BMD values at any of the sites in the pre- and post-menopausal subjects. Our data indicate a relationship between BMD values and serum lipid levels and suggest differences between pre- and post-menopausal women in terms of the effects of serum lipids on BMD at various skeletal sites.

Tumor necrosis factor α, CYP 17, urokinase, and interleukin 10 gene polymorphisms in postmenopausal women: correlation to bone mineral density and susceptibility to osteoporosis

Objective:Osteoporosis is a common disorder with a strong genetic component. We investigated the correlations between bone mineral density (BMD) and four gene polymorphisms (−308G>A tumor necrosis factor α (TNF-α), −34T>C CYP 17, *141T>C urokinase, and −627C>A interleukin 10 (IL-10) promoter), and their relationship to osteoporosis in postmenopausal women. Study design:These polymorphisms were determined using polymerase chain reaction (PCR) followed by restriction fragment length polymorphism (RFLP) analysis. BMD of the lumbar spine and proximal femur were measured using dual-energy X-ray absorptiometry. Results:The prevalence of each genotype was as follows: (1) 79.3% A/A, 16.6% A/G, and 4.1% G/G in −308G>A TNF-α; (2) 18.9% T/T, 52.1% T/C, and 29% C/C in −34T>C CYP 17; (3) 86.4% C/C and 13.6% C/T in *141T>C urokinase; (4) 46.2% A/A, 45% A/C, and 8.8% C/C in −627C>A IL-10 promoter. Subjects with genotype C/C in −627C>A IL-10 promoter had lower BMD values and a significantly greater risk for osteoporosis (OR 8.1, 95% CI 1.5–42.8) at the lumbar spine compared with subjects with genotype A/C in −627C>A IL-10 promoter, after adjustment for potential confounders. Conclusion:The RsaI IL-10 promoter gene polymorphism is associated with reduced BMD and predisposes women to osteoporosis at the lumbar spine.

Osteoporosis in scleroderma

To review the literature describing the association of osteoporosis (OP) with scleroderma (SSc). A Medline (PubMed) search identified all studies from 1966 to 2004 that investigated the association between OP and SSc. Search terms included "scleroderma," "systemic sclerosis," "osteoporosis, " "bone mineral density," "bone densitometry," and "prevalence." Eight case control studies and 1 retrospective study (comparing OP status to a reference standard) were identified. There is no clear association between bone mineral density (BMD) scores and scleroderma. Two of 4 studies have reported lower BMD scores in SSc, but appear not to have considered possible confounding risk factors. Earlier age of menopause has been reported in 2 of 3 studies, and thus, may be a confounder in some samples of women with SSc. Studies of bone metabolism markers have not provided any consistent explanatory mechanism for increased OP in SSc, and such markers may be unreliable in SSc as these are affected by the altered collagen turnover and fibrosis characteristic of SSc. It is unknown whether OP is truly increased in SSc or whether this association has been observed in some studies as a result of other confounding risk factors for OP. Clinical heterogeneity of SSc study samples and small sample sizes have contributed to the difficulty in obtaining valid estimates of the risk for the development of OP. There is no strong evidence in the literature for consistently lower BMD scores in SSc, or for altered biomarkers of bone resorption. Earlier menopause, corticosteroid use in some patients, and other factors secondary to SSc (such as malabsorption and inflammation), may be causal factors or may be confounders in studies of OP in SSc.

Lack of Association Between Androgen Receptor Polymorphisms and Bone Mineral Density or Physical Function in Older Men

Individuals whose androgen receptors have short polyglutamine tracts (resulting from CAG repeats) may have greater receptor signaling activity of the androgen receptor. We evaluated the association between bone mineral density (BMD) and CAG repeats in 91 older men with normal (control) and low femoral neck (FN) BMD (OP) or a history of femoral fracture (FX). Bioavailable testosterone (BioT) and physical performance, including composite score (EPESE) and physical activity (PASE), were also measured. Comparing FX, OP, and control subjects, we observed BMD T scores of 22.16 6 1.08, 22.26 6 0.74, and 20.20 6 0.40 (p < 0.001); CAG repeat lengths of 21.9 6 2.7, 22.5 6 2.4, and 22.3 6 2.9 (p = 0.63); BioT levels of 2.29 6 1.25, 2.19 6 1.11, and 3.99 6 1.25 nmol/L (p < 0.001); EPESE scores of 8.0 6 3.0, 9.7 6 2.0, and 11.3 6 0.9 (p < 0.001); and PASE scores of 91 6 66, 122 6 66, and 200 6 55 (p < 0.001), respectively. There were no significant correlations between CAG repeats and BioT or physical performance. Men with osteoporosis or fracture had lower BioT, physical performance, and physical activity than controls. This study found no association between CAG repeats and FN BMD in older men with normal or low BMD or FX.

Bone Mineral Density in Patients on Maintenance Hemodialysis and Effect of Chronic Hepatitis C Virus Infection

Objective: To determine the prevalence of osteopenia and osteoporosis in HD patients at our center; to investigate whether HCV infection affects BMD in hemodialysis patients; to test for correlations between bone mineral density (BMD) and clinical and laboratory parameters in this population. Subjects and Methods: The study involved 76 end‐stage renal disease patients. Forty‐three (56.6%) patients were tested negative for anti‐HCV antibodies and HCV‐RNA. Thirty‐three (43.4%) of them had positivity of anti‐HCV antibodies and permanent or intermittent HCV‐RNA positivity at least for two years. Mean HD duration was 86.4 months. Patients completed a standard questionnaire that listed age, sex, occupation, education level; cause of renal failure, smoking history, dialysis duration, and sports activities engaged in during life, and pathologic bone fractures. The women answered additional items about age at menarche, number of pregnancies and menopausal status. Each subject underwent a baseline physical examination, including measurement of body weight and height for calculation of body mass index. The results of laboratory tests that had been done at monthly visits in the previous year were retrospectively evaluated, and mean levels for the year were used for correlation testing. Bone mineral density was measured in the spine, femoral neck and forearm. Relationships between BMD values and chronic HCV infection, laboratory results and clinical parameters were analyzed. Results: In the 43 patients who were negative for anti‐HCV antibodies and HCV‐RNA, spine BMD testing showed osteopenia in 16 (37.2%) cases and osteoporosis in 7 (16.3%) cases. The corresponding values for the neck of the femur were 14 (32.6%) and 6 (14.0%), and for the forearm were 19 (44.2%) and 15 (34.9%). In the 33 anti‐HCV antibodies and HCV‐RNA positive patients; spine BMD testing showed osteopenia in 10 (30.3%) cases and osteoporosis in 7 (21.2%) cases. The corresponding values for the neck of the femur were 17 (51.5%) and 4 (12.1%), and for the forearm were 4 (12.1%) and 25 (75.8%). Bone mineral density decreased as dialysis duration increased (p < 0.05). There was no statistical difference between BMD measurements of chronic HCV infection positive and negative group. Conclusion: However the mean BMD values for all three sites in the 76 HD patients were low HCV infection may not be a risk factor for low BMD in this population.

Bone mineral density and prevalent vertebral fractures in men and women.

To test the hypothesis that the association between bone mineral density (BMD) and estimated volumetric BMD and prevalent vertebral fractures differs in men and women, we studied 317 Caucasian men and 2,067 Caucasian women (average age 73 years). A total of 43 (14%) men and 386 (19%) women had a vertebral fracture identified on lateral spine radiographs using vertebral morphometry. Hip and spine areal BMD was about 1/3 standard deviation lower among men and women with a vertebral fracture. A 0.10 g/cm(2) decrease in areal BMD was associated with 30-40% increased odds of having a fracture in men and 60-70% increased likelihood in women. Low bone mineral apparent density (BMAD) was also associated with 40-50% increased odds of a vertebral fracture in both genders. The probability of a man having a fracture was observed at higher absolute areal BMD values than observed for women (P=values for interaction of BMD x gender: trochanter, P=0.05; femoral neck, P=0.10; total hip, P=0.09). In contrast, the probability of fracture was similar in men and women across the range of estimated volumetric BMD (BMAD). In conclusion, low BMD and low BMAD are associated with increased odds of vertebral fracture in both men and women. Measures of bone mass that partially correct for gender differences in bone size may yield universal estimates of fracture risk. Prospective studies are needed to confirm this observation.

The effect of low-dose prednisone on bone mineral density in Peruvian rheumatoid arthritis patients.

The aim of this study was to determine the difference between bone mineral density (BMD) of rheumatoid arthritis (RA) patients on low-dose prednisone and matched RA patients without prior systemic corticosteroid therapy. Ninety patients attending our clinics and receiving 10 mg/day of prednisone or less for at least the previous 3 consecutive months were studied. The control group comprised 90 selected RA patients without corticosteroid therapy matched for age, race, gender, disease duration, use of methotrexate, postmenopause, and Health Assessment Questionnaire score. The BMD was measured using dual X-ray absorptiometry. Patients on prednisone had lower BMD than controls (0.94 +/- 0.17 vs 0.96 +/- 0.17 for L2-4 and 0.73 +/- 0.14 vs 0.76 +/- 0.16 for femoral neck), but these differences were not statistically significant (P > 0.05). In post hoc analysis, postmenopausal women on prednisone had more bone loss in femoral neck than controls (0.68 +/- 0.13 vs 0.74 +/- 0.15). Bone mineral density was not significantly reduced by low-dose prednisone in this diverse group of RA patients. A reduction in hip BMD was seen in postmenopausal women on prednisone.

BMD at multiple sites and risk of fracture of multiple types: long-term results from the Study of Osteoporotic Fractures.

In a large cohort of U.S. women aged 65 and older, we report the relationships of BMD measured at several sites, and subsequent fracture risk at multiple sites over > 8 years of follow-up. Although we found almost all fracture types to be related to low BMD, the overall proportion of fractures attributable to low BMD is modest. Although several studies have reported the relationship between bone mineral density (BMD) and subsequent fracture risk, most have been limited by short follow-up time, BMD measures at only one or two sites, or availability of data for only select fracture types. In the multicenter Study of Osteoporotic Fractures (SOF), we studied the relationship of several different BMD measures to fracture risk of multiple types in 9704 non-black women aged 65 and older. We previously reported on the relationship of peripheral BMD measures to risk of several types of fracture during an average 2.2-year follow-up period. In this expanded analysis, we present results of the relationship of both peripheral and central BMD measures and fractures of multiple types during 10.4 and 8.5 years of follow-up, respectively. We also report population attributable risk (PAR) estimates for osteoporosis and risk of several types of fracture. Our results show that almost all types of fractures have an increased incidence in women with low BMD. However, hip BMD is somewhat more strongly related to most of the fracture types studied than spine or peripheral BMD measures. Nonetheless, the proportion of fractures attributable to osteoporosis (based on a standard definition of osteoporosis) is modest, ranging from < 10% to 44% based on the most commonly used definition of osteoporosis (BMD T-score < -2.5). Finding effective prevention strategies for fractures in older women will require additional interventions beside preventions for bone loss, such as prevention of falls and other fracture risk factors.

Association between bone mineral density of the general skeletons and jaw bones

Associations between bone mineral density (BMD) of the general skeletons and jaw bones have been investigated to clarify the influences of skeletal low BMD or osteoporosis on periodontitis and tooth loss, especially in women. Some studies reported the significant associations between general skeletal BMD and BMD (or bone mass) of the jaw bones, however, the others failed to find this association. It is likely that the differences in the methods and regions in measuring BMD (or bone mass) of the jaw bones and in study sample size may contribute to this contradiction. Further systematical investigation in the large populations would be necessary in cooperation with medical professionals.

Bone mineral density and the risk of breast cancer: the Rotterdam Study

Estrogens play an important role in the development of breast cancer, but studies on serum levels of estrogens have shown inconsistent results. Bone mineral density is considered to be a marker for lifetime estrogen exposure. Some studies have suggested that a higher bone mass is associated with an increase in breast cancer risk. We investigated the association between bone mineral density (BMD), as measured at the lumbar spine and femoral neck, and the risk of breast cancer in women age 55 or older in the Rotterdam Study, a population-based cohort study in the Netherlands. Information on baseline lumbar spine and femoral neck BMD, as measured by DEXA (Lunar DPX-L), and cancer incidence was available for 3,107 women. The Rotterdam Cancer Registry provided information on follow-up of incident cancer. After an average follow-up time of 6.5 years, 74 new cases of breast cancer occurred. Z-scores of lumbar spine and femoral neck BMD were divided into tertiles and risk estimates for breast cancer were computed by the Cox proportional hazards model, using the middle tertile as a reference. Breast cancer risk in the upper tertile of lumbar spine BMD was doubled compared to the reference after adjustment for age, body mass index, and age at menopause (hazards ratio = 2.1 [1.1–3.7]), whereas risk estimates for women in the lower tertile did not significantly differ from the reference (hazards ratio = 1.5 [0.8–2.9]). Women with either a low intertrochanteric or femoral neck BMD appeared to have a somewhat decreased breast cancer risk, although this was not statistically significant. The results of this study suggest that in elderly women an association between especially lumbar spine BMD and incident breast cancer exists. Stimulating effects of estrogen on both trabecular bone and mammary cells may be responsible.

#25-S an examination of the association betweeen bone mineral density and mortality in older men

PURPOSE: This study investigated the relationship between bone mineral density (BMD) and mortality in men using data from the NHANES I Epidemiologic Follow-up Study, which tracked participants from enrollment in 1971–1974 through 1992. METHODS: This analysis included 1,130 men aged 50–74 when first contacted for NHANES I in 1971–1974 who had baseline BMD measurements as part of their first NHANES visit. Mortality rates were calculated by age-adjusted quartile of BMD. RESULTS: Tests for trend showed that lower baseline BMD was significantly associated with total (p < 0.0001), cardiac (p = 0.0213), and cancer (p = 0.0034) mortality. After adjusting for potential confounders (age, cigarettes/day, BMI, exercise, systolic blood pressure, diabetes, serum cholesterol, and race), Cox proportional hazards analyses revealed that lower BMD was associated with cardiac mortality only in the first three years of follow up, while the association between lower BMD and all-cause or cancer mortality persisted through 14 years of follow-up. CONCLUSIONS: We conclude that low BMD appears to be a marker for cardiac and cancer mortality; delineation of the causal pathway awaits further studies.

Densidade Mineral Óssea: Estudo Transversal em Pacientes com Síndrome de Turner

A síndrome de Turner (ST) caracteriza-se pela perda parcial ou total de um dos cromossomos X, hipogonadismo hipergonadotrófico e baixa estatura. A maioria dos estudos de densidade mineral óssea (DMO) em ST atribuem a osteoporose à ausência do desenvolvimento puberal e ao hipoestrogenismo, enquanto o envolvimento das alterações ósseas intrínsecas à ST permanece obscuro. O objetivo deste estudo foi verificar a associação entre a DMO com as variáveis como idade cronológica e óssea, peso, altura, cariótipo, doenças associadas e reposição estrogênica em pacientes com ST. Realizou-se um estudo transversal da DMO areal de L2-L4 por DEXA em 34 pacientes com diagnóstico citogenético de ST. Encontrou-se diferença estatística em relação à idade (as pacientes com z DMO &lt; -2,5 eram as de idade mais avançada), à altura (as pacientes com z DMO &lt; -2,5 eram as mais altas) e a reposição estrogênica (o z DMO foi menor nas pacientes que necessitaram de reposição hormonal). Sugere-se, portanto, que a idade e a reposição estrogênica podem ser fatores associados à baixa DMO na ST.

Bone Mineral Density and Stroke Risk

To the Editor: In their recent article, Jorgensen et al1 examined the relationship between bone mineral density (BMD) and stroke. They reported that female, but not male, stroke patients had lower BMD than population controls. Like the few other previous reports, it was based on fewer than 85 total cases. We attempted to replicate their findings by analyzing data from a population-based study. We looked at stroke prevalence and BMD, using data from the cross-sectional Third National Health and Nutrition Examination Survey (NHANES III).2 NHANES III collected data from a nationally representative sample of the civilian noninstitutionalized US population from 1988 to 1994. Analyses were limited to 6298 non-Hispanic white, non-Hispanic black, and Mexican-American men and women whose BMD levels were measured and who were aged 45 years and older at the time of the NHANES III examination, because relatively few strokes occur at younger ages. BMD was measured by trained examiners in mobile examination centers. Total proximal femoral BMD was measured by dual-energy x-ray absorptiometry (Hologic QDR-1000; Hologic, …

Low bone density is not associated with aortic calcification.

The aging process is associated with an increasing prevalence of osteoporosis and aortic calcification, but it is uncertain if these two conditions are interrelated. We examined the relationship between bone mineral density (BMD) and evidence of aortic calcification on spinal radiographs among 524 Japanese-American women living in Hawaii. The prevalence of aortic calcification increased with age from less than 10% below age 55 to essentially all women over age 75. Unadjusted BMD was significantly lower among women with aortic calcification at all measured sites (distal and proximal radius and calcaneus). However, the differences in BMD between women with and without calcification were diminished and no longer significant after adjustment for age. Aortic calcification was positively associated with body mass index (BMI), systolic blood pressure, diabetes, current smoking, and thiazide use, but negatively associated with physical activity index. Multivariate logistic regression analysis showed that age, systolic blood pressure, physical activity index (protective), and current smoking (common etiological factors for aortic calcification) were independently associated with aortic calcification, whereas BMD (mean Z-score) was not. We conclude that there is little evidence to support a direct relationship between osteoporosis (low BMD) and aortic calcification. Osteoporosis and aortic calcification appear to be independent processes that occur as women age. However, potential confounding factors may be involved, and prospective studies are needed to investigate this issue further.

An epidemiological study of the relationship between diet in the past and bone mineral density based on a survey of women aged 50 years and over in two public health centers, Ibaraki Prefecture.

The purpose of this study was to examine the relationship between bone mineral density (BMD) and past dietary habits of middle-aged and elderly women who were hig-risk population of osteoporosis. We examined dietary habits of 713 women aged 50 years and over who underwent a check-up for osteoporosis at two public health centers in Ibaraki Prefecture. Items examined were frequency of intake of milk, cheese, yogurt, small fish, eggs, cooked beans, tofu, natto, vegetables and seaweed in their 20's, 30's and 40's. GS/D values were used as the indicator of BMD. Women with GS/D values less than 2.3 were designated as the low BMD group, and those with GS/D values more than 2.3 were designated as the control group. The differences in the intake frequencies of the aforementioned foods by the two groups were evaluated by chi-square tests. The results of our study showed that each proportion of people who consumed milk, small fish or seaweed every day in their 30's and 40's, and also in their 20's for the case of milk, was higher in the control group significantly. It was also indicated that each proportion of people who consumed tofu or vegetable more than three times in a week was higher in the control group. Those who consumed little of each kind of food little were seen in the low BMD group. It was concluded that there was a relationship between BMD and dietary habits related to calcium intake.

Association of the vitamin D receptor start codon polymorphism (FokI) with bone mineral density in postmenopausal Korean women.

We undertook this study in order to examine the association between bone mineral density (BMD) and a polymorphism at the first of two potential translation initiation codons in the vitamin D receptor (VDR) gene. This polymorphism was detected by restriction fragment length polymorphism analysis, using polymerase chain reaction (PCR) and the restriction endonuclease FokI. The f allele indicates the presence of the FokI site, and the F allele its absence. The FokI genotype was determined in 174 postmenopausal Korean women, aged 43-71 years. The distribution of FokI genotypes in Koreans was found not to differ significantly from those found in Caucasians and Japanese, although it does differ significantly from that found in the black American population. We observed a significant association between the FokI polymorphism and lumbar BMD; P = 0.048, analysis of covariance [ANCOVA], but no association with femoral neck BMD (P = 0.505, ANCOVA). Those with the ff genotype had a 13.3% lower BMD in the lumbar spine than the FF subjects. In addition, a significantly higher prevalence of the ff genotype was observed in osteoporotic compared with osteopenic or normal women (P = 0.036, chi2 test). These data suggest that the ff genotype of the VDR gene correlates with decreased BMD in the lumbar spine in postmenopausal Korean women.

Prediction of fracture from low bone mineral density measurements overestimates risk

There is a well-established relationship between bone mineral density (BMD) and fracture risk. Estimates of the relative risk of fracture from BMD have been derived mainly from short-term studies in which the correlation between BMD at assessment and BMD in later life ranged from 0.8 to 0.9. Because individuals lose bone mineral at different rates throughout later life, the long-term predictive value of low BMD is likely to decrease progressively with time. This article examines and formalizes the relationship between current BMD, correlation coefficients, and long-term risk. The loss of predictive value has important implications for early assessment and supports the view that measurements should be optimally targeted at the time interventions are contemplated and, when necessary, repeated in later life.