Low Between Bone Mineral Density Research Articles

Relationship between blood pressure levels and bone mineral density in postmenopausal Turkish women

IntroductionWe investigated the association between bone mineral density (BMD) detected by dual-energy X-ray absorptiometric (DXA) method and blood pressure (BP) in a large sample of postmenopausal women.Material and methodsThe current study was based on a retrospective analysis of 586 postmenopausal women with a mean age of 60.8 ±8.8 years, who were screened for osteopenia or osteoporosis by DXA. Patients with hypertension (HT, n= 306) were compared with normotensive (NT, n = 290) individuals. Bone mineral density results for the femur neck and spine were classified into 3 groups according to World Health Organization criteria: normal (T score > –1.0 SD), osteopenia (T score –1.0 to –2.5 SD) and osteoporosis (T score < –2.5 SD). Patients with osteopenia or osteoporosis (T score < –1.0 SD) were grouped as having low bone mass (LBM).ResultsThere were no significant differences in femur T score, femur BMD, femur Z score, spinal T score, spinal BMD and spinal Z score between hypertensive and normotensive groups. The group of patients with low bone mass calculated from femur T scores had higher age, systolic BP, duration of hypertension and duration of menopause, but lower BMI. Similarly, patients with low spine BMD had higher age and duration of menopause, but lower BMI. Linear regression analysis showed a significant correlation between systolic BP and femur BMD and T score values. Furthermore, logistic regression analysis revealed that hypertension is an independent predictor of spinal osteopenia and osteoporosis.ConclusionsThe presence of hypertension is an independent predictor of spinal low bone density in Turkish women after menopause.

Bone mineral density, body mass index, postmenopausal period and outcomes of low back pain treatment in Korean postmenopausal women.

Women going through menopause experience bone loss and increased musculoskeletal pain, including low back pain. This study explored the relationships between bone mineral density (BMD) and body mass index (BMI), postmenopausal period and outcomes of treatment for low back pain in postmenopausal Korean women. On examining the medical records of 78 postmenopausal women hospitalized for low back pain, investigators found that women with low BMD were older and had been postmenopausal for longer periods than women with normal BMD. Postmenopausal length was positively correlated with pain scores at day 15 and 20 post-admission (P = 0.011 and 0.006) and negatively correlated with T-scores (P = 0.002). BMI was positively correlated with T-scores (r = 0.283, P = 0.022). In conclusion, age, postmenopausal length and BMI correlate with BMD in Korean women suffering from LBP. Larger studies investigating the associations between menopause, BMD, BMI and LBP seem desirable. Moreover, evidence-based therapeutic approaches should be explored for BMD and LBP management.

The relation between bone mineral density, bone turnover markers, and vitamin D status in ankylosing spondylitis patients with active disease: a cross-sectional analysis

SummaryOsteoporosis is a well recognized complication of ankylosing spondylitis (AS). This study indicates that increased bone turnover, inflammation, and low vitamin D levels are important in the pathophysiology of AS-related osteoporosis, and that bone turnover markers (BTM) are valuable markers to detect bone loss in AS.IntroductionThe aim of this study was to elucidate the pathophysiology of AS-related osteoporosis by investigating the relation between bone mineral density (BMD), BTM, vitamin D, and clinical assessments of disease activity and physical function, as well as to identify parameters that are related to low BMD (osteopenia or osteoporosis) in AS patients with active disease.MethodsOne hundred twenty-eight consecutive Dutch AS outpatients were included in this cross-sectional study. Bath AS Disease Activity Index (BASDAI), erythrocyte sedimentation rate (ESR), C-reactive protein, ASAS-endorsed disease activity score (ASDAS), Bath AS Functional Index (BASFI), bone formation markers procollagen type 1 N-terminal peptide (PINP) and osteocalcin (OC), bone resorption marker serum C-telopeptides of type I collagen (sCTX), 25-hydroxyvitamin D (25OHvitD), lumbar spine and hip BMD, and vertebral fractures were assessed. Z-scores of BTM were calculated using matched 10-year cohorts of a Dutch reference group to correct for the normal influence that age and gender have on bone turnover.ResultssCTX Z-score, OC Z-score, BASDAI, age, and gender were independently related to low BMD. In addition, PINP Z-score, ESR, 25OHvitD, age, and gender were independently related to sCTX and/or OC Z-score.ConclusionsThis study indicates that increased bone turnover, inflammation, and low vitamin D levels are important in the pathophysiology of AS-related osteoporosis. Furthermore, sCTX and OC Z-scores seem to be valuable markers to detect bone loss in AS patients in daily clinical practice where BMD of the lumbar spine, measured by DXA, may be overestimated due to osteoproliferation in patients with advanced AS.

Low bone mineral density is associated with increased mortality in elderly men: MrOS Sweden

We studied the nature of the relationship between bone mineral density (BMD) and the risk of death among elderly men. BMD was associated with mortality risk and was independent of adjustments for other co-morbidities. A piecewise linear function described the relationship more accurately than assuming the same gradient of risk over the whole range of BMD (p = 0.020). Low BMD was associated with a substantial excess risk of death, whilst a higher than average BMD had little impact on mortality. Previous studies have demonstrated an association between low BMD and an increased risk of death among men and women. The aim of the present study was to examine the pattern of the risk in men and its relation to co-morbidities. We studied the nature of the relationship between BMD and death among 3,014 elderly men drawn from the population and recruited to the MrOS study in Sweden. Baseline data included general health questionnaires, life style questionnaires and BMD measured using DXA. Men were followed for up to 6.5 years (average 4.5 years). Poisson regression was used to investigate the relationship between BMD, co-morbidities and the hazard function of death. During follow-up, 382 men died (all-cause mortality). Low BMD at all measured skeletal sites was associated with increased mortality. In multivariate analyses, the relationship between BMD and mortality was non-linear, and a piecewise linear function described the relationship more accurately than assuming the same gradient of risk over the whole range of BMD (p = 0.020). Low BMD is associated with a substantial excess risk of death compared to an average BMD, whereas a higher than average BMD has a more modest effect on mortality. These findings, if confirmed elsewhere, have implications for the constructing of probability-based fracture risk assessment tools.

Reduced Limbic and Hypothalamic Volumes Correlate with Bone Density in Early Alzheimer's Disease

Accelerated bone loss is associated with Alzheimer's disease (AD). Although the central nervous system plays a direct role in regulating bone mass, primarily through the actions of the hypothalamus, there is little work investigating the possible role of neurodegeneration in bone loss. In this cross-sectional study, we examined the association between bone mineral density (BMD) and neuroimaging markers of neurodegeneration (i.e., global and regional measures of brain volume) in early AD and non-demented aging. Fifty-five non-demented and 63 early AD participants underwent standard neurological and neuropsychological assessment, structural MRI scanning, and dual energy x-ray absorptiometry. In early AD, voxel-based morphometry analyses demonstrated that low BMD was associated with low volume in limbic grey matter (GM) including the hypothalamus, cingulate, and parahippocampal gyri and in the left superior temporal gyrus and left inferior parietal cortex. No relationship between BMD and regional GM volume was found in non-demented controls. The hypothesis-driven region of interest analysis further isolating the hypothalamus demonstrated a positive relationship between BMD and hypothalamic volume after controlling for age and gender in the early AD group but not in non-demented controls. These results demonstrate that lower BMD is associated with lower hypothalamic volume in early AD, suggesting that central mechanisms of bone remodeling may be disrupted by neurodegeneration.

Dietary vitamins K1, K2 and bone mineral density: the Hordaland Health Study

Summary Associations between bone mineral density (BMD) and dietary vitamins K1 and K2 in 4,461 individuals were studied. For women, odds ratio of low BMD was 1.48 in lowest to highest quartile of K1. A weak positive association was found for K2. Our results do not support dietary vitamins K as being major determinants of BMD.

Lower bone mineral density is associated with higher coronary calcification and coronary plaque burdens by multidetector row coronary computed tomography in pre‐ and postmenopausal women

There is growing evidence for the association between bone mineral density (BMD) and vascular calcification, which is related to cardiovascular disease. Coronary multidetector row computed tomography (MDCT) is a noninvasive tool developed to evaluate coronary status precisely. We used MDCT to evaluate this association. Eight hundred and fifteen subjects received routine checkups. After excluding subjects with factors affecting bone metabolism and cardiovascular disease, 467 subjects were analysed. Coronary calcification was measured with MDCT and BMD was measured with dual X-ray absorptiometry (DXA). The BMD of the femur and the lumbar spine (L-spine) were negatively associated with the coronary calcium score (CCS) after adjusting for age in women but not in men. This inverse correlation was stronger in women with a longer time since menopause (r = -0.35 at femur, postmenopausal women vs. r = -0.10 at femur, premenopausal women, P < 0.05), and it was stronger at the femur than in the L-spine (r = -0.35 at femur vs. r = -0.16 at L-spine, P < 0.01). The relationship was also stronger in postmenopausal women with osteoporosis and osteopaenia than in women with normal BMD. The lower BMD was associated with higher coronary plaque burdens and multidiseased coronary vessels in both men and women (P < 0.01). Increased CCS and subclinical atherosclerosis of plaque burdens as revealed by MDCT was associated with a low BMD in all women, independent of cardiovascular risk factors and age.

Association between bone mineral density and lifestyle factors or vitamin D receptor gene polymorphism in adult male workers: a cross-sectional study

The aim of this cross-sectional study was to investigate the association between bone mineral density (BMD) and lifestyle factors, as well as the influence of vitamin D receptor (VDR) gene polymorphism, in adult male workers. The subjects were 524 male employees aged 23-49 years (37.3 +/- 5.4 years, mean +/- standard deviation) working at a large-scale integrated manufacturing facility in Japan. BMD was measured at the nondominant radius by dual-energy X-ray absorptiometry. Lifestyle information was obtained by a questionnaire at the same time, and genomic DNA was isolated from peripheral leukocytes. The genotype frequencies of VDR gene polymorphism detected by Taq I digestion were 81.3%, 17.9%, and 0.8% for TT, Tt, and tt, respectively. BMD was 0.56 +/- 0.06 g/cm(2). Analysis of covariance with adjustment for age and body mass index (BMI) revealed that subjects who had a past history of exercise, current exercise from 3 to 7 days a week or daily alcohol intake showed significantly higher BMD than subjects without these features (0.56 +/- 0.06 versus 0.54 +/- 0.06, 0.58 +/- 0.06 versus 0.55 +/- 0.06, and 0.57 +/- 0.06 versus 0.55 +/- 0.06, respectively) (P < 0.05). Subjects who ate only 2 meals a day or smoked >/=21 cigarettes a day showed significantly lower BMD if they had the Tt or tt genotype than if they had the TT genotype (0.51 +/- 0.04 versus 0.56 +/- 0.06 and 0.51 +/- 0.05 versus 0.57 +/- 0.06, respectively) (P < 0.05). These findings suggest that the influence of lifestyle on BMD differs according to VDR gene polymorphism in adult male workers.

Relationship Between Low Bone Mineral Density and Varus Deformity in Postmenopausal Women with Knee Osteoarthritis

To assess the relationship between bone mineral density (BMD) and varus deformity arising from bone structural changes caused by knee osteoarthritis (OA) in postmenopausal women. This cross-sectional study involved 135 consecutive postmenopausal female patients who had varus knee OA and a Kellgren-Lawrence grade > or = 2. Knee radiographs were obtained with the patient standing on one leg, and subjects were classified into 3 tertile groups according to femorotibial angle, which was taken as a measure of varus knee OA severity. We also measured the 3 subangles that make up the femorotibial angle, and focused on the varus inclination of the tibial plateau. BMD was measured in the lumbar spine, femoral neck, and medial and lateral tibial condyles using dual-energy X-ray absorptiometry. Differences between femorotibial angle tertile groups were assessed, and associations between femorotibial sub-angles and BMD values at various points were evaluated. After adjustment for age and body mass index, there was no significant association between the varus inclination of the tibial plateau and lumbar spine BMD. A weak but statistically significant negative correlation existed between varus inclination of the tibial plateau and BMD at the ipsilateral proximal femur and lateral tibial condyle. Varus inclination of the tibial plateau was significantly more severe in the femorotibial angle tertile 3 group, and in patients with lower BMD in the ipsilateral lower limb. Varus knee OA may result not only from cartilage loss but also from structural changes of the bone.

Bone–Vascular Axis in Chronic Kidney Disease

Chronic kidney disease (CKD) is characterized by changes in mineral metabolism associated with alterations of its hormonal regulation and various forms of bone disease. In the past, these associations focused attention on the kidney–bone axis. The last decade has seen renewed interest on interactions among mineral metabolism disorders and extraosseous and cardiovascular calcifications observed in CKD or end-stage renal disease (ESRD). Vascular calcification is an active process similar to bone formation that implicates a variety of proteins involved in bone and mineral metabolism (1,2) and is considered part of a systemic dysfunction defined as CKD–mineral and bone disorder (3). Growing evidence linking bone with different functional and structural characteristics of the arterial tree has contributed to developing the concept of the bone–vascular axis (4). The first observations suggesting the existence of the bone–vascular axis were the frequent associations of osteoporosis and atherosclerotic vascular calcifications observed in postmenopausal women (5–7). Longitudinal population-based studies revealed a relationship between the progression of vascular calcifications and bone demineralization, and others were identified between bone mineral density (BMD) and aortic or central artery calcifications (6), or coronary arteries in type 2 diabetes (8). The osteopenia–osteoporosis association was also linked with arterial functional indexes, such as aortic stiffness and interactions independent of calcifications, suggesting broader biologic interplay (9,10). Relationships between bone and vascular modifications were also observed in CKD and ESRD patients. In dialysis patients, coronary artery calcification score was found to be inversely correlated with vertebral bone mass (11,12). In addition, a high systemic arterial calcification score combined with bone histomorphometry suggestive of low bone activity was observed in hemodialysis patients (13,14). Arterial stiffening and low spine BMD or calcaneal osteopenia were significantly associated in CKD and hemodialysis patients (15–17). …

Relationship Between Bone Mineral Density and Clinical Features in Women With Idiopathic Benign Paroxysmal Positional Vertigo

To evaluate the relationship between bone mineral density (BMD) and clinical features in women with idiopathic benign paroxysmal positional vertigo (IBPPV). Prospective study. Tertiary referral center. Patients with BMD measurements made after a diagnosis of IBPPV were included. The IBPPV (n = 78) and control groups (n = 177) were divided into ordinal age categories of similar size. Group A (n = 20) patients were aged 20 to 39 years, Group B (n = 21) patients were aged 40 to 49 years, Group C (n = 18) patients were aged 50 to 59 years, and Group D (n = 19) patients were aged 60 to 69 years. In each age range, the BMD values were compared according to the number of canalith repositioning maneuvers (CRMs) or the presence of recurrence. We divided all patients into 2 groups with the normal and abnormal BMD values and compared both groups based on the number of CRMs or the frequency of recurrence. The BMD value, the number of CRMs, and the presence of recurrence. In Groups A, B, and C, there was a significant difference in the BMD values between the control, 1-visit, and 2-or-more-visits subgroups. In Group D, the 2-or-more-visits subgroup had a lower BMD value than other subgroups. The difference in the number of CRMs between the normal and abnormal BMD groups was significant. In Groups A and B, there was a significant difference in the BMD values between the control, first-attack, and recurrent-attacks subgroups. In Groups C and D, the recurrent-attacks subgroup had lower BMD values than other subgroups. The difference in the frequency of recurrence between the normal and abnormal BMD groups was significant. Patients with IBPPV had lower BMD values compared with control subjects, and patients with low BMD values showed a significant increase in the number of CRMs required and the recurrence rate.

Factors affecting bone mineral density in men

In this study, in 131 men aged 20-75 years, we investigated correlations between bone mineral density (BMD) in the lumbar spine and femoral neck and endogenous factors (age, body mass index) as well as exogenous factors (calcium intake, physical activity, smoking, caffeine, socioeconomic and educational levels). The age had a negative effect on femoral neck BMD in patients overall, and on both lumbar spine and femoral neck BMD in patients under 50. Physical activity has effects on femoral neck BMD in men above 50. Lumbar vertebral BMD negatively correlated with smoking in patients overall, and this correlation persisted when patients aged 50 and older were analyzed separately. Femoral neck BMD was positively correlated with body mass index in men aged 50 and older. Given the variety of findings in the research literature regarding risk factors for low BMD, we suggest that genetic and geographic factors should be considered.

Correlation between bone mineral density and body composition in Japanese females aged 18-40 years with low forearm bone mineral density.

To clarify the relationship between bone mineral density (BMD) and body composition in Japanese women aged 18-40 years with low forearm BMD. The subjects were Japanese 199 women who had been selected for inclusion in the study based on a low forearm BMD determined at the Annual Women's Health Examination. The subjects' mean (+/- standard deviation) age, body height, body weight, and body mass index (BMI) were 33.5 (+/-4.3) years, 158.1 (+/-5.1) cm, 49.6 (+/-5.7) kg, and 19.8 (+/-2.1), respectively. The BMD of the lumbar spine, total body, and left arm were measured using dual-energy X-ray absorptiometry (DXA). Fat mass (FM), bone-free lean tissue mass (LTM), and body fat percentage (BF%) were measured simultaneously with DXA. In the structural equation model, the standardized regression weights for the path from BMI to BMD of all sites were 0.273-0.434. Conversely, the BF% to BMD of the total body and left arm were -0.192 and -0.296, respectively. In multiple regression analysis, the FM index (FMI) was significantly associated with the BMD of the lumbar spine as a weight-bearing site. The LTM index (LTMI) was significantly associated with the BMD of the total body and left arm as a non-weight-bearing site. Young females with low forearm BMD had low body weight and BMI. Thinness was shown to be a risk factor for low BMD, in accordance with results reported elsewhere. A gain in body weight may have the effect of increasing BMD, but our results suggest that to increase BMD, the gain in body weight must include increases in LTM, and not FM alone.

Bone Mineral Density and Vitamin D Status in Female and Male Patients with Osteoarthritis of the Knee or Hip

Objective: Osteoporosis (OP), osteoarthritis (OA) and vitamin D deficiency are age-related disorders. We investigated the association between bone mineral density (BMD), vitamin D and OA in patients undergoing total hip or knee replacements. Method: In total, 82 women and 35 men with mean ages of 70 and 68 years, respectively, were recruited for the study. The BMD of the lumbar spine and the proximal femur were measured by dual-energy X-ray absorptiometry. The vitamin D status was assessed by 25(OH)D levels, with a cut-off of ≤30 ng·ml^–1. Results: In total, 84.7% of the patients had a vitamin D deficiency; 20% of the men had a T-score below –2.5; 23.2% of the women were affected by OP. Furthermore, 37.1 and 42.7% of the male and female patients, respectively, had osteopenia. We concluded that OP and osteopenia were not due to immobility. Conclusion: The average age, rather than the frequency of OP, in cases with OA of the hip or knee differed from the general population. The incidence of low BMD in the male cohort was notably higher than expected. We detected a high prevalence of vitamin D deficiency, independent of the BMD.

The Relationship Between Dual Energy X-Ray Absorptiometry (DXA) and DXA With Laser (DXL) Measurements in Children

The present study was designed to examine the relationship between bone mineral density (BMD) measurements performed using conventional dual energy X-ray absorptiometry (DXA) in total body (TB), spine, and hip and the more recent technique of DXA with laser (DXL) in the calcaneus in a young population and to explore the diagnostic capacity of the heel DXL. One hundred and twelve persons, 2.2–20.6 yr of age, were studied using the 2 techniques. Significant correlations were observed between the heel BMD and BMD values in TB ( r = 0.73, p < 0.001), TB head excluded(HE) ( r = 0.83, p < 0.001), spine ( r = 0.72, p < 0.001), and hip ( r = 0.90, p < 0.001). The relationships between DXA and DXL measurements with 95% tolerance intervals are presented. Using heel DXL measurements to predict the lowest DXA quartiles at all the other measured sites revealed sensitivity levels of 0.9 (TB, spine, hip) and 1.0 (TB HE) and specificity levels of 0.86 (TB), 0.94 (TB HE), 0.92 (spine), and 0.95 (hip). We conclude that BMD values obtained with DXA and DXL correlate well and that the DXA and DXL techniques effectively identify the same individuals with low BMD. The DXL, which is portable, easy to use and gives a low radiation dose, can be useful for assessing bone mass in a young population.

Bone Mineral Density in Cystic Fibrosis: Benefit of Exercise Capacity

The aim of this study was to evaluate the association between bone mineral density (BMD) and objective maximal exercise measurements in adults with cystic fibrosis (CF). Twenty-five CF patients (19 males, 6 females, mean age 25.5 yr, range: 17–52) underwent BMD assessment and maximal-cycle ergometer exercise testing. We examined the relationship between gas exchange (% peak-predicted O 2 uptake, CO 2 output, O 2 saturation), exercise performance (maximum power, exercise duration), and respiratory mechanics (tidal volume, rate) with lumbar spine and total proximal femur BMD. The strongest clinical correlate with BMD was forced expiratory volume at 1 s (lumbar spine Z-score, r = 0.36; total proximal femur Z-score, r = 0.68, p < 0.01). The strongest exercise correlate was % peak-predicted O 2 uptake (lumbar spine Z-score, r = 0.44, p < 0.01; total proximal femur Z-score, r = 0.59, p < 0.01). There was a closer association between exercise parameters and total proximal femur BMD ( r = 0.43–0.60) than with lumbar spine BMD ( r = 0.04–0.45). Multiple regression analysis revealed VO 2 to be the strongest independent predictor of BMD ( R 2 = 0.86, p < 0.001) followed by petCO 2 and body mass index ( R 2 = 0.7 and 0.5, respectively, p < 0.01). Exercise appears to influence total proximal femur BMD more than lumbar spine BMD in CF. Exercise rehabilitation programs focusing on peripheral strength training may benefit those CF patients with low total proximal femur BMD.

Bone Mineral Density in End-Stage Renal Disease Patients: Association with Wasting, Cardiovascular Disease and Mortality

Background: Bone and mineral disorders may contribute to extraosseous ossifications and cardiovascular disease (CVD) in end-stage renal disease (ESRD) patients. We have investigated the relationship between bone mineral density (BMD) and inflammation, wasting, CVD and mortality in ESRD patients. Methods: BMD (dual energy X-ray absorptiometry) and biochemical, nutritional and inflammatory markers were assessed in 277 incident ESRD patients (GFR 7.1 ± 0.2 ml/min) who were then followed prospectively for a mean of 27 (range 1–60) months. Carotid plaques were determined in 103 patients. Results: Patients with carotid plaques, clinical manifestation of CVD and wasting (assessed by subjective global assessment) had significantly lower BMD than their counterparts. Low BMD was associated with high all-cause and cardiovascular mortality. Even after adjustment for several confounders and risk factors, all-cause (HR = 2.1, CI: 1.1–3.9, p = 0.02) and cardiovascular (HR = 2.8, CI: 1.2–6.3, p = 0.02) mortality remained significantly associated with low BMD. Conclusions: Low BMD is associated with wasting and CVD, and is an independent predictor of all-cause and cardiovascular mortality in ESRD patients.

Evaluation of cardiovascular risk factors and bone mineral density in post menopausal women undergoing coronary angiography

BackgroundThe underlying mechanism by which osteoporosis and cardiovascular disease may be linked is not fully understood. However studies mainly focused on the association between bone mineral density (BMD) and cardiovascular risk factors or atherosclerosis itself by only assessing the presence of vascular calcification. In this study we aimed to evaluate both cardiovascular risk factors, and presence of coronary artery disease (CAD) in post-menopausal women patients with and without low BMD. Materials and methodsStudy population consisted of post menopausal women who were scheduled to coronary angiography. Two hundred and twenty seven consecutive female patients were included in the study and evaluated for the presence of cardiovascular risk factors and CAD. Bone mineral density was measured in all patients either the day before or the day after coronary angiography. Low BMD was defined as T score<−1 and normal BMD was defined as T score≥−1. For statistical analysis patients were divided into two groups: patients with low BMD and patients with normal BMD. ResultsThere were not statistically significant differences between two groups in respect to body mass index, presence of diabetes mellitus, hypercholesterolemia, and smoking status. Age and presence of CAD was found to be statistically different between two groups being higher in patients with low BMD. Logistic regression analysis revealed that age was positively and independently associated with low BMD in post menopausal female patients (Odds ratio=1.072 CI: 1.036–1.11, p=0.001). ConclusionAge is found to be an independent predictor of decreased BMD in our study population recruited from the coronary angiography laboratory. However, neither cardiovascular risk factors, nor coronary artery disease itself has been found to be associated with low BMD.

High-Trauma Fractures and Low Bone Mineral Density in Older Women and Men

It is widely believed that fractures resulting from high trauma are not osteoporotic; however, this assumption has not been studied prospectively. To examine the association between bone mineral density (BMD) and high-trauma fracture and between high-trauma fracture and subsequent fracture in older women and men. Two prospective US cohort studies in community-dwelling adults 65 years or older from geographically diverse sites. The Study of Osteoporotic Fractures followed up 8022 women for 9.1 years (1988-2006). The Osteoporotic Fractures in Men Study followed up 5995 men for 5.1 years (2000-2007). Hip and spine BMD were assessed by dual-energy x-ray absorptiometry. Incident nonspine fractures were confirmed by radiographic report. Fractures were classified, without knowledge of BMD, as high trauma (due to motor vehicle crashes and falls from greater than standing height) or as low trauma (due to falls from standing height and less severe trauma). Overall, 264 women and 94 men sustained an initial high-trauma fracture and 3211 women and 346 men sustained an initial low-trauma fracture. For women, each 1-SD reduction in total hip BMD was similarly associated with an increased risk of high-trauma fracture (multivariate relative hazard [RH], 1.45; 95% confidence interval [CI], 1.23-1.72) and low-trauma fracture (RH, 1.49; 95% CI, 1.42-1.57). Results were consistent in men (high-trauma fracture RH, 1.54; 95% CI, 1.20-1.96; low-trauma fracture RH, 1.69; 95% CI, 1.49-1.91). Risk of subsequent fracture was 34% (95% CI, 7%-67%) greater among women with an initial high-trauma fracture and 31% (95% CI, 20%-43%) greater among women with an initial low-trauma fracture, compared with women having no high- or low-trauma fracture, respectively. Risk of subsequent fracture was not modeled for men. Similar to low-trauma nonspine fractures, high-trauma nonspine fractures are associated with low BMD and increased risk of subsequent fracture in older adults. High-trauma nonspine fractures should be included as outcomes in osteoporosis trials and observational studies.

Outdoor air pollution and bone mineral density in elderly men - the Oslo Health Study

The association between bone mineral density (BMD) and outdoor air pollution has not previously been explored. In this study including 590 elderly men, total body BMD was inversely associated with indicators of air pollution. Further studies to address any relation between air pollution and BMD and bone fracture are warranted. The relation between air pollution and bone mineral density (BMD) is unknown. Based on higher fracture rates and more osteoporosis in urban compared to rural populations, this exploratory study aimed at investigating the association between indicators of air pollution and BMD. In an osteoporosis sub-study of the population-based Oslo Health Study (2000-2001) BMD of total body and total hip (mg/cm(2)) was measured by DXA in 590 men 75-76 years old. Exposure to air pollution (particulate matter (PM(10) and PM(2.5)) and nitrogen dioxide (NO(2))) at each participant's home address was estimated from 1992 to 2001. Air pollution was inversely associated with total body BMD, whereas no significant association was found for total hip BMD. The adjusted odds ratio (OR) [95% confidence interval] for low total body BMD (Z-score <or=-1) was per standard deviation increase 1.33 [1.05-1.70] for PM(2.5), 1.28 [1.00-1.63] for PM(10), and 1.24 [0.97-1.59] for NO(2). Stratified by smoking status the adjusted OR for PM(2.5) was 1.73 [1.02-2.95] in current smokers, 1.40 [1.03-1.90] in former smokers and 0.83 [0.43-1.58] in non-smokers. There was a weak but statistically significant inverse association between indicators of air pollution and total body BMD. Further investigations are warranted.