Osteoporosis In Elderly Women Research Articles

Early Fracture of the Sacrum or Pelvis

A retrospective review of a series of cases with a complication of instrumented lumbosacral fusion. To present a previously undescribed complication, early sacral or pelvic stress fracture, after instrumented lumbosacral fusion and to identify the risk factors associated with this complication. There are a number of well-described complications of instrumented lumbosacral fusion, including delayed stress fracture of the pelvis. Early sacral or pelvic stress fracture after instrumented lumbosacral fusion has not been previously reported, to the authors' knowledge. The authors present three cases of early stress fracture occurring at 2-4 weeks after surgery in patients who underwent instrumented multilevel lumbosacral fusions for degenerative lumbosacral disease. Two patients had sacral fracture, which to the authors' knowledge, has not been previously reported. Risk factors included lumbosacral instrumentation and fusion, osteoporosis in elderly women, and iliac crest bone graft procurement. All patients were treated conservatively, with restricted ambulation and gradual return to activity. This complication can cause significant morbidity and a delay in the patient's return to function. A better understanding of the related biomechanical forces and preoperative risk factors may identify patients at risk and may aid in surgical planning and in expectations of postoperative recovery.

Body Composition and Osteoporosis in Elderly Women

Objectives: To study body composition in elderly osteoporotic women to determine the relationship of body weight, body fat mass and lean mass to bone mineral density (BMD), and to investigate the association between one-leg balance, osteoporosis and sarcopenia. Design and Setting: A cross-sectional study of a community-based population in Toulouse, France. Methods: For each participant, whole body composition and BMD were estimated using a dual-energy x-ray absorptiometry scanner. We investigated balance using a one-leg balance test. Participants: 129 healthy women aged 75–89 years, volunteers, ambulatory and living at home. Results: Total fat mass and appendicular skeletal muscle mass (ASM) were significantly lower in osteoporotic women than in the age- and sex-matched non-osteoporotic controls [18.7 ± 4.6 vs. 22.2 ± 6.6 for total fat mass (p < 0.01); 13.1 ± 1.6 vs. 13.8 ± 2.2 for ASM (p < 0.05)]. We did not find a positive association between osteoporosis and sarcopenia (OR = 0.75, CI 0.3–1.84), osteoporosis and one-leg balance (OR = 1.27, CI 0.51–3.17), or sarcopenia and one-leg balance (OR = 1.31, CI 0.52–3.36). There were significant positive correlations between BMD in all areas and body measurements (weight, fat mass, lean tissue mass), but fat mass accounted for more of the variance in total body and femoral BMD than lean tissue mass. Total fat mass alone, in a multivariate model, was correlated with whole body BMD, whereas femoral BMD was associated with both fat mass and lean tissue mass. Conclusion: Higher values of fat mass and lean tissue mass may have a protective effect on femoral bone density. Sarcopenia and osteoporosis are not necessarily linked with balance.

Population Based Epidemiologic and Morphologic Study of Femoral Shaft Fractures

The epidemiologic and morphologic features of all femoral shaft fractures in skeletally mature patients treated during a 10-year period in a semi-urban county were analyzed. Among an average adult population of 202,592 residents, 192 people sustained 201 traumatic femoral shaft fractures during the study period. The incidence was 9.9 fractures per 100,000 person-years. The highest age and gender specific incidences were seen in males from 15 to 24 years of age and in females 75 years of age or older. Seventy-five percent (151) of the fractures were the result of a high-energy trauma, 131 of which occurred in road traffic accidents. Unexpectedly, there were 50 low-energy fractures. Fractures of the middle 1/3 of the diaphysis were 79%. The majority, 155 (77%), of all fractures were transverse, oblique, or oblique transverse. Regarding the degree of comminution, the Winquist and Hansen Grade 0 (noncomminuted) fracture was the most common. Forty-eight percent of fractures were AO Type A, 39% were Type B, and 13% were Type C fractures. Of the 25 open fractures, 14 were Gustilo Type II. All six Type III open injuries were Type IIIA. Based on the data from the current study, most of the femoral fractures in this community might be treated adequately with conventional intramedullary nails, rather than using interlocking nails, provided the stability of fixation and fracture alignment can be maintained. Preventive measures against femoral shaft fractures should focus on protection of automobile drivers, especially young men, and on effective treatment of osteoporosis in elderly women.

Association of bone mineral density with polymorphism of the human matrix Gla protein locus in elderly women

The contribution of genetic factors has been implicated in the determination of bone mass in twin and family studies. Some of the genes involved would regulate bone metabolism, bone formation, and resorption, all processes that determine bone mass. One candidate gene matrix Gla protein gene (MGP), has been implicated in the pathogenesis of bone loss through a repression of bone formation. To analyze the genetic background for osteoporosis in elderly women, we have investigated a possible association between the CA repeat polymorphism at the human MGP gene locus and bone mineral density (BMD) of radial bone in 460 elderly Japanese women. Genotypes were classified into six groups according to the number of CA repeats present, from 13 to 18 (alleles A1 through A6). BMD was expressed as the adjusted BMD (ADJBMD), which was the body mass index (BMI)- and age-adjusted average BMD. The 214 women who lacked an A2 allele (212 bp, containing 17 repeats of CA) had significantly lower adjusted BMD than the participants (n = 246) who possessed an allele of that size (mean +/- SD; 0.303 +/- 0.062 vs 0.315 +/- 0.062 g/cm2; P = 0.0382). This result suggests that genetic variation at the MGP locus is associated with some determinants for BMD in elderly women. Therefore, this locus should serve as one of the genetic markers for osteoporosis.

Analysis of Compression Force in the Hip Joint during Impulsive Exercises: A Preliminary Study for Developing Exercise Protocol for Osteoporosis.

Past intervention studies on bone remodeling for preventing osteoporosis in elderly women often lack sufficient description of the intensity of the exercise, though bone remodeling is dependent on applied force at specific sites. The effectiveness of exercise in increasing bone density cannot be defined without sufficient description of the intensity and targeted site of the exercise. We conducted kinetic and kinematic analyses of the lower extremities in order to categorize exercise in terms of compression force applied at the proximal end of the femur, to formulate guidelines for prescribing exercise to elderly women. Thirty healthy women aged 18-24 participated in the study. Joint compression force at the proximal end of the femur was measured with the aid of motion analysis devices under several conditions of impulsive loading. Joint compression force at the proximal end of the femur was estimated for twenty-two exercise regimes varying from low to high-impact exercises, including jumping off, stepping down, vertical jumping, and dropping down after heel raises. Some exercises appear to be inappropriate for exercise intervention, because the variability for these exercises is high. Most of the jumping exercises, with coefficients exceeding 0.36, were excluded from further analysis. Of the remaining exercises, four were categorized as statistically different loads, as determined by a posthoc test of one-way analysis of variance of joint compression force. These included jumping off a 10 cm platform, stepping down from a 20 cm platform with the knees in the extended position, stepping down from a 20 cm platform with the knees in a relaxed position, and heel dropping at 80 cycles per minute with the knees in a relaxed position. The joint compression forces during these exercises were 2.32 ± .81, 1.81 ± .59, 1.45 ± .59, and 1.00 ± .27 times as much as the subject's body weight, respectively.

Risk assessment for osteoporosis using bone mineral density determination: a belgian perspective.

The availability of bone densitometry in daily clinical practice has revolutionized the capacity to detect osteoporosis, to estimate the risk of future fracture, and to select those patients who are likely to benefit most from preventive or therapeutic measures. In spite of the high availability of densitometry in Belgium and the high incidence of risk factors for osteoporosis in elderly women, osteoporosis is presumably underdiagnosed. It is likely that the limited use of widely available technology to evaluate osteoporosis results from a complex interaction of numerous factors, some of which are discussed. In spite of many unanswered questions, the main conclusion to be drawn from the Belgian experience is that a high density of densitometry facilities is no guarantee that the majority of women who are at greatest risk of fracture will actually become the focus of preventive measures or therapy.

Warfarin use and risk for osteoporosis in elderly women. Study of Osteoporotic Fractures Research Group.

Vitamin K deficiency may be associated with osteoporosis. To assess the effects of warfarin on bone. Prospective observational study. Four centers in the United States. 6201 elderly, postmenopausal women. Self-reported warfarin use, bone mineral density at the hip and the heel, hip bone loss over 2 years, and fractures during 3.5 years of follow-up. Analyses were adjusted for baseline differences, age, weight, and estrogen use. Compared with warfarin nonusers (n = 6052), warfarin users (n = 149) more frequently had poor health, involuntary weight loss, nonthiazide diuretic use, and frailty but had similar bone mineral density at the hip (difference, 1.6% [95% CI, -0.7% to 4.1%]) and heel (difference, 2.1% [CI, -1.6% to 5.6%]). Users and nonusers had similar rates of bone loss (1.1% and 0.8%; P = 0.18) and fractures (relative hazard, 1.0 [CI, 0.60 to 1.71). In this population, warfarin use did not decrease bone mineral density or increase fracture rates.

Oral signs as indicators of possible osteoporosis in elderly women

The relationship between oral signs and osteoporosis was investigated to assess the possibility of using this as an indicator of postmenopausal osteoporosis. Sixty-four women between the ages of 50 and 70 years were evaluated. Osteoporotic signs consisted of thoracic spine fracture as demonstrated on lateral chest radiographs. Oral signs were the number of teeth present, mandibular cortical width, alveolar bone resorption, and the morphologic classification of the inferior cortex on panoramic radiographs. The number of teeth present (N) was highly related to the probability of thoracic spine fracture and was used to derive the probability equation for the presence of thoracic spine fracture: probability value = 1/(1 + e-z), Z = 18.68-0.29 age -0.27N. A probability value higher than 0.5 suggests the possibility of thoracic spine fracture. It was concluded that this equation could serve as a simple and useful tool for dentists to assess the possibility of latent osteoporosis.

The different routes of administration and the effect of hormone replacement therapy on osteoporosis

To review osteoporosis, a disease characterized by low bone mass, microarchitectural deterioration of bone tissue leading to increased bone fragility and a consequent increase in fracture risk. The disorder has become a major health problem in the West, where increased life expectancy has placed new emphasis on disorders related to aging.Review of selected literature.Bone mass increases rapidly in growing children and adolescents, reaching a peak in adults in their 20s and 30s. After 35 to 45 years of age, bone mass begins to decline slowly. Men lose bone mass at approximately the same rate over their lifetime; in women, however, the rate of bone loss increases dramatically after their menopause, whether it is natural or surgical. It is also important to note that bone mass in women below the age of 50 is just two thirds of that found in men. These two factors--the low initial adult bone mass and the more rapid bone loss--combine to produce a high incidence of osteoporosis in elderly women. Significant morbidity and mortality are attributed to osteoporosis-related fractures, underlining the importance of new therapeutic and preventive modalities being evaluated and applied in high-risk populations. In adult women before the onset of menopause, rates of bone formation and bone resorption are approximately equal; calcium balance is maintained, and no loss of bone mass occurs. But after menopause, although both bone formation and bone resorption rates increase, the rate of bone resorption increase more rapidly, resulting in calcium imbalance and a net loss of bone. The first goal of therapy for osteoporosis is thus the restoration of bone resorption and bone formation to premenopausal levels. Optimally, bone formation may be maintained at a slightly higher level than that of bone resorption, producing a positive calcium balance.

Treatment of osteoporosis in elderly women

Prevention of osteoporosis is better than cure. This intuitive wisdom is strengthened by knowledge that osteoporosis due to gonadal deficiency is associated with a disruption of skeletal architecture that is irreversible by current treatments. Moreover, it is commonly assumed that bone is lost more slowly in later life than in the several years after the menopause, so that factors other than decreasing bone mass are assumed to be of greater importance for fracture risk. With the exception of fluoride, current treatments have not been shown to restore skeletal mass in patients with osteoporosis. These views have suggested that the management of osteoporosis in the elderly is of limited value and have reinforced the importance of preventive measures. Notwithstanding, there are several reasons for believing that intervention late in the natural history of bone loss is worthwhile. Whereas cross-sectional studies suggest that bone loss declines in later years, prospective studies indicate that bone loss is progressive and indeed accelerates in extreme old age. Moreover, the measurement of bone mass predicts future fracture in the elderly as effectively as it does at the time of the menopause. There are also several reasons why preventive approaches at the time of the menopause have limited applicability. Since current preventive treatments cannot be given indefinitely, a crucial question concerns the extent to which reversal of effect occurs after treatment withdrawal. If catchup bone loss does occur, it decreases markedly the cost-effectiveness of therapeutic intervention at the menopause and provides a convincing rationale for the use of interventions at a much later age. The optimum age for starting treatment is not yet determined but might be best directed 15 or so years after the menopause, well before the mean age of hip fracture. Since hip fracture provides the greatest socioeconomic impact of osteoporosis and since evidence is accumulating that treatments favorably affect hip fracture risk, it is suggested that greater attention should be given to the management of osteoporosis in the elderly.

6 Hormone replacement therapy for established osteoporosis in elderly women

6 Hormone replacement therapy for established osteoporosis in elderly women

90318000 17β-Estradiol and continuous norethisterone: A unique treatment for established osteoporosis in elderly women

90318000 17β-Estradiol and continuous norethisterone: A unique treatment for established osteoporosis in elderly women

17β-Estradiol and Continuous Norethisterone: A Unique Treatment for Established Osteoporosis in Elderly Women

Forty women aged 64.7 +/- 5.1 yr with established postmenopausal osteoporosis were blindly allocated to 1 yr's treatment with either continuous combined estrogen/progestogen therapy (2 mg estradiol + 1 mg norethisterone acetate + 500 mg calcium daily) or placebo + 500 mg calcium daily. In the group treated with hormones bone mineral density in the spine (dual photon absorptiometry) and bone mineral content in the ultradistal forearm (single photon absorptiometry) increased highly significantly by 8-10% during the 1 yr of treatment. Bone mineral content in the mid-shaft of the forearm (single photon absorptiometry) and the total body bone mineral (dual photon absorptiometry) increased by 3-5% when compared to that in the placebo group, which showed virtually unchanged values at all measurement sites. Seven of the women treated with hormones were examined after a further year of treatment. BMC increased by another 3-6%, reaching a 12% increase in bone mineral density in the spine after 2 yr of treatment. Biochemical estimates of bone resorption (fasting urinary calcium and hydroxyproline) and bone formation (serum alkaline phosphatase and plasma osteocalcin), decreased significantly (P less than 0.001) in the group treated with hormones, but remained unchanged in the placebo group. The reduction in indices of bone resorption was more pronounced than that in bone formation after one year, indicating a positive bone balance. No further changes were seen in these bone turnover parameters during the second year of treatment. In the group treated with hormones, serum levels of triglycerides, total cholesterol, and low density lipoprotein cholesterol decreased by about 12% (P less than 0.05-P less than 0.01), whereas high density lipoprotein cholesterol decreased by about 8% (P less than 0.001). The high density lipoprotein cholesterol/low density lipoprotein cholesterol ratio was unchanged. The hormone treatment did not produce any major side effects, and only minor bleedings were experienced by a few women. The present study demonstrates that treatment with female sex hormones in this particular combination is a realistic approach to the treatment of women with established postmenopausal osteoporosis.