Proximal Femur In Postmenopausal Women Research Articles

Lean mass as a determinant of bone mineral density of proximal femur in postmenopausal women.

To verify which component of body composition (BC) has greater influence on postmenopausal women bone mineral density (BMD). Four hundred and thirty women undergoing treatment for osteoporosis and 513 untreated women, except for calcium and vitamin D. Multiple linear regression analysis was performed in order to correlated BMD at lumbar spine (LS), total femur (FT), femoral neck (FN) with body mass (BM), total lean mass (LM) and total fat mass (FM), all determined by DXA. BM significantly correlated with all bone sites in untreated and treated women (r = 0.420 vs 0.277 at LS; r = 0.490 vs 0.418 at FN, r = 0.496 vs 0.414 at FT, respectively). In untreated women, the LM correlated better than FM with all sites, explaining 179% of LS; 32.3% of FN and 30.2% of FT; whereas FM explained 13.2% of LS; 277% of FN, 23.4% of FT In treated women, correlations with BC were less relevant, with the LM explaining 6.7% of BMD at LS; 15.2% of FN, 16% of FT, whereas the FM explained 8.1% of LS; 179% of FN and 176% of FT. LM in untreated women was better predictor of BMD than FM, especialy for distal femur, where it explained more than 30% of the BMD, suggesting that maintaining a healthy muscle mass may contribute to decrease osteoporosis risk. Treatment with anti-osteoporotic drugs seems to mask these relationships. Arch Endocrinol Metab. 2018;62(4):431-7.

Serum parathyroid hormone is associated with increased cortical porosity of the inner transitional zone at the proximal femur in postmenopausal women: the Tromsø Study.

Vitamin D deficiency leads to secondary hyperparathyroidism and increased risk for fractures, whereas its association with cortical porosity is less clear. We tested (i) whether serum 25-hydroxyvitamin D (25(OH)D) and PTH were associated with cortical porosity and (ii) whether the associations of 25(OH)D) and PTH with fracture risk are dependent on cortical porosity. This case-control study included 211 postmenopausal women, 54-94years old, with prevalent fractures and 232 controls from the Tromsø Study. Serum 25(OH)D, PTH, and bone turnover markers (procollagen type I N-terminal propeptide [PINP] and C-terminal cross-linking telopeptide of type I collagen [CTX]) were measured. Femoral subtrochanteric cortical and trabecular parameters were quantified using computed tomography, and femoral neck areal bone mineral density (FN aBMD) was quantified using dual-energy X-ray absorptiometry. Compared with controls, fracture cases exhibited reduced serum 25(OH)D and increased PTH, PINP, and CTX, increased femoral subtrochanteric cortical porosity, and reduced cortical thickness and FN aBMD (all, p < 0.05). Serum 25(OH)D was not associated with cortical parameters (all, p > 0.10). PTH was associated with increased PINP, CTX, and cortical porosity of the inner transitional zone and reduced trabecular bone volume/tissue volume and FN aBMD (p ranging from 0.003 to 0.054). Decreasing 25(OH)D and increasing PTH were associated with increased odds for fractures, independent of age, height, weight, calcium supplementation, serum calcium, cortical porosity, and thickness. These data suggest that serum PTH, not 25(OH)D, is associated with increased intracortical bone turnover resulting in trabecularisation of the inner cortical bone; nevertheless, decreasing 25(OH)D) and increasing PTH are associated with fracture risk, independent of cortical porosity and thickness.

Morphometric study of proximal femur in post-menopausal women: A radiological study

Novel imidazoline-functionalized diblock copolymers based on polystyrene (PS) and poly(D,L-lactide) (PLA) were synthesized as precursors to corresponding functional PS-based porous materials through a three-step sequential methodology starting from an asymmetric heterobifunctional initiator. α-Hydroxyl poly(4-cyanostyrene-co-styrene) random copolymers were first obtained via an atom transfer free-radical polymerization (ATRP) procedure by varying the amount of 4-cyanostyrene in the comonomer feed. Cyano groups were then transformed into corresponding imidazoline rings. Subsequently, the microwave-assisted ring-opening polymerization (ROP) of d,l-lactide from the imidazoline-functionalized PS-based macroinitiators allowed for the generation of semi-degradable diblock copolymers with different PLA volume fractions so as to develop microphase-separated morphologies. The precursors and resulting copolymers were analyzed by 1H, 13C NMR, and FT-IR spectroscopy. Upon induced shear-flow via channel-die processing, oriented materials constituted of PLA nanodomains in a polystyrene-based continuous matrix were formed. Hydrolysis in alkaline conditions of the PLA sacrificial block yielded imidazoline-functionalized porous PS-based matrices. The resulting porous frameworks were analyzed by scanning electron microscopy (SEM) and nitrogen sorption porosimetry.

The relationship between accelerometer-determined physical activity (PA) and body composition and bone mineral density (BMD) in postmenopausal women

Studies of the relationships between BMD, PA and body composition have shown variable results. Therefore, the aim of this cross-sectional study was to determine the relationships between accelerometer-determined PA and selected body composition parameters to total and regional BMD of the proximal femur in postmenopausal women. BMD and body composition were measured using dual energy X-ray absorptiometry in 97 women with a mean age 63.63±5.23 years. PA was monitored using an ActiGraph GT1M accelerometer. Correlation analysis did not show significant relationships between PA variables and BMD, but increases in body composition variables were associated with increases in BMD. Lean body mass was the strongest predictor of proximal femur BMD (r=0.18–0.37), explaining 10% of the variance for total femur, and 3–14% of the variance for regional femurs. Correlations increased when the analysis was controlled for age (rp=0.20–0.39). A significant relationship was also found between body fat mass and BMD (r=0.16–0.30; rp=0.25–0.37). Analysis of differences between women with normal BMD and osteopenic women showed statistically significant differences in age (p=0.003; η2=0.09) and lean body mass (p=0.048; η2=0.04). In conclusion, body composition is a stronger predictor of proximal femur BMD than PA variables. However, other studies are necessary to clarify the influence of long-term PA and exercise type on proximal femur BMD.

Reduced cortical bone compositional heterogeneity with bisphosphonate treatment in postmenopausal women with intertrochanteric and subtrochanteric fractures.

Reduction of bone turnover with bisphosphonate treatment alters bone mineral and matrix properties. Our objective was to investigate the effect of bisphosphonate treatment on bone tissue properties near fragility fracture sites in the proximal femur in postmenopausal women with osteoporosis. The mineral and collagen properties of corticocancellous biopsies from the proximal femur were compared in bisphosphonate-naive (-BIS, n = 20) and bisphosphonate-treated (+BIS, n = 20, duration 7 ± 5 years) patients with intertrochanteric (IT) and subtrochanteric (ST) fractures using Fourier transform infrared imaging (FTIRI). The mean values of the FTIRI parameter distributions were similar across groups, but the widths of the parameter distributions tended to be reduced in the +BIS group relative to the -BIS group. Specifically, the widths of the cortical collagen maturity and crystallinity were reduced in the +BIS group relative to those of the -BIS group by 28% (+BIS 0.45 ± 0.18 versus -BIS 0.63 ± 0.28, p = 0.03) and 17% (+BIS 0.087 ± 0.012 versus -BIS 0.104 ± 0.036, p = 0.05), respectively. When the tissue properties were examined as a function of fracture morphology within the +BIS group, the FTIR parameters were generally similar regardless of fracture morphology. However, the cortical mineral:matrix ratio was 8% greater in tissue from patients with atypical ST fractures (n = 6) than that of patients with typical (IT or spiral ST) fractures (n = 14) (Atypical 5.6 ± 0.3 versus Typical 5.2 ± 0.5, p = 0.03). Thus, although the mean values of the FTIR properties were similar in both groups, the tissue in bisphosphonate-treated patients had a more uniform composition than that of bisphosphonate-naive patients. The observed reductions in mineral and matrix heterogeneity may diminish tissue-level toughening mechanisms.

Emerging Options for the Treatment of Postmenopausal Osteoporosis: Focus on Denosumab

Objective: Denosumab, a fully human monoclonal antibody, is an antiresorptive drug in a late-stage of clinical development that neutralizes receptor activator of nuclear factor κB ligand (RANKL), thereby inhibiting osteoclast-mediated bone resorption. The purpose of this paper was to discuss the antifracture efficacy and safety of the subcutaneous administration of denosumab for the treatment of postmenopausal osteoporosis. Methods: PubMed was searched and strictly conducted randomized controlled trials (RCTs) regarding the effect of denosumab on skeletal health in postmenopausal women were identified. Results: The results of RCTs showed that a single subcutaneous dose of denosumab rapidly and profoundly reduced bone resorption and sustained (up to 6 months) this effect in postmenopausal women. Denosumab (60 mg, every 6 months) resulted in a sustained decrease in bone turnover, a rapid increase in bone mineral density (BMD), and an improvement of geometric parameters associated with bending and axial strength and cortical stability at purely cortical and mixed cortical/trabecular sites of the proximal femur in postmenopausal women with a low BMD. Denosumab (60 mg every 6 months) reduced the 3-year incidence of vertebral, nonvertebral, and hip fractures (Hazard ratios: 0.32, 0.80, and 0.60, respectively) in postmenopausal women with osteoporosis. Denosumab was well tolerated, and no related severe adverse events were observed. Conclusions: The subcutaneous administration of denosumab every six months effectively decreased bone resorption, increased the BMD, and reduced the risk of vertebral, nonvertebral, and hip fractures in postmenopausal women. Denosumab offers an emerging option for the treatment of postmenopausal osteoporosis.

Effects of Denosumab on the Geometry of the Proximal Femur in Postmenopausal Women in Comparison with Alendronate

Denosumab is a fully human monoclonal antibody against receptor activator of nuclear factor-κB ligand, an essential mediator of osteoclast activity and survival. In postmenopausal women with low bone mineral density (BMD), subcutaneous denosumab decreases bone resorption and increases BMD. This post hoc analysis reports on subjects treated for up to 24 months with denosumab 60 mg 6 monthly (N = 39), placebo (N = 39), or open-label alendronate 70 mg once weekly (N = 38) in a phase 2 study. Hip scans were done by dual-energy X-ray absorptiometry at baseline, 12, and 24 months; these were analyzed with hip structural analysis software to evaluate BMD and cross-sectional geometry parameters at the narrowest segment of the femoral neck, the intertrochanter, and the proximal shaft. Geometric parameters and derived strength indices included bone cross-sectional area, section modulus, and buckling ratio. At 12 and 24 months denosumab and alendronate improved these parameters compared with placebo. Denosumab effects were greater than alendronate at the intertrochanteric and shaft sites. The magnitude and direction of the changes in structural geometry parameters observed in this study suggest that denosumab treatment may lead to improved bone mechanical properties. Ongoing phase 3 studies will determine whether denosumab reduces fracture risk.

Bone density and geometry in assessing hip fracture risk in post-menopausal women

We used femoral neck structural parameters (FNSPs), calculated from bone mineral density (BMD) measurements of the femoral neck by dual X-ray absorptiometry, to discriminate osteoporotic fractures of the proximal femur in post-menopausal women. We compared 1646 women without fracture and 429 women with hip fractures, including 273 with femoral neck (FN) and 156 with trochanter (TR) fractures. The association between the studied parameters and the fractures was modelled using multiple logistic regression, and included age, height and weight. Fracture-predicted probability (FPP) was also calculated for each predictor tested. Receiver operating characteristic (ROC) curve areas with their standard errors (SEs) were calculated for the fracture status, having the calculated FPP as a test variable. The areas were compared by the Hanley-McNeil test. Hip fracture had lower BMD, cross-sectional area (CSA), section modulus (SM) and cortical thickness (CT), and higher buckling ratio (BR), than controls. To the same extent as FN BMD, BR best predicted the risk for each fracture, showing ROC curve areas of 0.809 (SE 0.011) for hip fracture, 0.789 (SE 0.014) for FN fracture, and 0.848 (SE 0.016) for TR fracture. The association of BR with fracture risk did not differ from that of FN BMD, which has a ROC curve area of 0.801 (SE 0.011) for hip fracture, 0.778 (SE 0.014) for FN fracture, and 0.852 (SE 0.016) for TR fracture. Both FN BMD and BR predicted TR fracture significantly better than they did FN fracture. FNSPs, although interesting in understanding the biomechanics of bone fragility, do not appear to add diagnostic value to the simple measurement of BMD.

Microphthalmia-associated Transcription Factor Polymorphisms and Association with Bone Mineral Density of the Proximal Femur in Postmenopausal Women

Microphthalmia-associated Transcription Factor Polymorphisms and Association with Bone Mineral Density of the Proximal Femur in Postmenopausal Women

Effects of denosumab on structural geometry of the proximal femur in postmenopausal women with low bone mass as determined by hip structural analysis

Effects of denosumab on structural geometry of the proximal femur in postmenopausal women with low bone mass as determined by hip structural analysis

The Osteoporosis Prevention and Arterial effects of tiboLone (OPAL) study: design and baseline characteristics

The Osteoporosis Prevention and Arterial effects of tiboLone (OPAL) trial is a three-arm, randomized, placebo-controlled, double-blind study to determine the effect of tibolone 2.5 mg (Org OD 14) and continuous combined conjugated equine estrogens plus medroxyprogesterone acetate (0.625 mg/2.5 mg respectively) on progression of intima-media thickness of the carotid arteries and bone mineral density of the lumbar vertebrae and proximal femur in postmenopausal women. A total of 866 healthy postmenopausal women were recruited in six U.S. centers and five European centers. Duplicate carotid ultrasound examinations of the common carotid artery, the carotid bifurcation, and the internal carotid artery were performed at baseline. Single measurements of bone mineral density of the lumbar vertebrae and proximal femur were obtained at baseline. After randomization, ultrasound examinations were repeated every 6 months for 36 months following baseline, with a duplicate examination at the end of the study. Bone mineral density was measured every 12 months throughout the trial. The primary outcome is change in mean common carotid intima-media thickness (CIMT), defined as the average of the intima-media thickness measurements performed circumferentially at predefined angles for the near and far wall of 10-mm segments of the right and left distal common carotid arteries. Unique new features of the OPAL study are the specifically developed OPAL ultrasound protocol, yielding highly reproducible CIMT measurements, and the use of two experienced core laboratories for CIMT readings (one in the United States and one in Europe) with one common quality assurance and control program. The OPAL study is a large, placebo-controlled trial evaluating the effects of tibolone, as well as one of the first large randomized studies to determine the effects of continuous combined estrogen-progestin therapy on carotid atherosclerosis in healthy postmenopausal women. The OPAL study results are expected to complement other studies on atherosclerosis progression in healthy postmenopausal women.

Association of the calcitonin gene (CA) polymorphism with bone mass and bone responsiveness to hormone therapy in postmenopausal Korean women

To evaluate the relationship between cytosine-adenine (CA) polymorphism of the calcitonin gene, serum calcitonin levels, bone mineral density (BMD) and bone responsiveness to hormone therapy (HT). Calcitonin (CA) polymorphism, serum calcitonin, and BMD at the lumbar spine and proximal femur were determined in 430 postmenopausal Korean women. In all, 181 women were treated with sequential HT for 2 years. Four major calcitonin alleles were present with a frequency greater than 5%: 122 base pair (bp) 61.3%, 108 bp 25.1%, 110 bp 7.0%, and 124 bp 6.2%. There were no differences in the BMD at the lumbar spine and proximal femur in postmenopausal women with zero, one, or two copies of major alleles. Serum calcitonin levels in women with two copies of the 108 bp allele were significantly higher than those in women with zero or one copy of the 108 bp allele. The annual rate of positive change of BMD at the femoral neck after HT was significantly higher in women homozygous for the 108 bp allele than in women with zero or one copy of the 108 bp allele, but the number of copies of the major calcitonin alleles was not significantly associated with HT-responsiveness. The calcitonin (CA) polymorphism is one of the genetic factors that may affect BMD changes at the femoral neck after HT in Korean women.

Effects of transdermal versus oral hormone replacement therapy on bone density in spine and proximal femur in postmenopausal women

International Journal of Gynecology & ObstetricsVolume 34, Issue 4 p. 399-399 Citations from the literature gynecological endocrinology Effects of transdermal versus oral hormone replacement therapy on bone density in spine and proximal femur in postmenopausal women JC Stevenson, JC StevensonSearch for more papers by this authorMP Cust, MP CustSearch for more papers by this authorKF Gangar, KF GangarSearch for more papers by this authorTC Hillard, TC HillardSearch for more papers by this authorB Lees, B LeesSearch for more papers by this authorMI Whitehead, MI WhiteheadSearch for more papers by this author JC Stevenson, JC StevensonSearch for more papers by this authorMP Cust, MP CustSearch for more papers by this authorKF Gangar, KF GangarSearch for more papers by this authorTC Hillard, TC HillardSearch for more papers by this authorB Lees, B LeesSearch for more papers by this authorMI Whitehead, MI WhiteheadSearch for more papers by this author First published: April 1991 https://doi.org/10.1016/0020-7292(91)90649-PAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume34, Issue4April 1991Pages 399-399 RelatedInformation

Effects of transdermal versus oral hormone replacement therapy on bone density in spine and proximal femur in postmenopausal women : Lancet 1990 336/8710 (265–269)

66 early postmenopausal women were randomised to 28-day cycles of either transdermal hormone replacement therapy--continuous oestradiol 17-beta 0.05 mg daily, with norethisterone acetate 0.25 mg daily for 14 of each 28 days--or oral therapy--continuous conjugated equine oestrogens 0.625 mg daily, with dl-norgestrel 0.15 mg daily for 12 of each 28 days. An untreated reference group of 30 women were studied concurrently. Bone density was measured in the lumbar spine and proximal femur by dual photon absorptiometry at 6-month intervals for 18 months. Skeletal turnover was assessed by serum measurements of calcium, phosphate, and alkaline phosphatase, and by urine estimations of hydroxyproline/creatinine and calcium/creatinine excretion. In both treatment groups by comparison with the untreated groups by comparison with the untreated group, bone density increased in the vertebrae and proximal femur and biochemical measurements indicated a significant reduction in bone turnover.

Effects of Transdermal versus Oral Hormone Replacement Therapy on Bone Density in Spine and Proximal Femur in Postmenopausal Women

STEVENSON, JOHN C.; CUST, MICHAEL P.; GANGAR, KEVIN F.; HILLARD, TIMOTHY C.; LEES, BELINDA; WHITEHEAD, MALCOLM I. Author Information

Effects of transdermal versus oral hormone replacement therapy on bone density in spine and proximal femur in postmenopausal women

66 early postmenopausal women were randomised to 28-day cycles of either transdermal hormone replacement therapy—continuous oestradiol 17-beta 0·05 mg daily, with norethisterone acetate 0·25 mg daily for 14 of each 28 days—or oral therapy—continuous conjugated equine oestrogens 0·625 mg daily, with dl-norgestrel 0·15 mg daily for 12 of each 28 days. An untreated reference group of 30 women were studied concurrently. Bone density was measured in the lumbar spine and proximal femur by dual photon absorptiometry at 6-month intervals for 18 months. Skeletal turnover was assessed by serum measurements of calcium, phosphate, and alkaline phosphatase, and by urine estimations of hydroxyproline/creatinine and calcium/creatinine excretion. In both treatment groups by comparison with the untreated group, bone density increased in the vertebrae and proximal femur and biochemical measurements indicated a significant reduction in bone turnover.

The Regional Specificities of Bone Metabolism in the Lumbar Spine, Metacarpal Bone and Proximal Femur in Postmenopausal Women

The Regional Specificities of Bone Metabolism in the Lumbar Spine, Metacarpal Bone and Proximal Femur in Postmenopausal Women