Prospective study of radial bone mineral density in a geographically defined population of postmenopausal Caucasian women

Tracking of Areal Bone Mineral Density From Age Eight to Young Adulthood and Factors Associated With Deviation From Tracking: A 17-Year Prospective Cohort Study

We have previously shown that bone mineral density (BMD) tracks strongly from age 8 to 16 years. This study aimed to describe whether this strong tracking continued to age 25 years and describe factors associated with deviation from tracking. Ninety-nine participants were followed from age 8 to 25 years and 197 participants from age 16 to 25 years. Outcomes measured were BMD at the spine, hip, and total body (by dual-energy X-ray absorptiometry [DXA]). Other factors measured were anthropometrics, inhaled corticosteroids (ICS) use, history of being breastfed, sports participation, fitness (by physical work capacity [PWC₁₇₀ ]), lean mass (LM), and fat mass (FM) (by DXA). There was moderate to strong tracking of BMD from age 8 to 25 years (correlation coefficients: males, 0.59 to 0.65; females, 0.70 to 0.82) and strong tracking from age 16 to 25 years (males, 0.81 to 0.83; females, 0.84 to 0.88) after adjustment for change in body size. From age 8 to 25 years, 54% to 56% of participants kept their BMD tertile position. PWC₁₇₀ at age 8 years, relative and absolute change in LM, and sports participation at age 25 years predicted males would improve their tertile position or remain in the highest tertile of spine or hip BMD. However, relative and absolute change in FM had the opposite association in males while absolute change in FM predicted positive deviation in females. From age 16 to 25 years, LM, PWC₁₇₀ , sports participation at age 16 years, and change in LM, PWC₁₇₀ , and sports participation at age 25 years predicted positive deviation in males. LM at age 16 years was positively associated and PWC₁₇₀ negatively associated with positive deviation in females. BMD tracks from childhood to early adulthood in both males and females. There appears to be greater capacity to alter tracking before age 16 years. Increasing LM in both sexes and improving fitness and sports participation in males during growth might be effective strategies to improve BMD in early adulthood. © 2017 American Society for Bone and Mineral Research.

Bone loss and the risk of non-vertebral fractures in women and men: the Tromsø study

SUMMARY

We assessed the association between the rate of forearm bone loss and non-vertebral fracture. Bone loss at the distal forearm predicted fractures, independently of baseline BMD, but not independently of follow-up BMD in women. The BMD level where an individual ends up is the significant predictor of fracture risk.

INTRODUCTION

Bone loss may predict fracture risk independently of baseline BMD. The influence of follow-up BMD on this prediction is unknown. The aim of this study was to assess the association between bone loss and fracture risk in both sexes in a prospective population-based study.

METHODS

We included 1,208 postmenopausal women (50 to 74 years), and 1,336 men (55 to 74 years) from the Tromsø Study, who had repeated distal and ultra-distal forearm BMD measurements. Non-vertebral fractures were registered from 2001 to 2005.

RESULTS

A total of 100 women and 46 men sustained fractures during the follow-up time. Independent of baseline BMD, the RR associated with distal site bone loss of 1 SD %/year was 1.23 (1.01-1.50) for low-trauma fractures (excluding hand, foot, skull & high-trauma) and 1.32 (1.07-1.62) for osteoporotic fractures (hip, wrist and shoulder). However, bone loss did not predict fracture after adjusting for follow-up BMD. The BMD level where an individual ends up became the significant predictor of fracture risk and not the rate of bone loss. Follow-up BMD at ultra-distal site was associated with low-trauma fractures in both sexes. While ultra-distal site BMD changes were not associated with fracture risk in both sexes.

CONCLUSION

Bone loss at the distal forearm predicted non-vertebral fractures, independently of baseline BMD, but not independently of follow-up BMD, in women. The BMD level where an individual ends up is the significant predictor of fracture risk and not the rate of bone loss.

Amount of bone loss in relation to time around the final menstrual period and follicle-stimulating hormone staging of the transmenopause

BACKGROUND AND OBJECTIVE

The objective of the study was to describe bone loss rates across the transmenopause related to FSH staging and the final menstrual period (FMP).

DESIGN AND SETTING

This was a population-based cohort of 629 women (baseline age 24-44 yr) with annual data points over 15 yr.

MEASUREMENTS

Measures were bone mineral density (BMD), FSH to define four FSH stages, and menstrual bleeding cessation to define the FMP. Bone loss rates were reported by obesity status.

RESULTS

Annualized rates of lumbar spine bone loss began in FSH stage 3, which occurs approximately 2 yr prior to the FMP (1.67%/yr); bone loss continued into FSH stage 4 (1.21%/yr). Mean spine BMD in FSH stage 4 was 6.4% less than spine BMD value in FSH stage 1. Annualized rates of femoral neck (FN) bone loss began in FSH stage 3 (0.55%/yr) and continued into FSH stage 4 (0.72%/yr). The FN difference between mean values in FSH stage 1 and FSH stage 4 was 5%. Annualized rates of spine bone loss in the 2 yr prior to the FMP were 1.7%/yr, 3.3%/yr in the 2 yr after the FMP, and 1.1%/yr in the 2- to 7-yr period after the FMP. Nonobese women had lower BMD levels and greater bone loss rates.

CONCLUSIONS

Spine and FN bone loss accelerates in FSH stage 3. Bone loss also began to accelerate 2 yr before the FMP with the greatest loss occurring in the 2 yr after the FMP. Bone loss rates in both spine and FN BMD were greater in nonobese women than obese women.

Longitudinal changes in forearm bone mineral density in women and men aged 45-84 years: the Tromso Study, a population-based study

The aim of this study was to describe changes in bone mineral density in Norwegian women and men aged 45-84 years in a population-based, longitudinal study. Bone mineral density (g/cm2) was measured at distal and ultradistal forearm sites with single x-ray absorptiometric devices in 3,169 women and 2,197 men at baseline in 1994-1995 and at follow-up in 2001 (standard deviation, 0.4 years). The mean annual bone loss was -0.5% and -0.4% in men and -0.9% and -0.8% in women not using hormone replacement therapy at the distal and ultradistal sites, respectively. In men, age was a negative predictor of bone mineral density change at both sites. Women not using hormone replacement therapy had the highest bone loss at the ultradistal site 1-5 years after menopause. The correlation between the two measurements was high: r = 0.93 and r = 0.90 in women and r = 0.96 and r = 0.93 in men for the distal and ultradistal sites, respectively. More than 70% kept their quartile positions, indicating a high degree of tracking of bone mineral density measurements. Although the study population live above the polar circle, the rate of bone loss was not higher at the distal and ultradistal forearm sites compared with that of other cohorts.

Exercise training, menstrual irregularities and bone development in children and adolescents

Weight bearing physical activity plays an important role in bone development. This is particularly important in children and adolescents since bone mineral density reaches about 90% of its peak by the end of the second decade, and because about one quarter of adult bone is accumulated during the two years surrounding the peak bone growth velocity. Recent studies suggested that the exercise-induced increase in bone mineralization is maturity dependent, and that there is a "window of opportunity" and a critical period for bone response to weight bearing exercise during early puberty and premenarchal years. This supports the idea that increase in physical activity during childhood and adolescence can prevent bone disorders (like osteoporosis) later in life. In contrast, strenuous physical activity may affect the female reproductive system and lead to "athletic amenorrhea". The prevalence of "athletic amenorrhea" is 4-20 times higher than the general population. As a consequence, bone demineralization may develop with increased risk of skeletal fragility, fractures, vertebral instability, and curvature. Menstrual abnormalities in the female athlete result from hypothalamic suppression of the spontaneous pulsatile secretion of gonadotropin releasing hormone. Recent studies suggested that reduced energy availability (increased energy expenditure with inadequate caloric intake) is the main cause of the central suppression of the hypothalamic pituitary-gonadal axis. Therefore, effort should be made to optimize the nutritional state of female athletes, and if not successful, to reduce the training load in order to prevent menstrual abnormalities, and deleterious bone effects in particular during the critical period of rapid bone growth.

Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study

Few studies have evaluated risk factors for bone loss in elderly women and men. Thus, we examined risk factors for 4-year longitudinal change in bone mineral density (BMD) at the hip, radius, and spine in elders. Eight hundred elderly women and men from the population-based Framingham Osteoporosis Study had BMD assessed in 1988-1989 and again in 1992-1993. BMD was measured at femoral neck, trochanter, Ward's area, radial shaft, ultradistal radius, and lumbar spine using Lunar densitometers. We examined the relation of the following factors at baseline to percent BMD loss: age, weight, change in weight, height, smoking, caffeine, alcohol use, physical activity, serum 25-OH vitamin D, calcium intake, and current estrogen replacement in women. Multivariate regression analyses were conducted with simultaneous adjustment for all variables. Mean age at baseline was 74 years +/-4.5 years (range, 67-90 years). Average 4-year BMD loss for women (range, 3.4-4.8%) was greater than the loss for men (range, 0.2-3.6%) at all sites; however, BMD fell with age in both elderly women and elderly men. For women, lower baseline weight, weight loss in interim, and greater alcohol use were associated with BMD loss. Women who gained weight during the interim gained BMD or had little change in BMD. For women, current estrogen users had less bone loss than nonusers; at the femoral neck, nonusers lost up to 2.7% more BMD. For men, lower baseline weight and weight loss also were associated with BMD loss. Men who smoked cigarettes at baseline lost more BMD at the trochanter site. Surprisingly, bone loss was not affected by caffeine, physical activity, serum 25-OH vitamin D, or calcium intake. Risk factors consistently associated with bone loss in elders include female sex, thinness, and weight loss, while weight gain appears to protect against bone loss for both men and women. This population-based study suggests that current estrogen use may help to maintain bone in women, whereas current smoking was associated with bone loss in men. Even in the elderly years, potentially modifiable risk factors, such as weight, estrogen use, and cigarette smoking are important components of bone health.

Evaluation of tibial cortical bone by ultrasound velocity in oriental females

In order to evaluate the feasibility of detecting bone status by measuring cortical ultrasound velocity, ultrasonic transmission velocity of the anterior cortex of shin was measured on 175 normal Chinese females aged 31-75 years (mean 52.3 +/- SD 9.1 years). The data were compared with bone mineral density (BMD) of the lumbar spine and/or hip measured by dual energy X-ray absorptiometry (DXA), which was performed on the same day as speed of sound (SOS) examination. Comparison was made with SOS of Caucasian women previously reported in the literature. SOS of three volunteers measured by two different operators were also enrolled in our study for precision testing. The mean value of SOS of the 175 females was 3850.7 +/- 119.3 m s-1 (range: 3411.7-4220.5 m s-1), the peak value being in the fourth decade. The rate of decrease of transmission velocity per decade from fourth decade to fifth decade was 1.7%, while that of fifth decade to sixth decade was 2.2% and that of sixth decade to seventh decade was 4.0%. The interoperative and intraoperative coefficient variance with and without reposition were under 0.32%. SOS moderately correlated with BMD at different sites, the best correlation being with the lumbar spine anteroposterior projection (r = 0.509; p < 0.0001, Pearson's test). There were significant differences in SOS between pre- and post-menopausal groups (p = 0.01, ANOVA test), and between peri- and post-menopausal groups (p = 0.02), but there was no correlation of body weight and height with SOS. SOS also inversely correlated with age and post-menopausal duration. The mean value of SOS in our study was similar to that of Caucasians, but the rate of decrease over 50 years of age was faster. The rate of decline of tibial cortical SOS was similar to that of trabecular bone as previously reported in the literature. As there is a significant decrease of SOS in older females, and older Oriental females suffer from an accelerated cortical bone loss, it is concluded that cortical bone SOS may be a useful method for detecting potential osteoporotic patients in this ethnic group.

Evidence for increased bone formation following a brief endurance-type training intervention in adolescent males

The effect of exercise training, particularly relatively brief periods, on bone turnover markers in adolescents has been poorly studied. Thirty-eight healthy males (16+/-0.7 years) participated in a 5-week summer school program in which 20 subjects were randomly assigned to a training group consisting of 2 h/day, 5 days/week of endurance exercise, and 18 subjects were assigned to a control group. Bone formation was assessed by measurements of circulating osteocalcin, bone-specific alkaline phosphatase (BSAP), and the C-terminal procollagen peptide (PICP). Bone resorption was assessed by urinary levels of free deoxypyridinoline cross-links (dPYR) and the C-(CTX) and N-terminal (NTX) telopeptide cross-links. Prior to training, there was a weak positive correlation between fitness and PICP (r = 0.27, p < 0.05), but no correlations were observed between fitness and either the other markers of bone formation or bone resorption. Training led to a significant increase in (1) osteocalcin (15+/-4%, p < 0.03), (2) BSAP (21+/-6%, p < 0.02), and (3) PICP (30+/-11%, p < 0.03) and to a significant decrease in NTX (-21 +/- 3%, p < 0.05). These bone turnover markers did not change in the control subjects (osteocalcin, 0+/-4%; BSAP, 2+/-4%; PICP, -4 +/- 6%; NTX, -6 +/- 4%). There was no change in urinary dPYR and CTX in either control or trained subjects. Fitness is only weakly, if at all, correlated with bone formation, but a relatively brief period of endurance training leads to a substantial increase in bone formation markers in adolescent males. School-based, short-term exercise training programs could play a role in enhancing bone formation in adolescents.

Does back pain predict subsequent fracture in postmenopausal women?

This longitudinal study was undertaken to determine if back pain of postmenopausal women can well predict fragility fracture during 7-year follow-up. In 1983-84, 434 Caucasian women aged 55-80 years were examined at baseline. The incidence of fractures that occurred in the following 7 years and changes of radial bone mineral density (BMD) over 5 years were obtained. There was no significant association between baseline back pain and 7-year fracture incidence after baseline assessment (OR=1.137, [95%CI 0.674, 1.916]). However, the odds ratio in the association between 7-year fracture incidence and a prior history of back pain was 1.686, [95%CI 0.925, 3.073]. This association was statistically significant (OR=2.126, [95%CI 1.409, 2.844]) when age, baseline BMD, constitution, physical activity levels, and baseline back pain were taken into account. Although pain is subject to information bias in its reporting, it is suggested that a history of previous back pain could be a good predictor for postmenopausal fracture.

Hip and calcaneal bone loss increase with advancing age: longitudinal results from the study of osteoporotic fractures

It is uncertain whether or how rapidly elderly women continue to lose bone with advancing age. To determine rates of change in bone mass at the hip and at the calcaneus in elderly women and to compare these rates of change among estrogen users and nonusers, we prospectively measured rates of change in bone mineral density (BMD) at the total hip and its four subregions (mean +/- SD, 3.55 +/- 0.29 years between examinations) and at the calcaneus (mean +/- SD, 5.69 +/- 0.33 years between examinations) in 5689 community-dwelling white women aged 65 years or older at the baseline examination. The rate of decline in total hip BMD steadily increased from 2.5 mg/cm 2/year (95% confidence interval 2.0 to 2.9) in women 67-69 years old to 10.4 mg/cm 2/year in those aged 85 or older (95% confidence interval 8.4 to 12.4). The rate of bone loss also increased with aging at all subregions of the hip and at the calcaneus. The average loss of bone from the total hip is sufficient to increase the risk of hip fracture by 21% per 5 years in women aged 80 years or older. Compared with nonusers, current estrogen users had a 33% lower age-adjusted mean rate of loss at the total hip (2.9 vs 4.3 mg/cm 2/year, p < or = 0.0001) and a 35% lower age-adjusted mean rate of loss at the calcaneus (3.9 vs 6.0 mg/cm 2/year, p < or = 0.0001). The rate of bone loss in the hip and calcaneus steadily increases with advancing age in older women. Estrogen therapy may significantly decrease this loss. Efforts to understand and prevent bone loss should include elderly women.

Why elderly women should be screened and treated to prevent osteoporosis

It has been argued that women must be screened and treatment begun for osteoporosis at menopause, since there is an irreversible and substantial loss of bone in the 10 years following menopause. Screening and treatment of women after age 65 has been understudied, since it has been assumed that bone loss in elderly women is slow and treatment would be ineffective if initiated at that time. A number of recent results now suggest that the value of screening elderly women should be reassessed. First, several large studies have demonstrated that we can identify elderly women at high risk of future hip and other fractures using bone mass, particularly bone mass at the hip, as well as other risk factors. Second, it has been shown in recent longitudinal studies that bone loss not only continues but accelerates in old age. Third, a continuing strong association of bone mass with fracture risk, even after age 80, suggests that therapies that slow bone loss will reduce fracture risk in this age group. Lastly, there is a slowly growing body of direct evidence that therapy can reduce fracture risk in the elderly. In addition, findings in a number of studies suggest that there is less necessity to screen and treat at menopause for a number of reasons. First, recent longitudinal results suggest that bone loss at menopause is less accelerated than had been believed and that the accelerated phase is briefer. Second, there is some evidence that elderly women treated with antiresorptive agents experience an increase in bone mass, with the result that an 80-year-old woman who has been treated since menopause has only slightly higher bone mass than an 80-year-old who began treatment at age 65. Lastly, at age > or = 65 we can more precisely estimate the risk of hip fracture and therefore target treatment more cost-effectively. We conclude that there is ample justification for screening and treating elderly women. Furthermore, cost-effectiveness analyses that compare early and late screening and treatment options, as well as combinations of the two, must be performed in order to develop an optimal screening and treatment algorithm for osteoporosis.

Is tubal ligation a risk factor for low bone density and increased risk of fracture?

OBJECTIVE

Osteoporosis is a major women's health problem, because it is responsible for about 1.3 million fractures in the United States each year. Estrogen deficiency is a major risk factor in the pathogenesis of osteoporosis. Recent evidence has indicated that tubal ligation may cause menstrual dysfunction and estrogen deficiency. This study examined the association between tubal ligation and bone mass in a group of elderly postmenopausal women.

STUDY DESIGN

Subjects were 2215 white women > or = 65 years old participating in the Baltimore center of the Study of Osteoporotic Fractures. Bone mineral density of the proximal and distal radius and the calcaneus was measured by single photon absorptiometry. Multiple regression analysis was performed to determine whether tubal ligation had an independent effect on bone density. The effect of tubal ligation on the risk of hip and osteoporotic fractures was estimated by Cox proportional hazards model.

RESULTS

Women who reported a tubal ligation had lower, although not statistically significant, bone density of the radius and calcaneus. The relative risk of hip (1.05, 95% confidence limit 0.84 to 1.32) and osteoporotic fractures (1.01, 0.80 to 1.29) was not significantly increased in women with tubal ligation.

CONCLUSION

We conclude that elderly women who had a tubal ligation have small changes in bone density that are not of sufficient magnitude to increase their risk of osteoporotic fractures.

Treatment of osteoporosis in the elderly

Fracture risk is adversely related to bone density, wherever it is measured. Women should be screened by bone densitometry around the time of the menopause and treated with calcium or hormones if the density is low. Women with vertebral compression should be treated with calcitriol if calcium absorption is low, with hormones if urine calcium is high, and with calcitriol and hormones if both abnormalities are present. It is uncertain whether newer treatments offer any advantages over this regimen. Vitamin D is indicated in household individuals or others with low levels of 25 OHD to prevent loss from secondary hyperparathyroidism and perhaps also to improve muscle power.

Age-related differences in cross-sectional geometry of the forearm bones in healthy women

Men exhibit age-related adaptive changes in long bone geometry, namely, endosteal resorption and periosteal apposition of bone, that help to preserve bone strength. It is not clear whether women undergo similar adaptive responses. To address this question, we assessed the bone mineral density and cross-sectional geometry of the radius and ulna at the one-third distal site by single photon absorptiometry and computed tomography (CT) in healthy young (n = 21, age 20-30 years) and older (n = 22, age 63-84 years) women. We used the CT data to compute the total subperiosteal, medullary, and cortical areas, as well as the maximum, minimum, and polar moments of inertia. We normalized the geometric parameters for bone length and performed comparisons using both the original and size-corrected data. Radial and ulnar bone mineral content and density were 20-30% lower in the older women (P < 0.0001). Ulnar width, total area, medullary area, and maximum and polar moment of inertia were greater in the older than in the younger women. Although we observed similar trends when we examined the radius data that were corrected for bone size, age-related differences in radial geometry were less pronounced and were not significant. We conclude that women undergo endosteal resorption and periosteal apposition of the ulna with age, thereby exhibiting an adaptive pattern that helps to preserve bone strength. The different behavior of these two bones suggests that local, rather than systemic, factors underlie this adaptation.

The effect of oestradiol implants on regional and total bone mass: a three-year longitudinal study

OBJECTIVE

Although there is evidence from cross-sectional studies that percutaneous oestrogen administration protects against menopausal bone loss, few longitudinal data are available. We have examined the effect of 3 years' treatment with percutaneous oestradiol on total body calcium, spinal trabecular bone mineral density and radial bone mineral content in post-menopausal women.

DESIGN AND PATIENTS

Twenty-nine post-menopausal women, aged 37-55 years, who had undergone hysterectomy and had experienced the onset of menopausal symptoms within the previous 2 years, were studied before and for 3 years during hormone replacement with oestradiol implants, given at approximately 6-monthly intervals.

MEASUREMENTS

Total body calcium was measured by prompt gamma neutron activation analysis, spinal trabecular bone mineral density by quantitative computed tomography and radial bone mineral content by single-photon absorptiometry.

RESULTS

There was a significant increase in the mean total body calcium, spinal trabecular bone mineral density and radial bone mineral content over the 3 years of the study. The mean (+/- SEM) percentage change per annum was +2.4% (+/- 0.8) for total body calcium (P < 0.01), +3.3% (+/- 0.6) for spinal trabecular bone mineral density (P < 0.001) and +1.2% (+/- 0.6) for radial bone mineral content (P < 0.05).

CONCLUSIONS

Percutaneous oestradiol replacement therapy prevents menopausal bone loss and is associated with a sustained and significant increase in total body calcium, spinal trabecular bone mineral density and radial bone mineral content over a 3-year treatment period. Oestradiol implants thus have skeletal effects comparable to those of oral or transdermal oestrogens.

Body size, estrogen use and thiazide diuretic use affect 5-year radial bone loss in postmenopausal women

Understanding factors associated with more rapid bone mineral loss among aging women is important for establishing preventive strategies for intervention. This study reports factors associated with the 5-year change in radial bone mineral density (BMD) determined prospectively in 435 women aged 55-80 years at baseline. The baseline study included measurement of radial BMD (gm/cm2) by single photon densitometry and personal interview. The baseline protocol was replicated 5 years later in a follow-up study. Women with a lower baseline weight or Quetelet index, smaller triceps skinfold and less arm muscle area had significantly greater 5-year bone loss (p = 0.001). Current users of estrogens had less radial bone loss (2.8% vs 7.3%, p = 0.0005) than women not currently using estrogens. Current users of estrogen had significantly less 5-year loss if use had been for 5 years or longer (-1.0% vs -6.9%, p = 0.05). Current users of the thiazide class of medications had less 5-year radial bone loss (5.0% vs 7.4%, p = 0.0035) than women without current thiazide use. Baseline dietary calcium, alcohol consumption and smoking were not associated with BMD change. This suggests that greater body size, and current use of estrogens or thiazide antihypertensives are associated with less radial bone mass loss in a 5-year period among postmenopausal women.

A 5-year longitudinal study of forearm bone mass in 307 postmenopausal women

We measured forearm bone mineral content at the beginning and end of a 5 year period in 307 untreated postmenopausal volunteers. We also measured height, weight, and a number of biochemical variables in plasma and urine after an overnight fast. The initial mean age of the subjects was 59.0 years (range 39-72), and the mean years since menopause was 10.0 (range 1-37). The mean forearm BMC fell from 1034 +/- 9.6 (SEM) to 982 +/- 9.3 mg/cm (P < 0.001). The coefficient of correlation between the first and second measurements was 0.96. The mean rate of change was -1.0% per annum (with a 99% range of -4 to 1% per annum), which agreed well with previous estimates from cross-sectional data. There was a significant negative correlation between rate of change in bone mass and initial value (r = -0.23; P < 0.001), which was eliminated by expressing change as a percentage of initial bone mass. Of the other variables measured, the one that was most significantly related to the percentage change in bone mass was the urinary hydroxyproline/creatinine ratio (r = -0.35; P < 0.001), which we regard as a marker only. By stepwise regression, the only significant determinants of the rate of change in bone mass were body weight (positive, P < 0.001), years since menopause (positive, P < 0.005), urine calcium (negative, P < 0.01), and serum estrone (positive, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

A four-year longitudinal study of bone loss in patients with inflammatory bowel disease

Serial measurements of spinal trabecular and radial cortical bone density were made over 4 years in 70 patients with inflammatory bowel disease. Mean rates of bone loss for the cohort differed little from rates reported in normal populations; however, some patients showed increased rates of loss, including patients whose bone density at entry to the study was already well below normal. There was a significant correlation between the amount of corticosteroid prescribed and spinal trabecular bone loss in males, but no significant correlation with other clinical parameters. Increased rates of bone loss emphasise the need for bone densitometry and prophylactic measures in patients with inflammatory bowel disease.

Longitudinal study of cortical bone loss in patients with inflammatory bowel disease

Bone mineral density of the radius was measured by single-photon absorptiometry in 50 patients with inflammatory bowel disease. Thirty-three had Crohn's disease and 17 ulcerative colitis; 25 were women. The mean age was 45 years (range, 18-70 years). Measurements were repeated in 39 of them after a mean follow-up period of 7.9 years (range, 7.1-8.2 years). In female patients the mean (95% confidence interval) annual change in radial bone mineral density was -0.74% (-1.34% to -0.14%) (P = 0.022), the greatest bone loss occurring in postmenopausal women (mean, -1.16% (-2.01% to -0.30%)). In male patients the mean annual rate of bone loss was -0.07% (-0.41% to 0.28%) (P = NS). Patients with abnormally low values at the first measurement remained osteopenic at the second measurement, whilst some others with normal values initially showed increased rates of bone loss and had a subnormal bone mineral density after the follow-up period. These results show increased rates of cortical bone loss in some patients with inflammatory bowel disease and emphasize the need to monitor bone mass in these patients so that prophylactic measures can be instituted.

Rates of change in bone mineral density of the spine, heel, femoral neck and radius in healthy postmenopausal women

Rates of change in bone mineral density (BMD) at four skeletal sites were measured in 288 healthy postmenopausal women (41-71 years) who were participants in a 2-year calcium supplement trial. Mean calcium intake from food and supplements was 719 +/- 299 (sd) mg/day during the study. Annualized change in spine (L2-4) BMD, adjusted for body size, dietary calcium intake, treatment group and smoking was -2.24% +/- 2.07% (sd) in women who were 1 to 2 years postmenopausal and declined in women through 5 years after menopause. The rate of change in women who were 6 or more years postmenopausal was -0.96% +/- 2.96%. Mean adjusted change in heel BMD in all women was -1.16% +/- 3.26%. At the femoral neck and radius there was no significant adjusted change in BMD in the group as a whole (femoral neck -0.24% +/- 2.55%; radius -0.14% +/- 2.24%), and the rate of bone loss was not detectably accelerated in women closest to menopause. Rates of bone loss in the subset of subjects who received no calcium supplementation tended to be greater at all skeletal sites.