Skeletal site-specific effects of jump training on bone mineral density in adults: a systematic review and meta-analysis

Preserving or preventing declines in bone mineral density (BMD) is imperative. As jumping is a high-impact bone-loading action, this meta-analysis evaluated the efficacy of jump training to improve BMD and bone turnover relative to non-jumping controls in men and women > 18 years, following Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines. PubMed and COCHRANE Library databases were searched until February 2022. Fifteen articles (19 jumping-trials) met the predetermined search criteria. Eighteen trials were included for BMD data (n = 666 participants). There was a significant small-moderate effect of jumping on femoral neck BMD (%mean difference: 95%CI, +1.50%: 0.83%; 2.17%, p < 0.0001), that remained significant after sub-analysis by age for both younger (+1.81%: 0.98%; 2.65%) and older adults (+1.03%: 0.02%; 2.03%). BMD of total hip (+1.26%: 0.56%; 1.96% vs + 0.06%: -0.96%; 1.08%), and trochanter (+0.84%: 0.20%; 1.48% vs -0.16%: -1.08%; 0.76%) increased significantly with jump training only in younger adults and non-significantly at the lumbar spine (+0.84%: -0.02%; 1.7% vs -0.09%: -0.96%; 0.77%) only in younger but not older adults, respectively. The BMD response to jump training appears to be site-specific, with the highest sensitivity at the femoral neck. No dose-response effect suggests moderate certainty of a gain in femoral neck BMD when performing the median jump-load of 50 jumps four times weekly.

Types of dairy foods and risk of fragility fracture in the prospective Nurses' Health Study cohort

BACKGROUND

Fragility fractures present enormous health challenges for women. Dairy products provide many bone-beneficial nutrients, such as calcium and vitamin D. Individual dairy foods may exert different effects on bone health.

OBJECTIVES

The aim of this study was to investigate the associations between total dairy, yogurt, milk, and cheese and fragility fracture risk among females in the prospective Nurses' Health Study (NHS) conducted in the United States.

METHODS

In the current analysis, 103,003 females with mean age of 48 y were followed from 1980-2004. Proportional hazards models were used to estimate risk of first fracture (of the wrist, hip, or vertebrae) by intakes of dairy foods (total dairy, milk, yogurt, or cheese) obtained from a food frequency questionnaire. Fractures that were caused by high-trauma events were not included. We relied on self-reported data for wrist and hip fractures whereas for vertebral fractures, medical records were used to confirm cases.

RESULTS

A total of 5495 incident fracture cases were documented during follow-up. After controlling for relevant confounding variables, consumption of ≥2 servings/d of total dairy (compared with <1 serving/d) was associated with lower fracture risk (hazard ratio [HR]: 0.74; 95% confidence interval [CI]: 0.61, 0.89). More than 2 servings of milk per day (compared with <1 serving/d) were associated with a lower fracture risk (HR: 0.85; 95% CI: 0.77, 0.94). Intakes of calcium, vitamin D, and protein from nondairy sources did not modify the effects of total dairy or milk on fracture risk. There was no association between yogurt intake and fracture risk. Intake of cheese (≥1 servings/d compared with <1 serving/wk) was weakly associated with lower fracture risk (HR: 0.89; 95% CI: 0.79, 0.99).

CONCLUSIONS

Higher total dairy, milk, and cheese intakes are associated with lower risks of fracture in females in the NHS.

Glucocorticoid-induced osteoporosis in premenopausal women: management for the rheumatologist

PURPOSE OF REVIEW

This review seeks to summarize the literature relevant to the treatment of glucocorticoid-induced osteoporosis in premenopausal women; an issue commonly encountered by rheumatologists and yet lacking good clinical practice guidelines.

RECENT FINDINGS

Although most of the relevant literature on osteoporosis includes postmenopausal women only, data from both randomized controlled trials and case reports suggest bisphosphonates can be an effective and well tolerated treatment for premenopausal patients. Data for other medications to treat premenopausal osteoporosis is less robust.

SUMMARY

The use of bisphosphonates in young women may be safer than initially thought and should likely be used for the treatment of glucocorticoid-induced osteoporosis in rheumatology clinics. Further research is needed to continue to understand long-term risk.

Smoking is associated with an increased risk for fractures in women after childbirth: a nationwide population-based cohort study in Finland

BACKGROUND AND PURPOSE

Smoking weakens bone health and increases the risk of fractures. We investigated the incidence of fractures in smoking, fertile-aged women and compared it with that of non-smoking, fertile-aged women using data from nationwide registers.

PATIENTS AND METHODS

We conducted a retrospective register-based nationwide cohort study from 1998 to 2018. We identified all women smoking during pregnancy from the Medical Birth Register and compared these with non-smokers. We gathered fractures for both groups from the Care Register for Health Care. Pregnancies with missing smoking or socioeconomic status were excluded. A Cox regression model was used to analyze adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for fractures during the 5-year follow-up starting from delivery. The model was adjusted for the age of the mother at the time of delivery and socioeconomic status.

RESULTS

The smoking group included 110,675 pregnancies and the non-smoking group 628,085 pregnancies. The overall fracture rate was higher in smokers after 1-year follow-up (aHR 1.7, CI 1.5-2.0) and 5-year follow-up (aHR 1.7, CI 1.6-1.8). After 5-year follow-up, the fracture rates for polytraumas (aHR 2.3, CI 1.4-3.7), inpatient admitted fractures (aHR 2.0, CI 1.7-2.4), and non-admitted fractures (aHR 1.8, CI 1.7-1.9) were all higher among smoking women.

CONCLUSION

Smoking in fertile-aged women was associated with a higher risk of fractures during the 1-year and 5-year follow-up after giving birth, also after adjusting for age and socioeconomic status. Whether the increased fracture risk is caused by direct effects of smoking on bone health or riskier behavior remains uncertain.

Osteoporosis risk group: Screening for osteoporosis in dental clinics using panoramic radiographs

Osteoporosis is a specific condition which is characterized by low bone mineral density (BMD) and deterioration of bone structure resulting in an increased susceptibility to fractures. It contributes to a great deal of morbidity and mortality, and is a large burden to the healthcare system, especially in the case of the elderly population. In the last four decades, a plethora of studies have reported characteristic oral radiographic findings in the early stages of osteoporosis, suggesting the possible use of oral radiographic signs for the early detection of the condition. Digital orthopantomographs (OPGs) are usually taken for the screening of dental patients during routine dental evaluations. These radiographs and the characteristic changes seen on them may have a significant role in the screening for initial osteoporotic changes. A number of precise radiomorphometric indices of the mandible have also been developed to allow quantification of the mandibular bone mass for identification of the initial signs of osteoporosis. The present review focuses on the possible role of panoramic radiographs in the initial screening for osteoporosis in dental clinics in high-risk groups.

Predicting osteoporosis with body compositions in postmenopausal women: a non-invasive method

Background

The prevalence of osteoporosis is rising steadily as the aging population increases. Bone mineral density (BMD) assessment is a golden standard to establish the diagnosis of osteoporosis. However, the accessibility and radiation exposure limited its role in community screening. A more convenient approach for screening is suggested.

Methods

A total of 363 postmenopausal women over the age of 50 were included in this study and assessed with the body composition [including fat-free mass (FFM), fat mass (FM), and basal metabolic rate (BMR)] and BMD. Normal distributions and correlation coefficients among variables were calculated using the Shapiro-Wilk test and Pearson’s correlation analysis, respectively. A receiver operating characteristic (ROC) curve was plotted, and the area under ROC curves (AUC) was determined to obtain the optimal cutoff values of the body composition variables for osteoporosis prediction.

Results

The correlation coefficient of FFM, FM, FM ratio, and BMR with femur neck T-score was 0.373, 0.266, 0.165, and 0.369, respectively, while with spine T-score was 0.350, 0.251, 0.166, and 0.352, respectively (p < 0.01 for all). FFM, FM, and BMR showed an optimal cutoff value of 37.9 kg, 18.6 kg, and 1187.5 kcal, respectively, for detecting osteoporosis.

Conclusions

The present study provided a model to predict osteoporosis in postmenopausal women, and the optimal cutoff value of FFM, FM, and BMR could be calculated in the Asian population. Among these factors, BMR seemed a better predictor than others. The BMR could be a target for exercise intervention in postmenopausal women for maintaining or improving BMD.

Trial registration

ClinicalTrials.gov, NCT02936336. Retrospectively registered on13 October 2016.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13018-021-02351-3.

[Progress of change in bone mineral density after knee arthroplasty]

Objective

To summarize research progress of change in bone mineral density (BMD) after knee arthroplasty and its diagnostic methods, influencing factors, and drug prevention and treatment.

Methods

The relevant literature at home and abroad was reviewed and summarized from research status of the advantages and disadvantages of BMD assessment methods, the trend of changes in BMD after knee arthroplasty and its influencing factors, and the differences in effectiveness of drugs.

Results

The central BMD and mean BMD around the prosthesis decrease after knee arthroplasty, which is closely associated with body position, age, weight, daily activities, and the fixation methods, design, and material of prosthesis. Denosumab, bisphosphonates, and teriparatide et al. can decrease BMD loss after knee arthroplasty.

Conclusion

BMD after knee arthroplasty decreases, which is related to various factors, but the mechanism is unclear. At present, some inhibitors of bone resorption can decrease BMD loss after knee arthroplasty. However, its long-term efficacy remains to be further explored.

Serum anti-Müllerian hormone levels are associated with low bone mineral density in premenopausal women

OBJECTIVE

To investigate the associations between anti-Müllerian hormone (AMH) and bone mineral density (BMD) induced by ovarian insufficiency in premenopausal women.

METHODS

Subjects were consecutively enrolled from January 2015 to December 2018. Dual energy X-ray absorptiometry (DXA) examination was set as the gold standard, with T-scores less than -2.5/1 as thresholds for the definition of osteoporosis (OP)/osteopenia.

RESULTS

A total of 87 subjects were included in the low BMD group, and 39 subjects were included in the control group. Serum AMH levels were decreased significantly in the low BMD group (p < 0.05) with a negative correlation between AMH and age. Strong positive correlations between AMH and BMD/T-score existed in all subjects and subjects with low BMD, and remained even after age adjustment. An exploratory multivariate regression model indicated that age and AMH remained predictive and might be independent risk factors with adjusted odds ratios (ORs) of 0.9 (p = 0.009) and 36 (p < 0.001), respectively. The receiver operating characteristic (ROC) curve analysis estimated that the sensitivity and specificity were 78.2 and 76.9%, respectively, for identifying low BMD subjects from controls when the cut-off value for AMH was set to 0.800 ng/mL.

CONCLUSIONS

Serum AMH levels are associated with low BMD in premenopausal women with suspected ovarian insufficiency.

Estimating the Effect of Elagolix Treatment for Endometriosis on Postmenopausal Bone Outcomes: A Model Bridging Phase III Trials to an Older Real-World Population

Elagolix, a gonadotrophin‐releasing hormone antagonist, is used in premenopausal women with endometriosis. There is a risk of bone loss with elagolix, but the long‐term effects of BMD loss later in life cannot be directly assessed and has not been quantified. To address this gap in knowledge, this study indirectly estimated the impact of elagolix on postmenopausal fracture risk. BMD change in premenopausal women with endometriosis treated with elagolix was modeled from the phase III program data (elagolix group) and used to simulate treatment effects on (fracture risk assessment tool estimated) 10‐year risks of hip and major osteoporotic fracture in women ages 50 to 79 years from the 2005–2010 National Health and Nutrition Examination Survey (NHANES; N = 2303). Change in the proportion of women reaching risk‐based antiosteoporotic treatment thresholds was also estimated. For elagolix versus NHANES, median 10‐year risk of major osteoporotic fracture was 4.73% versus 4.70% in women ages 50 to 59 years, 7.03% versus 6.97% in women ages 60 to 69 years, and 10.83% versus 10.68% in women ages 70 to 79 years. Median 10‐year risk of hip fracture in these same groups was 0.19% versus 0.18% for women ages 50 to 59 years, 0.51% versus 0.49% for women 60 to 69 years, and 2.22% versus 2.14% for women 70 to 79 years. The proportion of women reaching risk‐based antiosteoporotic treatment thresholds caused by elagolix 150 mg daily for 12 months was 0.36% higher at age 50 to 59 years, 0.23% at age 60 to 69 years, and 1.79% at age 70 to 79 years. The number needed to harm was 643 for one additional hip fracture and 454 for one additional major osteoporotic fracture. Results were similar for elagolix 200 mg twice a day for 3 months. In the modeled scenarios, elagolix had minimal impact on long‐term risk of fracture and reaching risk‐based treatment thresholds. © 2020 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Depot Medroxyprogesterone Acetate Use and Blood Lead Levels in a Cohort of Young Women

BACKGROUND

Injectable contraceptive use is common, with 74 million users worldwide. Use of the injectable contraceptive depot medroxyprogesterone acetate (DMPA) is associated with bone mineral density loss. We hypothesize that increased bone resorption with DMPA use allows for mobilization of the toxic metal lead stored in bone to blood, presenting users with increased systemic exposure to lead.

OBJECTIVE

The objective of our study was to investigate the association between current DMPA use and blood lead concentrations.

METHODS

We conducted a cross-sectional analysis using enrollment data from the Study of Environment, Lifestyle & Fibroids (SELF), a cohort of 1,693 African-American women who were 23-35 years of age. Data on DMPA use were collected by computer-assisted telephone interview. Blood lead concentrations were measured in whole blood samples among 1,548 participants (91% of cohort). We estimated the adjusted percent difference in blood lead concentrations and 95% confidence intervals (CI) between current DMPA users and nonusers using multivariable linear regression.

RESULTS

Geometric mean blood lead concentration was 0.69 μ g / dL (95% CI: 0.67, 0.71). After adjustment, current DMPA users (7% of cohort) had blood lead concentrations that were 18% higher than those of nonusers (95% CI: 8%, 29%). Similar associations were observed with additional analyses to assess for potential bias from smoking, DMPA-induced amenorrhea, use of estrogen-containing contraceptives, having given birth in the prior year, and history of medical conditions or current medication use associated with bone loss.

DISCUSSION

Our results indicate that current DMPA use is associated with increased blood lead concentrations. Further research, particularly in populations highly exposed to lead, is warranted to consider tradeoffs between the adverse effects of lead on human health and the importance of DMPA as a contraceptive option to prevent unintended pregnancy. https://doi.org/10.1289/EHP7017.

Effectiveness of a Mini-Trampoline Training Program on Balance and Functional Mobility, Gait Performance, Strength, Fear of Falling and Bone Mineral Density in Older Women with Osteopenia

Purpose

To evaluate the effectiveness of a combined balance-, strength-, and jumping-exercise intervention on a mini-trampoline performed by older women with osteopenia on static balance and functional mobility, gait speed, strength of the upper and lower limbs, fear of falling, as well as to investigate its influence on bone mineral density (BMD).

Patient and methods

Using a randomized controlled study design, participants (range: 56-83 years) were assigned either to the intervention group (IG; n=20, mean age 69.6 ± 5.3 years) performing a specifically tailored intervention on a mini-trampoline or to the control group (CG; n=20, 67.4 ± 6.8 years), that did not undertake any intervention beyond regular osteopenia treatment. The intervention was performed twice a week for 12 weeks, each session lasting 45-60 mins and consisted of balance, strength and jumping exercises. Static balance and functional mobility was measured by one-leg stance (OLS) and timed up and go test (TUG). Upper and lower limb strength was evaluated by the arm curl test (ACT) and the 30-s chair stand test (CST) whereas gait speed was measured by the 6 m walking test (WT). Fear of falling was measured using the Falls Efficacy Scale - International (FES-I). BMD was measured at the lumbar spine and femoral neck using Dual-energy X-ray absorptiometry (DXA).

Results

Significant interactions (group x time) were found for all parameters (p<0.001) except for BMD, measured at the lumbar spine (p=0.064) and femoral neck (p=0.073). All test parameters of balance and functional mobility tests (OLS, TUG), strength tests (ACT, CST), WT, FES-I and BMD (femoral neck) showed significant improvement in the IG (p<0.05).

Conclusion

The combined 12-week intervention was highly effective in improving balance and functional mobility, strength, gait performance and fear of falling in patients with osteopenia.

Effects of Zumba® and Aquagym on Bone Mass in Inactive Middle-Aged Women

Background and objectives: Regular exercise may stimulate bone formation and reduce the loss of bone mass in premenopausal women. This study aims to evaluate the effect of high-impact physical activity (Zumba^®) and low-impact physical activity (Aquagym) on bone mass in inactive middle-aged women. Materials and methods: Fifty-five healthy inactive women (30⁻50 years old) were recruited in Spain in 2016 and were randomly allocated into one of three groups: High impact group (HIG: n = 15), low impact group (LIG: n = 12) and control group (CG: n = 28). HIG and LIG were recruited from Madrid and the CG from Toledo. HIG and LIG completed a 12-week intervention program with three 40' sessions per week of Zumba^® or Aquagym; respectively. Dual energy X-ray absorptiometry (DXA) measured bone mineral content (BMC) and areal bone mineral density (aBMD) at total body less head (TBLH), lumbar spine and right hip. Results: Post-intervention adjusted data showed no significant differences in BMC between any of the groups nor in aBMD between HIG and LIG. Interestingly; significant differences for the HIG vs. CG were found in the change in total hip aBMD (1.76% vs. -0.44%), femoral neck aBMD (1.80% vs. -2.71%), and intertrochanter aBMD (2.03% vs. -0.50%). Moreover, significant differences for the LIG vs. CG were also found in the change in femoral neck aBMD (-0.54% vs. -2.71%). Conclusions: The regular practice of Zumba^® and Aquagym might reduce the progressive deterioration of bone mass in inactive middle-aged women.

Low Skeletal Muscle Mass is Associated with the Risk of Low Bone Mineral Density in Urban Dwelling Premenopausal Women

To evaluate the relationship between skeletal muscle mass and bone mineral density (BMD) and to determine the association between low skeletal muscle mass and low BMD in urban dwelling young adults. This study was based on data from the 2008-2011 Korea National Health and Nutrition Examination Surveys. The subjects were 1702 20-49-year-old men and 2192 premenopausal women (age 20-55 years). BMD at the lumbar spine, femoral neck, and total hip and the appendicular skeletal muscle mass (ASM) were measured by dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was defined as weight-adjusted ASM. Mildly and severely low muscle skeletal mass were defined as SMI that was 1-2 and >2 standard deviations below the sex-specific mean ASM of young adults, respectively. Low BMD was defined as T score of less than -1.0 at the lumbar spine, femoral neck, and/or total hip. After adjusting for confounders, skeletal muscle mass was positively associated with BMD at the lumbar spine, femoral neck, and total hip in both men and women. Mildly and severely low skeletal muscle mass increased the risk of low BMD in premenopausal women [OR (95% CI) = 1.4 (1.1-1.9) and 2.4 (1.2-4.6), respectively] but not men. In women, low skeletal muscle mass independently was associated with the risk of low BMD at the femoral neck and total hip but not the lumbar spine. Skeletal muscle mass was independently associated with BMD in urban dwelling young men and women, but low skeletal muscle mass was associated with the risk of low BMD in premenopausal women only.

Effect of Calcium Derived from Lithothamnion sp. on Markers of Calcium Metabolism in Premenopausal Women

A double-blind crossover pilot trial tested the hypothesis that botanically derived calcium could demonstrate greater influence over calcium metabolism markers compared with a nonplant-derived calcium carbonate supplement or placebo. Twelve fasting female subjects received a single oral dose of Aquamin F™ (derived from the marine algal Lithothamnion sp.), or calcium carbonate, or placebo. Blood and urine samples were collected at baseline and over 12 h to evaluate ionized and total calcium and parathyroid hormone (PTH). Subjects treated with Aquamin F demonstrated significantly greater urinary clearance of calcium after 12 h compared with placebo (P = .004). Following a meal at 90 min, subjects treated with Aquamin F demonstrated a more prolonged suppression of serum PTH concentration (significantly lower than placebo at 90, 120, and 240 min). Calcium carbonate provided an intermediate response; urinary clearance was not significantly different from placebo treatment and PTH was only significantly lower than placebo at 90 min. Aquamin F may demonstrate greater influence over these markers of calcium metabolism than calcium carbonate or placebo, as suggested by a greater calciuric response and a more prolonged suppression of serum PTH concentrations following a meal in premenopausal women.

Association between body weight and proximal tibial bone mineral density after bilateral total knee arthroplasty

BACKGROUND

Proximal tibial bone mineral density (BMD) has been studied for its potential impact on subsidence and loosening of the tibial component after total knee arthroplasty (TKA). However, no known studies of proximal tibial BMD after TKA have evaluated the effect of major impact factors such as body weight (BW), muscle strength, and level of activity. We aim to determine whether factors such as level of activity, quadriceps strength, BW, gender, age, and prosthetic design affect proximal tibial BMD over the mid- to long-term following TKA.

METHODS

We evaluated 36 patients (72 knees) who were undergoing bilateral TKA performed by a single surgeon. Median follow up time was 115months (range, 60-211months) for a minimum of five years. We measured BMD in the proximal tibia and used a hand-held dynamometer to measure quadriceps isometric strength, recording the maximum value of three measurements for each patient.

RESULTS

Univariate analyses using Spearman's correlation coefficient for continuous variables revealed a weak negative correlation between age and BMD (r=-0.316, P=0.007) and a moderate positive correlation between BW and BMD (r=0.430, P<0.001). However, no significant correlations were found between the other factors above and BMD for continuous and discrete variables. Based on multivariate analyses, only BW had a significant effect on BMD (β=0.342, P=0.003).

CONCLUSIONS

BW is the most impact factor on the proximal tibial BMD after mid- to long-term follow up TKA. Therefore, the management of BW may contribute to prevention of decline of tibial BMD for TKA patients owing to aging.

Levels of serum estradiol and lifestyle factors related with bone mineral density in premenopausal Mexican women: a cross-sectional analysis

BACKGROUND

Many factors, such as heredity, ethnicity, nutrition and other lifestyle factors, have been related to bone mineral density in postmenopausal women. Additionally, bone mass has been significantly associated with decreased estrogen levels. However, fewstudies have been conducted on premenopausal women. The present study was designed to estimate the relationship between low bone mineral density and levels of serum estradiol and lifestyle factors in premenopausal Mexican women.

METHODS

A cross-sectional study was conducted in 270 women between 40 and 48 years of age who participate in the Health Workers Cohort Study. Information on socio-demographic and lifestyle factors were obtained through a self-administered questionnaire. Body mass index and serum estradiol were measured with standard procedures; bone mineral density was assessed using dual-energy X-ray absorptiometry. Multiple linear and logistic regression models were computed to evaluate the relationship between low bone mineral density and levels of serum estradiol and lifestyle factors.

RESULTS

In linear regression analysis levels of estradiol, body mass index, physical activity, and vitamin D intake were positively related to bone mineral density. Age, cigarette smoking and caffeine were inversely associated with BMD. Finally, the odds of low bone mineral density increase significantly when the premenopausal women had low levels of serum estradiol (OR = 4.93, 95 % CI: 2.14, 11.37).

CONCLUSION

These data support that low serum estradiol, advancing age, lower physical activity, lower vitamin D intake, cigarette smoking, and higher amount of caffeine intake are linked to low bone mineral density in premenopausal Mexican women.

Steroidal contraceptive use is associated with lower bone mineral density in polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a common condition affecting reproductive-aged women with features including hyperandrogenism and menstrual irregularity frequently treated with hormonal steroidal contraceptives. Women with PCOS appear to have lower bone mineral density (BMD). While steroidal contraceptives may positively affect bone health, their effect on BMD in PCOS is not known. The aim of this study was to assess BMD in women with PCOS according to recent contraceptive use. A cross-sectional analysis of 95 pre-menopausal overweight or obese sedentary women with PCOS [age 29.4 ± 6.4 years, body mass index (BMI) 36.1 ± 5.3 kg/m(2)] who either recently took steroidal contraceptives (ceased 3 months prior) or were not taking steroidal contraceptives was conducted. Clinical outcomes included BMD, anthropometry, insulin, glucose, reproductive hormones, dietary intake and vitamin use. BMD was significantly lower for women who used contraceptives compared to those who did not (mean difference 0.06 g/cm(2) 95 % confidence interval -0.11, -0.02, p = 0.005). In regression models, lower BMD was independently associated with contraceptive use (β = -0.05, 95 % CI -0.094, -0.002, p = 0.042), higher testosterone (β = -0.03, 95 % CI -0.05, -0.0008, p = 0.043) and lower BMI (β = 0.006, 95 % CI 0.002, 0.01, p = 0.007) (r (2) = 0.22, p = 0.001 for entire model). We report for the first time that overweight and obese women with PCOS with recent steroidal contraceptive use had lower BMD in comparison to non-users independent of factors known to contribute to BMD. Whether this observation is directly related to steroidal contraceptive use or other factors requires further investigation.

Efficiency of jumping exercise in improving bone mineral density among premenopausal women: a meta-analysis

BACKGROUND

Jumping exercise is frequently regarded as an optimum strategy for increasing pubertal bone growth, but its role in promoting or preserving adult bone mineral density (BMD) is still undefined.

OBJECTIVES

This meta-analysis aimed to evaluate the evidence for the influence of jumping exercise on BMD in premenopausal women and to define the effectiveness of high-impact exercise in improving or maintaining female bone health.

METHODS

We searched MEDLINE, PubMed, EMBASE, SPORTDiscus, Google Scholar and BIOSIS up to 1 September 2013 for jumping exercise influence on BMD in premenopausal women. The search terms used were 'jumping', 'skipping', 'brief exercise', 'high impact', 'bone density', 'BMD', 'femoral neck', 'lumbar spine', and 'trochanter', and the search was limited to females. Six papers met the search criteria.

RESULTS

Six studies on BMD in the femoral neck (Q = 2.63, p = 0.854, I (2) = 0.0 %), trochanter (Q = 2.10, p = 0.10, I (2) = 0.0 %) and lumbar spine (Q = 1.17, p = 0.979, I (2) = 0.0 %) were highly homogenous in determining skeletal responses to jumping exercise. Jumping exercise significantly increased BMD in the femoral neck {weighted mean difference (WMD) [fixed effect] = 0.017 g/cm(2), 95 % confidence interval (CI) 0.014-0.20, p < 0.001} and trochanter (WMD [fixed effect] = 0.021, 95 % CI 0.018-0.024, p < 0.001). However, the lumbar spine seemed to benefit less from such high-impact exercise (p = 0.181). Visual inspection of the plots implicated some degree of asymmetry, indicating a slightly positive treatment effect at the femoral neck and trochanter sites.

CONCLUSIONS

Based on meta-analysis of existing studies, the sensitivity of skeletal response to jumping exercise in premenopausal women is significant and site-specific, with significant benefit from high-impact exercise noted, especially at the hip.

A review of osteoporosis management in younger premenopausal women

The purpose of this review is to describe the available evidence for osteoporosis treatments in young and premenopausal women. A review of articles evaluating the treatment or prevention of osteoporosis in young (age less than 50 years) or premenopausal women was conducted. Several trials evaluating the treatment of anorexia nervosa and use of hormone therapy in those women, the use of bisphosphonates in women undergoing chemotherapy for breast cancer and the use of bisphosphonates, teriparatide and vitamin D in women with glucocorticoid-induced osteoporosis are described. Limited data were found to support the treatment of osteoporosis in women with idiopathic osteoporosis or cystic fibrosis, or after kidney transplant. The evidence for treatment of osteoporosis in premenopausal women is not nearly as robust as that for postmenopausal osteoporosis. Although fracture risk in the premenopausal population is low, women with secondary osteoporosis may benefit from treatment with various agents, depending upon the condition.

Skeletal manifestations of treatment of breast cancer on premenopausal women

With increasing use of screening mammography and more effective adjuvant systemic therapies, the majority of women diagnosed with early stage breast cancer will be long-term survivors and experience personal cures. Among the common side effects of adjuvant therapies is treatment-related bone loss, primarily as a result of estrogen deprivation. Whereas this occurs in both postmenopausal and premenopausal women, this brief review will focus on pre- or perimenopausal women when initially diagnosed with breast cancer. An important distinction is between those women who retain ovarian function despite cancer or preventative treatments and the more common situation of premenopausal women who as result of cancer treatments undergo ovarian failure or early menopause. Some women with treatment-related ovarian failure will have sufficient treatment-related bone loss to be at increased risks of subsequent nontraumatic fractures and/or osteoporosis and will be candidates for antiresorptive treatments. The noncancer treatment risk factors, screening and treatments for the management of osteopenia and osteoporosis are generally the same in postmenopausal women with and without breast cancer. However, premenopausal women with relatively rapid onset of treatment-related ovarian failure and bone loss pose several challenges. Awareness of treatment-related bone loss and risks of subsequent osteoporosis is a high priority in an ever-increasing population of breast cancer survivors.

Exercise and bone mineral density in premenopausal women: a meta-analysis of randomized controlled trials

Objective. Examine the effects of exercise on femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD) in premenopausal women. Methods. Meta-analysis of randomized controlled exercise trials ≥24 weeks in premenopausal women. Standardized effect sizes (g) were calculated for each result and pooled using random-effects models, Z score alpha values, 95% confidence intervals (CIs), and number needed to treat (NNT). Heterogeneity was examined using Q and I(2). Moderator and predictor analyses using mixed-effects ANOVA and simple metaregression were conducted. Statistical significance was set at P ≤ 0.05. Results. Statistically significant improvements were found for both FN (7g's, 466 participants, g = 0.342, 95%  CI = 0.132, 0.553, P = 0.001, Q = 10.8, P = 0.22, I(2) = 25.7%, NNT = 5) and LS (6g's, 402 participants, g = 0.201, 95%  CI = 0.009, 0.394, P = 0.04, Q = 3.3, P = 0.65, I(2) = 0%, NNT = 9) BMD. A trend for greater benefits in FN BMD was observed for studies published in countries other than the United States and for those who participated in home versus facility-based exercise. Statistically significant, or a trend for statistically significant, associations were observed for 7 different moderators and predictors, 6 for FN BMD and 1 for LS BMD. Conclusions. Exercise benefits FN and LS BMD in premenopausal women. The observed moderators and predictors deserve further investigation in well-designed randomized controlled trials.

Assessing osteoporosis risk factors in Spanish menopausal women

OBJECTIVES

(1) To assess the prevalence of osteoporosis risk factors in Spanish menopausal women; (2) to detect medical and lifestyle risk factor differences between perimenopausal and postmenopausal women; (3) and to identify the main factors responsible for osteoporosis.

METHODS

Cross-sectional descriptive study encompassing women aged 45-65 across Spain. The study population sample was collected through random sampling and a total of 10,514 women were included. Socio-demographic, medical history, and lifestyle data were assessed.

RESULTS

The prevalence of osteoporosis risk factors was 67.6%. The most common risk factors were physical inactivity (53.6%), use of medication related to osteoporosis risk (45.9%), and low calcium intake (30.1%). There were statistically significant differences between peri- and postmenopausal women in terms of smoking status, alcohol intake, personal history, poor dairy product intake, and medication use that could increase risk. Logistic regression analysis showed that osteoporosis was significantly associated with age, family history, age at onset of menopause, Kupperman Index, prolonged immobilization, weight loss, and other diseases that increase the probability of developing osteoporosis.

CONCLUSIONS

A high prevalence of women taking osteoporosis risk-related medication was observed in our study. There was correlation between the menopausal symptoms' degree of severity and the risk of suffering from osteoporosis.

Zoledronic acid preserves bone mineral density in premenopausal women who develop ovarian failure due to adjuvant chemotherapy: final results from CALGB trial 79809

BACKGROUND

Chemotherapy-induced ovarian failure (CIOF) is a frequent side-effect of adjuvant chemotherapy that results in rapid bone loss. We hypothesised that zoledronic acid (ZA), a third-generation amino bisphosphonate, would prevent bone loss in premenopausal women who developed CIOF.

METHODS

Women (439) were randomised to intravenous (i.v.) ZA 4 mg every 3 months for 2 years starting within 1-3 months after randomization (arm A) or 1 year after randomization (arm B, controls). CIOF was prospectively defined as ≥ 3 months of amenorrhoea, follicle-stimulating hormone (FSH) ≥ 30 MIU/ml and non-pregnant at 1 year. The primary end-point was the percentage change in bone mineral density (BMD) in the lumbar spine (LS) from baseline to 12 months in the ZA and in control groups in women who developed CIOF; the secondary end-point was BMD in LS at 3 years in all randomised women.

FINDINGS

One hundred and fifty (56%) met the definition of CIOF at 1 year. Overall, grade 3 toxicities of ZA were fatigue (1%) arthralgias (21%) and pain (84%). The median percent change (interquartile range, IQR) at 1 year was +1.2% (-0.5% to +2.8%) and -6.7% (-9.7% to -2.9%) p<0.001 and at 3 years was +1.0% (-1.6% to +5.2%) and -0.5% (-3.7% to +3.2%) p=0.019 in arms A and B, respectively.

INTERPRETATION

ZA every 3 months is well tolerated and prevents rapid bone loss in premenopausal women that develop CIOF. Giving ZA with rather than 1 year after the start of adjuvant chemotherapy is the preferred sequence to prevent bone loss.

Winning a won game: caffeine panacea for obesity syndemic

Over the past decades, chronic sleep reduction and a concurrent development of obesity have been recognized as a common problem in the industrialized world. Among its numerous untoward effects, there is a possibility that insomnia is also a major contributor to obesity. This attribution poses a problem for caffeine, an inexpensive, “natural” agent that is purported to improve a number of conditions and is often indicated in a long-term pharmacotherapy in the context of weight management. The present study used the “common target” approach by exploring the tentative shared molecular networks of insomnia and adiposity. It discusses caffeine targets beyond those associated with adenosine signaling machinery, phosphodiesterases, and calcium release channels. Here, we provide a view suggesting that caffeine could exert some of its effects by acting on several signaling complexes composed of HIF-1α/VEGF/IL-8 along with NO, TNF-α, IL1, and GHRH, among others. Although the relevance of these targets to the reported therapeutic effects of caffeine has remained difficult to assess, the utilization of caffeine efficacies and potencies recommend its repurposing for development of novel therapeutic approaches. Among indications mentioned, are neuroprotective, nootropic, antioxidant, proliferative, anti-fibrotic, and anti-angiogenic that appear under a variety of dissimilar diagnostic labels comorbid with obesity. In the absence of safe and efficacious antiobesity agents, caffeine remains an attractive adjuvant.

Increased serum osteopontin is a risk factor for osteoporosis in menopausal women

SUMMARY

Osteopontin (OPN)-deficient mice are resistant to ovariectomy-induced osteoporosis. Therefore, we hypothesized that women with OPN overexpression may show less resistance to postmenopausal osteoporosis. In this study, we first demonstrated that serum OPN levels could be used as a biomarker for the early diagnosis of osteoporosis in postmenopausal women.

INTRODUCTION

Animal studies indicate that OPN-deficient mice are resistant to ovariectomy-induced osteoporosis.

METHODS

From 2004 to 2006, 124 women over the age of 45 were enrolled in a menopausal group, while another 95 women, from 25 to 45 years of age with regular menstruation, were enrolled into a childbearing age group. The serum concentrations of OPN were calculated using the enzyme-link immunosorbent assay method, and bone mineral densities were determined with dual energy X-ray absorptiometry.

RESULTS

Serum OPN levels had a significant positive correlation with age (menopausal group, p < 0.0001) and a negative correlation with body weight, height, hip bone mineral density, and T-scores in the menopausal group. In contrast, there was a positive correlation with the E2 concentration and height, but there was no significant association with the above variables in the childbearing age group. Additionally, high serum OPN levels (>14.7 ng/ml) was a significant risk factor causing menopausal osteoporosis (odds ratio = 2.96, 95% confidence interval, 1.055-8.345).

CONCLUSION

Serum OPN levels could be used as a biomarker for the early diagnosis of osteoporosis in postmenopausal women.

Time-course of exercise and its association with 12-month bone changes

Background

Exercise has been shown to have positive effects on bone density and strength. However, knowledge of the time-course of exercise and bone changes is scarce due to lack of methods to quantify and qualify daily physical activity in long-term. The aim was to evaluate the association between exercise intensity at 3, 6 and 12 month intervals and 12-month changes in upper femur areal bone mineral density (aBMD) and mid-femur geometry in healthy premenopausal women.

Methods

Physical activity was continuously assessed with a waist-worn accelerometer in 35 healthy women (35-40 years) participating in progressive high-impact training. To describe exercise intensity, individual average daily numbers of impacts were calculated at five acceleration levels (range 0.3-9.2 g) during time intervals of 0-3, 0-6, and 0-12 months. Proximal femur aBMD was measured with dual x-ray absorptiometry and mid-femur geometry was evaluated with quantitative computed tomography at the baseline and after 12 months. Physical activity data were correlated with yearly changes in bone density and geometry, and adjusted for confounding factors and impacts at later months of the trial using multivariate analysis.

Results

Femoral neck aBMD changes were significantly correlated with 6 and 12 months' impact activity at high intensity levels (> 3.9 g, r being up to 0.42). Trochanteric aBMD changes were associated even with first three months of exercise exceeding 1.1 g (r = 0.39-0.59, p < 0.05). Similarly, mid-femoral cortical bone geometry changes were related to even first three months' activity (r = 0.38-0.52, p < 0.05). In multivariate analysis, 0-3 months' activity did not correlate with bone change at any site after adjusting for impacts at later months. Instead, 0-6 months' impacts were significant correlates of 12-month changes in femoral neck and trochanter aBMD, mid-femur bone circumference and cortical bone attenuation even after adjustment. No significant correlations were found at the proximal or distal tibia.

Conclusion

The number of high acceleration impacts during 6 months of training was positively associated with 12-month bone changes at the femoral neck, trochanter and mid-femur. These results can be utilized when designing feasible training programs to prevent bone loss in premenopausal women.

Trial registration

Clinical trials.gov NCT00697957

Predictors and prevalence of low bone mineral density in fully ambulatory persons with multiple sclerosis

The implications of having multiple sclerosis (MS) for bone health are incompletely understood. The aim of this population-based study is to identify past and current exposures that are associated with bone mass in fully ambulatory persons with MS up to age 50 years and to determine the prevalence of low bone mineral density (BMD) in this group. We measured BMD (hips, lumbar spine, forearms), physical function, BMI, and serum 25(OH) vitamin D in 55 women and 25 men with MS. Patients provided information on demographic variables and medical history, as well as past and current vitamin D and calcium intake, physical activity, and lifestyle habits. In regression analyses, BMD levels were adjusted for age, sex, and BMI. At the femoral neck, strong associations were found for walking distance (beta = 0.152; P < 0.001) and age (beta = -0.004; P = 0.003), and less certain associations for male sex (beta = 0.055; P = 0.014) and 10-foot timed tandem walk (-0.008; P = 0.013). At the lumbar spine, walking distance (beta = 0.013; P = 0.006) and possibly physical activity growing up (beta = 0.035; P = 0.028) and male sex (beta = -0.057; P = 0.042), were associated with BMD. At the ultradistal radius, strength of grip (beta = 0.001; P = 0.002), and, less certainly, summer outdoor activities age 16-20 (beta = 0.021; P = 0.009), and age at MS onset (beta = 0.002; P = 0.036) were associated with BMD. Low BMD (z score < or = -2) was present in 19 out of 80 patients. This study shows that MS-related variables as well as past exposures differentially affect BMD at three clinically important skeletal sites. Low BMD is prevalent in these young patients. Bone health should receive attention in care for persons with MS.