Associations of physical activity and calcium intake with bone mass and size in healthy women at different ages

Associations of calcium intake and physical activity with bone density and size in premenopausal and postmenopausal women: a peripheral quantitative computed tomography study

The purpose of this cross-sectional study was to examine the impact of long-term physical activity (PA) and calcium intake on non-weight-bearing radius and weight-bearing tibia. Altogether, 218 healthy, nonsmoking women, [92 premenopausal women, mean age, 32.6 years (SD, 2.2 years), and 126 postmenopausal women, mean age, 67.3 years (SD, 2.0 years)] participated. The subjects were divided according to their habitual levels of physical activity (PA+ or PA-) and calcium intake (Ca+ or Ca-). The distal end and shaft regions of the radius and tibia were evaluated with peripheral quantitative tomography (pQCT). For the shaft regions, bone mineral content (BMC), cortical cross-sectional area (CoA), cortical density (CoD), and bone strength index, that is, 1-11.9% of the density-weighted section modulus (BSI) were determined. For the distal ends, BMC, total cross-sectional area (ToA), trabecular density (TrD), and BSI were determined. The BMC at the distal radius in the young PA+ group was 6.6% (95% CI, 1- to 11.9%) lower than that of the PA- group. A similar nonsignificant trend was found for the radial shaft. The radial shaft showed a mechanically more competent structure among the older subjects with a BSI 8.5% (95% CI, 1.8-15.6%) higher in the older PA+ group than in the older PA- group. The associations between calcium intake and the radial bone characteristics were systematically positive in both age groups. PA seemed to benefit the distal tibia. In the younger age group the TrD was 6.9% (95% CI, 1.8-12.4%) higher in the PA+ group, and in the elderly the BMC was 5% (95% CI, 0.3-9.9%) higher in the PA+ group than in the PA- group. Note that in the younger age group the ToA was 5.1% (95% CI, 0-9.1%) smaller in the PA+ group than in the PA- group, and in the older age group the ToA was 4.2% (95% CI, -0.3-8.9%) greater in the PA+ group than in the PA- group. The association of PA and bone characteristics at the tibial shaft was positive in both age groups (statistically significant for the older subjects). The tibial shaft BSI of the older PA+ group was 8.6% (95% CI, 2.6-14.9%) better than that of the old PA- group. There was no association between calcium intake and the tibial bone characteristics in either age group. In conclusion, high calcium intake was positively associated with a mechanically competent structure in the radius among both younger and older women, whereas the influence of PA did not become apparent until older ages. PA seemed to benefit particularly the weight-bearing tibia, whereas calcium intake was not associated with the tibia.

Modifiable determinants of bone status in young women

The purpose of this study was to evaluate the contributions of exercise, fitness, body composition, and calcium intake during adolescence to peak bone mineral density and bone structural measurements in young women. University Hospital and 75 healthy, white females in the longitudinal Penn State Young Women's Health Study were included. Body composition, total body, and hip bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry (DXA), exercise scores by sports-exercise questionnaire during ages 12-18 years, and estimated aerobic capacity by bike ergometry. Section modulus values (a measurement of bending strength) cross-sectional area (CSA), subperiosteal width, and cortical thickness were calculated from DXA scan data for the femoral neck and femoral shaft. Calcium intakes were calculated from 39 days of prospective food records collected at 13 timepoints between ages 12 and 20 years; supplemental calcium intakes were included. Section moduli at the femoral neck and shaft were correlated significantly with lean body mass, sports-exercise scores (R(2) = 0.07-0.19, p < 0.05), and aerobic capacity (R(2) = 0.06-0.57, p < 0.05). Sports-exercise scores correlated with BMD at the femoral neck and shaft. Average total daily calcium intake at age 12-20 years ranged from 486 to 1958 mg/day and was not significantly associated with total or regional peak BMD or bone structure measures at 20 years of age. It was shown that achievable levels of exercise and fitness have a favorable effect on BMD and section modulus of the femoral neck and femoral shaft in young adult women, whereas daily calcium intake of >500 mg in female adolescents appears to have little, if any effect.

Validity of bone mineral density measurements in distal sites as an indicator of total bone mineral density in a group of pre-adolescent and adolescent women

BACKGROUND

The study of bone mineral density (BMD) has received attention due to the importance of osteoporosis as a public health problem in Mexico. The objective of this study was to assess the validity of BMD measures in distal forearm and calcaneus with portable densitometers as indicators of BMD on other anatomic sites.

METHODS

We conducted a cross-sectional study with 219 women from 9 to 22 years of age in Cuernavaca, Morelos, Mexico. We measured BMD in central sites (the entire skeleton, excluding head, proximal femur, and lumbar spine) using dual X-ray absorptiometry (DXA) and in peripheral sites (distal forearm and calcaneus) using a portable densitometer with DXA technology. Measurements of height, weight, body composition, physical activity, and demographic characteristics were collected. Agreement of measurements of BMD was assessed using correlation and regression analysis, and the method proposed by Bland and Altman.

RESULTS

Higher levels of BMD were found in total skeleton (0.88 g/cm(2)) than in calcaneus (0.48 g/cm(2)) and distal forearm (0.38 g/cm(2)) (p <0.05). Moderate-to-high positive correlation coefficients (all significant) (p <0.05) were found between BMD in distal forearm and calcaneus vs. central anatomic sites, ranging from r = 0.49 to r = 0.78. BMD was higher in central sites compared with distal forearm and calcaneus.

CONCLUSIONS

Measurement of BMD in distal forearm and calcaneus with portable densitometers provided valid indicators of BMD in central anatomic sites among pre-adolescent and adolescent women in Mexico.

Determination of bone size of hip, spine, and wrist in human pedigrees by genetic and lifestyle factors

Osteoporosis is a major public health problem defined as a loss of bone strength, of which bone size is an important determinant. Compared with extensive studies on bone mass, studies on the importance of factors determining variation in bone size are relatively few. In particular, the significance of genetic factors is largely unknown. In 49 pedigrees with 703 subjects bone sizes of the hip, spine, and wrist were measured by dual X-ray absorptiometry. We evaluated the contribution of genetic factors in determining variation in bone size of the hip, spine, and wrist while studying age, sex, weight, height, exercise, smoking, alcohol consumption, and the interaction among these factors as covariates for their effects on bone size. We found that, on average, males have larger bone sizes. Male bone sizes at the spine and hip increased with age; however, the effect of age in our female subjects was nonsignificant. Height invariably affected bone size at all the sites studied. Alcohol consumption and exercise generally had significant effects in increasing bone size at the spine and/or hip in both males and females. After adjusting for sex, age, weight, height, lifestyle factors, and the significant interactions among these factors, heritabilities (+/-SE) were, respectively, 0.48 (0.09), 0.64 (0.08), and 0.60 (0.09) for bone size at the hip, spine, and wrist.

Mineral mass, size, and estimated mechanical strength of triple jumpers' lower limb

This study was designed to examine the anticipated strong influence of extreme impact loading on the mineral mass, size, and gross structural properties of triple jumpers' lower limb bones. We compared the bone data obtained with peripheral quantitative computed tomography (pQCT) and dual-energy X-ray absorptiometry (DXA) from 8 Finnish triple jumpers with corresponding data from gender-, age-, height-, and weight-matched nonathletic peers. The volumetric (trabecular) density was significantly higher in the jumpers than in controls (from an average 18% difference at the distal tibia to a 41% difference at the proximal tibia), whereas the cortical density did not differ between groups. The DXA-derived areal bone mineral density of the femoral neck and lumbar spine was 31% higher in the jumpers than in controls, compared with a 16% difference between groups at the less-loaded distal radius. The lower limb bones were comparable in size between groups except at the distal femur where a significant 4%-6% difference was observed in favor of the triple jumpers. Mean tibial cortical wall thickness and area were substantially greater in the triple jumpers; the mean group difference ranged from about 20% at the shaft sites, to over 50% at the distal tibia. Given the apparently stronger cortices in the triple jumpers, the section moduli (bone strength index) of their femoral necks and tibiae were 19%-31% higher compared with the control group. Our findings indicate the ability of extreme impact loading to considerably improve bone's mechanical competence. Adaptation to loading seems to occur in a site-specific fashion by gross geometric changes, structural or architectural changes, or by their combination. The loading effect was best seen as enlarged bone cortices, probably after the trabecular density had reached its ceiling.

Comparison of bone parameters by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography in Hutterite vs. non-Hutterite women aged 35-60 years

A previous report of elevated dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) Z scores suggests that Hutterite females might be significantly less likely to develop osteoporosis compared with other U.S. females. In the present study, we sought to determine if high Hutterite DXA BMD Z scores were elevated because of larger bone size. Hutterites reside in isolated, self-sufficient colonies with an emphasis on agricultural production, and girls enter a strenuous task rotation at age 15 years. We obtained cross-sectional bone measurements of the 66% distal tibia using peripheral quantitative computed tomography (pQCT) to compare bone size and geometry on 97 Hutterite and 30 non-Hutterite women, aged 35-60 years. Total body (TB) and lumbar bone mineral content (BMC), BMD, and bone area measurements by DXA were available on a subset of the study population. We identified no differences between groups in pQCT total bone area, cortical bone area, or cortical bone density. Larger bone area by DXA was apparent in Hutterites compared with non-Hutterites at the TB (least square means: 2038 +/- 8 cm2 vs. 1953 +/- 19 cm2, p < 0.05) and lumbar (least square means: 58 +/- 0.5 cm2 vs. 57 +/- 2 cm2, p < 0.01) sites. TB BMC adjusted for TB bone area was marginally higher in Hutterites compared with non-Hutterites (least square means: 2341 +/- 15 g vs. 2281 +/- 30 g, p = 0.08). Hutterites had marginally higher TB BMD Z scores when controlling for weight and age (least square means: 1.3 +/- 0.1 vs. 0.8 +/- 0.2, p = 0.07). Hutterites had higher lumbar BMC adjusted for lumbar bone area and weight (least square means: 65 +/- 1 g vs. 58 +/- 2 g, p < 0.01) and higher weight-and age-adjusted lumbar BMD Z scores (least square means: 1.1 +/- 0.1 vs. 0.1 +/- 0.4, p = 0.01). Our data indicate that a true advantage in trabecular bone density probably exists among Hutterite women aged 35-60 years. Hutterite women might be protected against age-related fractures because of their larger bone size and higher bone density at normally susceptible trabecular sites.

Bone mineral density of visually handicapped women

While physical activity is an essential factor for muscle performance and development and also for the maintenance of bone mass in the loaded bones, apparently low intensity of physical activity of blind persons may compromise the muscle performance and bone mineral density (BMD). Therefore, the aim was to study whether there are differences in BMD of the weight-bearing or non-weight-bearing bones between visually handicapped persons and those with normal sight. Nineteen visually handicapped premenopausal women and their matched pairs were recruited to the study. The mean age of the visually handicapped women was 39.9 years (SD 8.1) and that of the women with normal vision 39.7 years (6.5). BMD of the distal radius, femoral neck and trochanter was measured with dual energy X-ray absorptiometry (DXA), and isometric muscle strength of the extremities and trunk with a dynamometer. Between-group differences were compared with paired Student's t-test. The BMD at the femur was 8% higher in favour of the group with normal sight, whereas radial BMD was similar in the two groups. The t-score was -1.0 (95% confidence interval -1.5 to -0.5) for the femoral neck BMD and -0.7 (-1.1 to -0.2) for the trochanter BMD in the group with impaired vision. The respective t-scores for the group with normal sight were -0.3 (-0.9 to 0.3) for the femoral neck and 0 (-0.7 to 0.7) for the trochanter. Visual handicap seems to be a risk for lower BMD of the weight-bearing proximal femur, but not for lower BMD of the non-weight-bearing distal radius.

Effect of physical activity during teenage years, based on type of sport and duration of exercise, on bone mineral density of young, premenopausal Japanese women

In this cross-sectional study, 91 healthy premenopausal women aged 20-39 years were investigated to determine the effect of physical activities during their teenage years on their current bone mineral densities (BMD). We measured whole-body BMD (WBMD), lumbar BMD (LBMD), and radial BMD (RBMD) with dual energy X-ray absorptiometry (DXA). Using a questionnaire, we asked the women about their physical activities during junior and senior high school and at present. We also asked about their current nutritional status and past and current milk intake. After adjusting for age, body mass index (BMI), current total calorie and calcium (Ca) intake, and milk intake when they were teenagers and at present, we determined that subjects who exercised during extracurricular activities at each of the three periods (during junior and senior high school and at present) had significantly higher WBMD and LBMD (P <0.01, respectively) than did those who did not exercise at those times. Subjects who played high-impact sports at each period had significantly higher WBMD and LBMD than did subjects who played low-impact sports (P <0.05, respectively). Subjects who had exercised regularly from their teenage years to the present had significantly higher BMD at all sites than BMD in other subjects after adjusting for the potential confounders described above (P <0.05, respectively). Our data suggest that continuous exercise beginning in junior high school, especially high-impact sports, may be associated with greater current bone mass. It is important to incorporate adequate exercise beginning in the teenage years to lower one's future risk for osteoporosis.

Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women

We studied the effects of a 6-month withdrawal of exercise after 12 months of progressive impact (jump) plus lower body resistance training on risk factors for hip fracture in premenopausal women (age, 30-45 years). Twenty-nine women completed the 12-month training and detraining programs and were compared with 22 matched controls. Bone mineral density (BMD) at the greater trochanter, femoral neck, lumbar spine, and whole body and body composition (% body fat) were measured by dual energy X-ray absorptiometry (DXA; Hologic QDR-1000/W). Knee extensor and hip abductor strength were assessed via isokinetic dynamometry (Kin-Com 500H); maximum leg power was tested using a Wingate Anaerobic Power test; and dynamic postural stability was measured on a stabilimeter (Biodex). All measurements were conducted at baseline, 12 months and 18 months with an additional midtraining measurement of BMD. Exercisers trained three times per week in a program of 100 jumps and 100 repetitions of resistance exercises at each session. Intensity was increased using weighted vests to final values of 10% and 13% of body weight (BW) for jump and resistance exercises, respectively. Differences between groups from training were analyzed by repeated measures analysis of covariance (ANCOVA), adjusted for baseline values. Detraining effects were analyzed by comparing the changes from training with the changes from detraining using repeated measures analysis of variance (ANOVA). Baseline values were not significantly different between exercisers and controls. Percent change over the training period was significantly greater in the exercise group than in the control group at the greater trochanter (2.7 +/- 2.5% vs. 0.8 +/- 0.8%, respectively; p < 0.01) and approached significance at the femoral neck (1.2 +/- 3.2% vs. -0.3 +/- 1.9%, respectively; p = 0.06). Significant improvements also were observed in exercisers versus controls for strength and power with exercisers increasing 13-15% above controls, whereas stability was not different between groups. After 6 months of detraining, BMD and muscle strength and power decreased significantly toward baseline values, whereas control values did not change. We conclude that the positive benefits of impact plus resistance training on the musculoskeletal system in premenopausal women reverse when training is withdrawn. Therefore, continued training, perhaps at a reduced frequency and intensity, is required to maintain the musculoskeletal benefit from exercise that may lower fracture risk in later life.

Structural trends in the aging femoral neck and proximal shaft: analysis of the Third National Health and Nutrition Examination Survey dual-energy X-ray absorptiometry data

Hip scans of U.S. adults aged 20-99 years acquired in the Third National Health and Nutrition Examination Survey (NHANES III) using dual-energy X-ray absorptiometry (DXA) were analyzed with a structural analysis program. The program analyzes narrow (3 mm wide) regions at specific locations across the proximal femur to measure bone mineral density (BMD) as well as cross-sectional areas (CSAs), cross-sectional moments of inertia (CSMI), section moduli, subperiosteal widths, and estimated mean cortical thickness. Measurements are reported here on a non-Hispanic white subgroup of 2,719 men and 2,904 women for a cortical region across the proximal shaft 2 cm distal to the lesser trochanter and a mixed cortical/trabecular region across the narrowest point of the femoral neck. Apparent age trends in BMD and section modulus were studied for both regions by sex after correction for body weight. The BMD decline with age in the narrow neck was similar to that seen in the Hologic neck region; BMD in the shaft also declined, although at a slower rate. A different pattern was seen for section modulus; furthermore, this pattern depended on sex. Specifically, the section modulus at both the narrow neck and the shaft regions remains nearly constant until the fifth decade in females and then declined at a slower rate than BMD. In males, the narrow neck section modulus declined modestly until the fifth decade and then remained nearly constant whereas the shaft section modulus was static until the fifth decade and then increased steadily. The apparent mechanism for the discord between BMD and section modulus is a linear expansion in subperiosteal diameter in both sexes and in both regions, which tends to mechanically offset net loss of medullary bone mass. These results suggest that aging loss of bone mass in the hip does not necessarily mean reduced mechanical strength. Femoral neck section moduli in the elderly are on the average within 14% of young values in females and within 6% in males.

Determination of bone mineral density of the hip and spine in human pedigrees by genetic and life-style factors

In 40 human pedigrees with 563 subjects, we evaluated the contribution of genetic and life-style factors (exercise, smoking, and alcohol consumption) and the interactions between non-genetic factors in determining bone mineral density (BMD) of the hip and spine. In our analysis, we adjusted for age, weight, height, menopausal status in females, life-style factors, and the significant interactions among these factors. For the spine and hip BMD, heritabilities (h(2)) (+/- SE) were, respectively, 0.68 (0.21) and 0.86 (0.28) in males and 0.64 (0.13) and 0.67 (0.14) in females. Exercise had significant beneficial effects for male spine BMD and female hip BMD. Alcohol consumption experienced in our sample had significant beneficial effects on hip BMD in both sexes. Although the main effect of smoking was not significant, there were significant interaction effects between smoking and other important factors (e.g., exercise, weight, alcohol consumption). For example, for female spine BMD, exercise had significant beneficial effects in smokers; however, its effect in non-smokers was non-significant. This result indicates that exercise may reduce deleterious effects of smoking (if any) on BMD, but may have minor effects in increasing BMD in non-smokers. The various interaction effects among risk factors explicitly revealed here for the first time indicate that the detailed effects and direction of individual risk factors may depend on the presence and magnitude of other factors. Weight invariably affected BMD of the hip and spine in both sexes. Age effects were significant for hip BMD, but not for male spine BMD.

Exercise-induced bone gain is due to enlargement in bone size without a change in volumetric bone density: a peripheral quantitative computed tomography study of the upper arms of male tennis players

Bilateral bone characteristics of the humerus (proximal, shaft, and distal sites) and radius (shaft and distal sites) in 12 former Finnish national-level male tennis players (mean age 30 years) and their 12 age-, height-, and weight-matched controls were measured with peripheral quantitative computed tomography (pQCT). The pQCT variables analyzed were bone mineral content (BMC), total cross-sectional area of bone (Tot.Ar), cross-sectional area of the marrow cavity (M.Cav.Ar), cortical bone (Co.Ar) and trabecular bone (Tr.Ar), volumetric density of cortical (Co.Dn) and trabecular (Tr. Dn) bone, cortical wall thickness (Co.Wi.Th), bone strength index (BSI), and principal moments of inertia (I(min) and I(max)). In the players, significant side-to-side differences, in favor of the dominant (playing) arm, were found in BMC (ranging 14%-27%), Tot.Ar (16%-21%), Co.Ar (12%-32%), BSI (23%-37%), I(min) (33%-61%), and I(max) (27%-67%) at all measured bone sites, and in Co.Wi.Th. (5%-25%) at the humeral and radial shafts, and distal humerus. The side-to-side M.Cav.Ar difference was significant at the proximal humerus (19%) and radial shaft (29%). Concerning the players' Co.Dn and Tr.Dn, the only significant side-to-side difference was found in the Co.Dn of the distal humerus, with the playing arm showing a slightly smaller Co.Dn than the nonplaying arm (-2%). In controls, significant dominant-to-nondominant side differences were also found, but with the majority of the differences being rather small, and significantly lower than those of the players. In conclusion, despite the large side-to-side differences in BMC, the volumetric bone density (Co.Dn, Tr.Dn) was almost identical in the dominant and nondominant arms of the players and controls. Thus, the players' high playing-arm BMC was due to increases in the Tot.Ar, M.Cav.Ar, Co.Ar, and CW.Th. In other words, the playing arm's extra bone mineral, and thus increased bone strength, was mainly due to increased bone size and not due to a change in volumetric bone density. These upper arm results may not be generalized to the entire skeleton, but the finding may give new insight into conventional dual-energy X-ray absorptiometry (DXA)-based bone density measurements when interpreting the effects of exercise on bone.

Calcium requirements of physically active people

Dietary calcium and physical activity have been independently, but inconsistently, associated with the development of increased peak bone mass and reduced bone loss later in life. An examination of the literature points to important effects of dietary calcium on bone health. During the development of peak bone mass, calcium intakes of <1 g/d are associated with lower bone mineral density. At intakes approaching calcium requirements, physical activity is a more important predictor of bone mineral density than is calcium intake. In studies of postmenopausal women, calcium intakes of 1 g (25 mmol/d) appear to be necessary to effect a positive impact of exercise on bone mineral density in the spine. Calcium intakes recommended for protecting bone health appear to be adequate to protect against other disorders with an etiology that includes inadequate dietary calcium. Calcium requirements as modified by physical activity need to be determined for each population subgroup according to sex, age, race, and cultural environment.

Risk factors for stress fractures

Preventing stress fractures requires knowledge of the risk factors that predispose to this injury. The aetiology of stress fractures is multifactorial, but methodological limitations and expediency often lead to research study designs that evaluate individual risk factors. Intrinsic risk factors include mechanical factors such as bone density, skeletal alignment and body size and composition, physiological factors such as bone turnover rate, flexibility, and muscular strength and endurance, as well as hormonal and nutritional factors. Extrinsic risk factors include mechanical factors such as surface, footwear and external loading as well as physical training parameters. Psychological traits may also play a role in increasing stress fracture risk. Equally important to these types of analyses of individual risk factors is the integration of information to produce a composite picture of risk. The purpose of this paper is to critically appraise the existing literature by evaluating study design and quality, in order to provide a current synopsis of the known scientific information related to stress fracture risk factors. The literature is not fully complete with well conducted studies on this topic, but a great deal of information has accumulated over the past 20 years. Although stress fractures result from repeated loading, the exact contribution of training factors (volume, intensity, surface) has not been clearly established. From what we do know, menstrual disturbances, caloric restriction, lower bone density, muscle weakness and leg length differences are risk factors for stress fracture. Other time-honoured risk factors such as lower extremity alignment have not been shown to be causative even though anecdotal evidence indicates they are likely to play an important role in stress fracture pathogenesis.

Long-term recreational gymnastics, estrogen use, and selected risk factors for osteoporotic fractures

The purpose of this cross-sectional study was to examine whether long-term participation in recreational gymnastics or folk dancing or estrogen replacement therapy (ERT) is associated with mechanically more competent bones and improved muscular strength and body balance. One hundred and seventeen healthy, female postmenopausal recreational gymnasts (mean age 62.1 [SD 4.7] years) and 116 sedentary controls (mean age 61.5 [4.6] years) were enrolled in the study. Bone mineral content (BMC) of the distal radius, femoral neck, and trochanter were measured with dual-energy X-ray absorptiometry. BMC of the midshaft and distal tibia and trabecular density (TrD) of the distal tibia were measured with peripheral computed quantitative tomography. Maximal isometric strength, muscular power, cardiorespiratory fitness, and body balance of the participants were also assessed. The cardiorespiratory fitness, muscular strength, and dynamic balance of the recreational gymnasts and folk dancers combined were significantly better than those of the controls, the average group difference ranging from 7.5% (95% confidence interval 5.0-9.9%) in dynamic balance to 12.8% (6.6-19. 4%) in dynamic muscular power. ERT was not associated with the fitness indicators, muscular power, or balance, but was significantly associated with the BMC at all the measured bone sites, the mean group difference between estrogen users and nonusers ranging from 6.5% (3.7-9.3%) for the tibial shaft to 11.8% (6.4-17. 0%) for the distal radius. Recreational gymnastics, in turn, was significantly associated with higher BMC at the tibia only, the mean group difference being 3.9% (0.9-6.9%) for the tibial shaft and 7.7% (3.7-11.9%) for the distal tibia. Recreational gymnastics was also associated with higher TrD at the distal tibia (5.2%; 1.2-9.2%), whereas estrogen usage did not show such association. The results indicate that ERT seems especially effective in preventing postmenopausal bone loss, whereas recreational gymnastics and folk dancing improve muscular performance and body balance in addition to increased bone mass and bone size in the tibia. All these factors are essential in prevention of fall-related fractures of the elderly.

Association between calcium ingested from drinking water and femoral bone density in elderly women: evidence from the EPIDOS cohort

Although the main source of dietary calcium is dairy products, the calcium contained in mineral water, which is as available as that of milk, could provide a valuable source of calcium. We analyzed the data from the EPIDOS multicenter study to evaluate the relationship between both dietary calcium and that supplied by drinking water and bone density measured at the femoral neck by dual-energy X-ray absorptiometry. The study included 4434 women over 75 years of age who had not received any treatment likely to interfere with calcium metabolism. A significant correlation was found between total calcium intake and bone density at the femoral neck (r = 0.10, p < 0. 001). After adjustment for the main variables influencing bone density, an increase of 100 mg/day in calcium from drinking water was associated to a 0.5% increase in femoral bone density, while a similar increase in dietary calcium from other sources only led to a 0.2% increase; however, this difference was not significant. The consumption of calcium-rich mineral water may be of interest, especially in older women who consume little calcium from dairy products.

Strange osteosclerosis at femoral neck

A 4 (1/2) yr follow-up of bone mineral density of a young woman revealed a dramatic 84% increase at the femoral neck, whereas the increase at the trochanter was only 11%. This finding suggested a very substantial accumulation of bone mineral in the neck region only. In the immediate repeated DXA scan, however, all the signs of this osteosclerosis disappeared. The primary reason for this strange DXA finding was a discrete contact failure in the control electronics of the scanner that confused the analysis of the scan data. The standard quality control was unable to detect this malfunction.