Bone changes in postmenopausal Spanish women

Total and regional bone mineral content in healthy Spanish subjects by dual-energy X-ray absorptiometry

DESIGN

This is an observational cross-sectional study.

OBJECTIVE

The aim of the present study was to describe and analyze patterns of change in total and regional bone mineral content in relation to age and gender in a sedentary Spanish sample population (from the Community of Madrid). The age range of the sample population was from birth to 80 years.

MATERIALS AND METHODS

One thousand one hundred twenty healthy subjects were recruited and divided into 16 groups according to age. Each subject underwent whole-body densitometry using dual-energy X-ray absorptiometry. An analysis was made of the amount of bone mineral content (BMC) in the whole body and in different regions: the head, trunk, upper limbs, and lower limbs.

RESULTS

Gender differences in mean values for upper limbs and lower limbs are statistically significant between 16 and 70 years of age. For the head and trunk, the mean BMC values show the most significant gender differences between 16 and 25 years of age (p <or= 0.001). Total bone mineral content (TBMC) and TBMC-to-height ratio show significant gender differences between 16 and 70 years of age. In females, TBMC values increase up to 20 years of age and in males up to 25 years of age.

CONCLUSION

We have determined an evolutionary normal pattern of bone mineral content in urban Spanish people.

Regional variation of intracortical porosity in the midshaft of the human femur: age and sex differences

This study investigated age and sex differences in patterns of porosity distribution in the midshaft of the human femur. Cross-sections were obtained from 168 individuals from a modern Australian population. The sample comprised 73 females and 95 males, aged between 20 and 97 years. Microradiographs were made of 100-microm sections and pore and bone areas were determined using image processing software. Initially the sample was divided by age: young (20-44 years), middle (45-64 years) and old (65+ years), but it was found that analysis on the basis of the ratio of medullary area to total subperiosteal area gave clearer results. The cortex was divided into three rings radially and into octants circumferentially and the porosity of each segment was calculated. Results showed that a pattern with raised porosity in the posterior and anterolateral regions, and with greater porosity in the inner parts of the cortex, becomes more pronounced with age. In males this pattern develops steadily; in females there are much greater differences between the middle and older groups than earlier in life. The patterns observed are consistent with progressive bone loss occurring along a neutral axis of the cortex where bending stress is lowest and the mechanical advantage of the bone is least.

Gynecological factors and body mass index as determinants of bone mass in normal postmenopausal women. A study with peripheral quantitative computed tomography (pQCT)

OBJECTIVE

This paper studied the influence of several gynecological factors (years since menopause (YSM), age at menarche and gynecological age or reproductive life) simultaneously with anthropometric factors as determinants of bone mass in 189 healthy postmenopausal women.

METHODS

Bone mass was determined by peripheral quantitative computed tomography.

RESULTS

An overall evaluation showed that YSM correlated negatively with trabecular and cortical bone density (BMDTrab and BMDCorti) (P<0.05 in both cases). Age at menarche correlated negatively with BMDCorti (P<0.05) and gynecological age correlated positively with BMDTrab (P<0.05). Classifying the women according to their body mass index (BMI), the YSM correlation persisted in those subjects whose BMI was >25 kg/m(2), and in age at menarche and gynecological age of women whose BMI was <25 kg/m(2) (P<0.05). After separating women according to their age at menarche, their gynecological age and BMI, the only significant difference that persisted was in BMDTrab which was lower in the group with gynecological age <33 years, with a BMI <25 kg/m(2) (P=0.020). Parity and smoking had no impact on our results. By multiple regression, with BMD as the dependent variable and the gynecological factors as independent variables, we only observed significance between YSM and BMDCorti (P<0.005). The same was observed after separating women according to their BMI in the >25 kg/m(2) group (P<0.05).

CONCLUSIONS

Our data stress the importance of YSM on BMDTrab and BMDCorti, of age at menarche on BMDCorti and of gynecological age on BMDTrab. However, YSM is the gynecological factor that mainly determines BMD. The differences observed between measurements taken with pQCT and other methods commonly used to estimate bone mass indicate that results obtained with one technique cannot be extrapolated to other methods.

Ultrasound bone velocity on proximal phalanges in premenopausal, perimenopausal, and postmenopausal healthy women

RATIONALE AND OBJECTIVES

The authors studied premenopausal, perimenopausal, and postmenopausal women to determine if ultrasound bone velocity (UBV) on proximal phalanges of women reflect bone changes related to gonadal status and age.

METHODS

A total of 166 healthy women-64 postmenopausal women (mean age 58.7 +/- 9.4 years), 41 perimenopausal women (mean age 49.5 +/- 2.9 years), and 61 premenopausal women (mean age 36.8 +/- 7.1 years)-were studied. All the women underwent UBV study of the 2nd to 5th proximal phalanges on the nondominant hand and the mean value of all ultrasound measurements was calculated.

RESULTS

The postmenopausal women had a UBV that differed significantly, one-way analysis of variance, from that of the perimenopausal women and premenopausal women (both P < 0.001). The UBV measurements of the perimenopausal women differed significantly from those of the premenopausal women (P < 0.01). Simple linear regression analysis of the relation between UBV and age showed that this was significant and negative in the overall group of women (r = -0.69; P < 0.0001), significant in the perimenopausal (r = -0.66; P < 0.001) and postmenopausal women (r = -0.69; P < 0.001) and nonsignificant in the premenopausal women (r = 0.08; P not significant). In the postmenopausal women, the correlation between UBV and years since menopause was larger (r = -0.71; P < 0.0001) than the correlation between UBV and chronological age.

CONCLUSIONS

Ultrasound bone velocity of the phalanx, as a method for measuring changes in bone with age, has a precision that makes it possible to detect changes in bone mass in perimenopausal women and may perform similarly to other bone mass measurements.

Age trends in remodeling of the femoral midshaft differ between the sexes

Cross-sectional area properties of the femoral midshaft from 203 individuals of known height and weight. 1-97 years of age, from a modern Australian population were quantified using automatic video image analysis. The aim of this study, taking height and weight into account, was to determine whether (a) age trends in remodeling differ between the sexes, (b) men are better able to compensate for bone loss with age, and (c) this protective mechanism is carried through into old age. Our findings indicated that during adulthood there are distinct gender differences in femoral remodeling. From around the third to the seventh decade, men showed a fairly uniform increase in subperiosteal area, polar moment of inertia, and medullary area. Women displayed two distinct phases during this period: relative stability until around the menopause and then a marked increase in all of the above variables. In old age, gender differences diminished, both sexes showing reduced periosteal apposition and increased endosteal resorption. The resultant decline in cortical area of approximately 4% in men and 15% in women from the third to the eighth decade was significant only in women. For a given height, men had larger, stiffer femoral shafts with a greater cortical width and area and maintained this advantage into old age. Diaphyseal bone was not immune from age-related changes affecting other skeletal sites: however, due to compensatory remodeling, which was particularly evident in men, this was not reflected in increased fracture rates.

Prophylaxis of osteoporosis with calcium, estrogens and/or eelcatonin: comparative longitudinal study of bone mass

OBJECTIVE

To evaluate three different therapeutic regimens for the prevention of osteoporosis in natural and surgical postmenopausal women who had been found to have rapid bone loss in analytical studies.

METHODS

A total of 104 naturally or surgically postmenopausal women were studied, and subsequently followed-up during 1 year for avoidance of the influence of seasonal variation on bone mass, a factor overlooked in several studies. They were randomized into four groups of 26 patients each: the untreated control group (mean age 50 +/- 5 years); the hormonal replacement treatment (HRT) group (mean age 48 +/- 6 years), which was treated for 24 days each month with transdermal 17 beta-estradiol, 50 mg/day, together with medroxiprogesterone, 10 mg during 12 days; the calcium group (mean age 50 +/- 4 years), which was treated with elemental calcium, 1 g/day; and the calcitonin group (mean age 50 +/- 5 years), which was treated for 10 days each month with eel calcitonin, 40 IU/day and with elemental calcium, 500 mg/day. Full-body bone densitometry, for measuring total body bone mineral content (TBBMC), was carried out in all the women at baseline and 1 year. TBBMC was corrected for body weight by dividing its value by body weight (TBBMC/W).

RESULTS

After 1 year TBBMC/W was lower in every group: -2.14% (P < 0.001) in the control group; -0.14% (P = NS) in the HRT group (P < 0.05 vs. controls); -0.18% (P = NS) in the calcium group (P < 0.05 vs. controls); and -0.06% (P = NS) in the calcitonin group (P < 0.01 vs. controls; P < 0.05 vs. calcium and HRT).

CONCLUSIONS

These findings show that all three treatments are effective in the prevention of postmenopausal loss of bone mass.

Changes in the cortical and trabecular bone compartments with different types of menopause measured by peripheral quantitative computed tomography

Our objective was to study the changes in the bone mineral density of the cortical and trabecular compartments with different types of menopause. A total of 153 normal postmenopausal women (mean age 48 +/- 5 years) were studied. The women were divided into three groups based on mean age at menopause: early menopause (menopause before 43 years), normal menopause (menopause at 44-52 years), and late menopause (menopause after 52 years). The number of years since menopause was similar in all three groups (+/- 5 years). Cortical and trabecular bone mineral density was determined in all the women using peripheral quantitative computed tomography. Our results show that only the trabecular bone mineral density differed significantly among the groups (Kruskal-Wallis: P = 0.0029). The women with early menopause had a lower trabecular bone density than the women with normal and late menopause (P = 0.0019 and P < 0.0001, respectively). Among the women with early menopause, 22 had experienced menopause before the age of 40 and 25 after the age of 40; there were significant differences in trabecular bone mineral density between these two subgroups (P < 0.05). Trabecular bone mineral density, the only variable studied that varied among the groups, correlated significantly with the duration of reproductive life (simple linear regression: r = 0.340, P < 0.0001). In conclusion, these findings emphasize the importance of the duration of reproductive life as a determinant of bone mass in women.

Correlation of total-body bone mineral content determined by dual-energy X-ray absorptiometry with bone mineral density determined by peripheral quantitative computed tomography

RATIONALE AND OBJECTIVES

We sought to determine the value of peripheral quantitative computed tomography (pQCT) in measuring bone mineral density.

METHODS

In 50 healthy, eugonodal premenopausal women, we correlated measurements of total bone mineral content (BMCTB), made with dual-energy X-ray absorptiometry (DXA), and bone mineral density, determined by pQCT.

RESULTS

The partial correlations, adjusted for weight and age, between BMCTB and cortical bone density, total bone density, and trabecular bone density were .71 (p < .0001), .63 (p < .0001), and .32 (p < .05), respectively.

CONCLUSION

These results and the advantages of pQCT--providing precise bone density determinations for trabecular and compact bone separately, having a high spatial resolution that allows a "compartmental" analysis of bone structure, having a low coefficient of variation, and having a minimal radiation dose (< 5 mrem)--confirm the adequacy of using this method for bone mass studies.

Evidence that the loss of bone mass induced by GnRH agonists is not totally recovered

There is disagreement as to whether the loss of bone mass induced by GnRH agonists is reversible. In part, the differences of opinion might be attributed to the fact that the influence of weight and seasonal changes on bone mass is often overlooked. Taking into consideration weight and seasonal changes in bone mass, total (TBBMC) and regional body bone mineral content were measured in 38 women treated with GnRH agonists for 6 months for endometriosis or leiomyomata. Measurements were made at the onset of treatment, at 6 months of treatment and at 6 months after finishing treatment. TBBMC was corrected for body weight. Body weight had increased significantly at 6 months of treatment (P = 0.0175). Regional bone mineral content showed the following: limbs, no changes; head, significantly lower at 12 months than at baseline (P = 0.0036) and at 6 months (P = 0.0343) of therapy; trunk, significantly lower at 6 months (P = 0.0002) compared to baseline, but the values at 1 year were not significantly different from either the baseline or the 6-month values; pelvis, the same pattern of change as in the trunk (P = 0.0349). TBBMC was significantly lower at 6 months of treatment (P < 0.0001) and at 1 year (P = 0.0162). TBBMC adjusted for weight experienced the same changes as unadjusted bone mineral content (P < 0.0001 and P < 0.0009 at 6 months and 1 year, respectively). Our findings indicate that the bone mass lost with GnRH treatment had not been restored 6 months after discontinuing treatment.

Discrimination of total body bone mineral density measured by dexa in vertebral osteoporosis

The assessment of bone mineral density (BMD) is the usual study to detect patients at risk for developing osteoporosis. The aim of this study was to compare the discriminative ability of total body BMD and its different subregions with the more usual measurements of BMD of the lumbar spine and femoral neck in women with osteoporotic fractures of the spine. The BMD was determined in 61 osteoporotic (at least one vertebral wedge fracture visible in the lateral X-ray film of the thoracic or lumbar spine) and 61 age-matched control women. Measurements were made by dual X-ray absortiometry (DXA) with a total body scanner. The BMD of the osteoporotic women was significantly lower at all skeletal areas compared with control (P < 0.001). The diminution was less pronounced but still significant at the arms (P < 0.05). The areas with the largest Z score in the osteoporotic group were antero-posterior lumbar spine (-1.78), femoral neck (-1.71), legs (-1.67), and total body (-1.59). There was no significant difference among the Z scores of the four above-mentioned measurements. The Z score of the arms (-0.79), spine (-1.12), and head (-1.29) were significantly lower than the Z score of the total body. The Z score of the pelvis was lower than the Z score of the total body but the difference only approached statistical significance (0.05 > P < 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison between metacarpal bone measurements by computarized radiogrammetry and total body DEXA in normal and osteoporotic women

We evaluated the precision of metacarpal radiogrammetry by computed radiography as a technique for bone mass measurement. Measurements obtained using this method were compared with densitometric measurements of total body bone mass using dual-energy X-ray absorptiometry. Our results showed that the coefficients of variation for radiogrammetric measurements were similar in 60 women with osteoporosis and in 100 normal women: 0.7% in both groups for external diameter of the second metacarpal, 2.41% in the normal women and 2.03% in the women with osteoporosis for internal diameter, and 2.3% and 2.4%, respectively, for cortical thickness. Except for external metacarpal diameter, which did not differ between normal and osteoporotic women, all the measurements were smaller in the women with osteoporosis (p < 0.001). The correlation between metacarpal cortical thickness and total body bone mineral content was r2 = 0.462 in the women with osteoporosis, r2 = 0.476 in the controls, and r2 = 0.522 in the two groups combined (all p < 0.001). There was a significant correlation (p < 0.001) between cortical thickness and densitometric metacarpal measurements of both the diaphysis and epiphysis. These results confirm the value of radiogrammetry as a technique for quantitating bone mass under normal and pathological conditions. Additional advantages of the method are minimal radiation dose delivered, possibility for storing the image and data, and technical facility.

Quantitative peripheral computed tomodensitometric study of cortical and trabecular bone mass in relation with menopause

Changes in total, cortical and trabecular bone mass were studied using quantitative peripheral computed tomodensitometry on the forearm of 58 normal eugonadal premenopausal women and 116 normal postmenopausal women to evaluate the evolution of bone components with age. In premenopausal women, no changes were seen in any bone component. In postmenopausal women, only trabecular bone mass diminished in the first 5 years after menopause (P < 0.05). It continued to decrease in the next 5 years (P < 0.05), but not later. Cortical bone mass experienced a significant loss 6-10 years after menopause (P < 0.001), and more than 15 years after menopause (P < 0.0005). These results are similar to those obtained with other techniques, and document the differing behavior of the cortical and trabecular bone components with years of menopause.