Screening for osteoporosis by bone densitometry: a stratified intervention approach

Effects of Zoledronate on Mortality and Morbidity after Surgical Treatment of Hip Fractures

We aimed to evaluate the effects of intertrochanteric femoral fractures on mortality, morbidity, and cost of zoledronate treatment in elderly patients treated by osteosynthesis. Based on Evans classification, 114 patients with unstable intertrochanteric femoral fractures were treated with osteosynthesis. After the surgical treatment of intertrochanteric fractures, the treatment group (M/F, 24/32; mean age, 76.7 ± SD years) received zoledronate infusion, and the control group (M/F, 20/38; mean age, 80.2 ± SD years) received placebo. Postoperative control visits were performed at 6-week, 3-month, 6-month, and 12-month time points. Functional level of patients was evaluated by the modified Harris hip score and Merle d'Aubigné hip score. By 12 months, the mean HHS in treatment and control groups was 81.93 and 72.9, respectively. For time of death of the patients, mortality was found to be 57.1% (16/28) on the first 3 months and 92.9% (26/28) on the first six months. The mortality rate in the treatment and control groups was 14.3% (8/56) and 34.5% (20/58), respectively. The use of zoledronic acid after surgical treatment of intertrochanteric femoral fractures in osteoporotic elderly patients is a safe treatment modality which helps to reduce mortality, improves functional outcomes, and has less side effects with single dose use per year.

Milk supplementation of the diet of postmenopausal Chinese women on a low calcium intake retards bone loss

The Chinese diet is low in calcium (less than 500 mg/day on average), and previous observational studies have suggested an association between a low calcium intake and risk of hip and vertebral fracture. In this study, we randomly assigned 200 postmenopausal Chinese women (age range, 55-59 years) to receive 50 g of milk powder containing 800 mg of calcium per day or to a control group. The following are the mean percentage changes (and SEs) in height and bone mineral density (BMD) over 24 months: for height, -0.1 +/- 0.2 cm in the milk supplementation group and -0.2 +/- 0.1 cm in the control group; for BMD at the total hip, -0.06 +/- 0.22% in the milk supplementation group and -0.88 +/- 0.26% in the control group; for BMD at the spine (L1-L4), -0.56 +/- 0.29% in the milk supplementation group and -1.5 +/- 0.29% in the control group; for total body BMD, -0.32 +/- 0.16% in the milk supplementation group and -1.2 +/- 0.19% in the control group (p < 0.05 by analysis of covariance [ANCOVA] for repeated measures for height and BMD at all sites). The milk supplementation group had less loss in terms of both height and BMD than the control group (p < 0.05 by ANCOVA for repeated measures). Serum parathyroid hormone (PTH) concentration was lower and serum 25-hyroxyvitamin D [25(OH)D] level was higher in the milk supplementation group than the control group at 12 months (p < 0.05 by paired t-test). We conclude that supplementing the diet of postmenopausal Chinese women with high calcium milk powder retards bone loss.

Low bone mass in premenopausal parous women: identification and the effect of an information and bone density feedback program

The aims of this study of premenopausal parous women were to determine whether low bone mass could be accurately identified by clinical risk factors and to describe the effect of an information and bone mineral density (BMD) feedback program on lifestyle behavior. The subjects were a convenience sample of 271 women who took part in a cohort study of cot death in 1988, and in a population-based study of the determinants of bone mass in 1996. These subjects were provided with BMD feedback according to their T-score. Those with a score < -1.0 at either the femoral neck or lumbar spine were sent a letter indicating that their BMD was low (n = 72), whereas those scoring above -1.0 at both sites (n = 199) were told that their BMD was normal. Both groups were given a comprehensive osteoporosis information leaflet. In late 1997 we were able to contact 256 subjects (95%). In logistic regression, the presence or absence of low BMD was correctly classified in 79% of cases (p < 0.0001) by a model containing body mass index, fracture history, smoking, breastfeeding history, and sports participation. The model had poor sensitivity (38%) but high specificity (93%). At follow-up, those with low BMD had similar smoking cessation rates (16 vs 17%, p = 0.93) but higher rates of increased calcium intake (61 vs 9%), calcium supplement use (39 vs 4%), and increased physical activity (41 vs 17%) (all p < 0.001) in comparison with those with normal BMD. We conclude that a feedback program can alter self-reported behavior in young women for at least 12 mo and that the magnitude of effect is greatest in those with low BMD. Identification of these subjects by clinical risk factors is good but suboptimal, suggesting that measurement of BMD may be necessary to target most accurately and effectively those at highest risk.

The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women

The etiology of age-related bone loss is unclear but both lack of exercise and dietary calcium deficiency have been implicated in its causation. This 2-year randomized placebo-controlled study was designed to examine the effects of increased dietary calcium and exercise in 168 women who were more than 10 years postmenopausal. The subjects were randomized into one of 4 groups: placebo, milk powder containing 1 g of calcium, calcium tablets 1 g/night, and calcium tablets 1 g/night and an exercise regimen. The exercise group aimed to undertake 4 h of extra weight-bearing exercise per week and were undertaking 10% more activity than other groups at 2 years. Bone mineral density at the lumbar spine, three hip sites, and two sites of the tibia close to the ankle joint were measured at 6 month intervals. Dietary intake was evaluated by a weighed food record, exercise was evaluated by an exercise diary, and blood and urine samples were obtained to examine effects on calcium homeostasis. Individual data points were compared using repeated measures ANOVA and least squares regression. Calcium supplementation by either the calcium tablets or the milk powder resulted in cessation of bone loss at the intertrochanteric hip site (placebo, calcium tablets, calcium and exercise, milk powder -0.81, +0.17, +0.23, and +0.07% per year, respectively; p < 0.05 for all supplementation groups compared with placebo) with similar results at the trochanteric hip site. The calcium and exercise group had less bone loss at the femoral neck site when compared with calcium supplementation alone (placebo, calcium tablets, calcium and exercise, milk powder -0.67, -0.18, +0.28, and -0.18% per year, respectively; p < 0.05 for calcium and exercise compared with calcium alone). There was a significant reduction in the rate of bone loss at the ultradistal site of the tibia (placebo, calcium tablets, calcium and exercise, milk powder -2.5, -1.6, -1.0, and -1.5% per year, respectively; p < 0.05 for all supplementation groups compared with placebo). There was no significant bone loss at the spine site in any group.(ABSTRACT TRUNCATED AT 250 WORDS)