Osteoporosis: visions for care and prevention--a conference report

Changes in Behavior and Behavioral Intentions among Middle-Age Women: Results from an Osteoporosis Prevention Program

The purpose of this study was to evaluate changes in behaviors and behavioral intentions that occurred among 342 middle-age women ( M age 49.5 yr.) after participating in an Osteoporosis Prevention Program. The valid and reliable Osteoporosis Preventing Behaviors Survey (developed by Doheny and Sedlak) and a survey developed for this work were measures. Significant changes in behaviors were reported, especially increases in weight-bearing physical activity, dairy product intake, and decreases in consumption of caffeine-containing beverages. Many subjects reported intentions to increase physical activity and calcium intake. An Osteoporosis Prevention Program may help promote osteoporosis prevention behaviors, but intents must be followed up to check actual change.

Coincidence of calcified carotid atheromatous plaque, osteoporosis, and periodontal bone loss in dental panoramic radiographs

PURPOSE

This study was performed to assess the correlation of calcified carotid atheromatous plaque (CCAP), the mandibular cortical index, and periodontal bone loss in panoramic radiographs.

MATERIALS AND METHODS

One hundred eighty-five panoramic radiographs with CCAP and 234 without this finding were evaluated by 3 observers for the presence of osseous changes related to osteoporosis and periodontal bone loss. Chi-squared and Mann-Whitney U tests were used to compare the two groups for an association of CCAP with the mandibular cortical index and periodontal bone loss, respectively.

RESULTS

There was a statistically significant coincidence of CCAP and osseous changes related to osteopenia/osteoporosis, with a p-value <0.001. There was no statistically significant coincidence of CCAP and periodontal bone loss. When comparing the 2 groups, "With CCAP" and "Without CCAP", there was a statistically significant association with the mean body mass index (BMI), number of remaining teeth, positive history of diabetes mellitus, and vascular accidents. There was no statistically significant association with gender or a history of smoking.

CONCLUSION

This study identified a possible concurrence of CCAP and mandibular cortical changes secondary to osteopenia/osteoporosis in panoramic radiographs. This could demonstrate the important role of dental professionals in screening for these systemic conditions, leading to timely and appropriate referrals resulting in early interventions and thus improving overall health.

Risk factors associated with osteoporosis in Hispanic women

This study examined risk factors for osteoporosis in Hispanic women. Factors examined included ethnicity, gender, age, height, weight, family and personal history of fractures, height loss, exercise, diet, time since menopause or hysterectomy, hormone replacement therapy (HRT), calcium supplementation, hypertension, thyroid disease, diabetes, arthritis, chemotherapy, family history of breast cancer, use of water pills, fosamax, steroids, alcohol, and smoking. Most results found parallel those found in the Caucasian population. Heavier patients had greater bone density, as well as patients who exercised and those using HRT. Older patients had lower bone density as did diabetic patients. Results not anticipated were higher bone density in patients not taking calcium supplements, and in patients who consumed alcohol.

Osteoporosis prevention education: Behavior theories and calcium intake

Osteoporosis is a worldwide health concern. Preventing osteoporosis, and subsequent fractures, has become a goal of many health care practitioners, especially dietetics professionals. However, few prevention models have proven effective. The goal of this project was to determine whether an educational, theory-based osteoporosis prevention program would significantly impact calcium intake. This project used a convenience sample of 42 women who participated in an 8-week educational intervention, similarly to a community class. The program included hands-on activities to increase self-efficacy and was based on the Health Belief Model and Theory of Reasoned Action (TRA). The main outcome measures were calcium intake and constructs from the Health Belief Model and TRA. Significant changes in the Health Belief Model and TRA constructs at postintervention included increased perceived susceptibility to osteoporosis ( P <.001), perceived benefits to increasing calcium intake ( P <.001), and increased self-efficacy related to calcium intake ( P </=.003). Statistically significant regression equations were found for all preintervention intentions related to calcium. Postintervention calcium intake significantly increased to 821+/-372 mg/day ( P <.0001). Results of this project can be used as guidelines for dietetics professionals to develop osteoporosis prevention programs for their clientele.

The physiology, medical management and oral implications of menopause

BACKGROUND

Approximately 36 million women in the United States are in the postmenopausal phase of life. The vast majority of these women experienced spontaneous cessation of menses between the ages of 47 and 55 years when the production of estrogen decreased because of an inadequate number of functioning follicles within their ovaries. Fewer women entered menopause after surgical removal of both ovaries. This procedure usually is performed prophylactically to prevent ovarian cancer in conjunction with a hysterectomy, which is required to treat abnormal bleeding, endometriosis or pelvic inflammatory disease. The physiological changes associated with spontaneous or surgical menopause cause some women to experience uncomfortable symptoms such as hot flashes, night sweats and vaginal dryness. In addition, estrogen deprivation arising from menopause in association with age-related factors disproportionately increases the risk of developing cardiovascular disease (that is, myocardial infarct, stroke), osteoporosis, Alzheimer's disease and oral disease. Hormone replacement therapy, or HRT (estrogen or estrogen and progestin), often is prescribed on a short-term basis to alleviate the uncomfortable symptoms associated with estrogen deficiency and on a long-term basis to prevent some of the chronic illnesses common to postmenopausal women.

CONCLUSIONS

Dentists who treat women entering menopause need to consider the stressful phase of life their patients are experiencing. Clinical findings of postmenopausal problems on dental examination may include a paucity of saliva, increased dental caries, dysesthesia, taste alterations, atrophic gingivitis, periodontitis and osteoporotic jaws unsuitable for conventional prosthetic devices or dental implants. Panoramic dental radiographs may reveal calcified carotid artery atheromas.

CLINICAL IMPLICATIONS

Dentists have an opportunity to refer women who are not under the care of a gynecologist for an evaluation to determine the appropriateness of HRT for its systemic and oral health benefits.

Risk of irregular menstrual cycles and low peak bone mass during early adulthood associated with age at menarche

BACKGROUND

The risk of irregular menstrual cycles and low peak bone mass of the lumbar spine in young adult women, associated with age at menarche, has not been clearly defined. The aim of this study was to investigate this further.

METHODS

A total of 180 college females aged 20-23 years were surveyed about menstruation, exercise, and calcium intake by means of a questionnaire. We also measured vertebral bone mineral density in these women by dual energy X-ray absorptiometry. The subjects were divided into six groups according to their age at menarche. Comparisons were made of the mean body mass index (BMI) and T-scores (the ratio to the mean bone mineral density of young adult Japanese women) among those groups, and odds ratios of irregular menstrual cycles and low peak bone mass less than 87% (- 1 standard deviation (SD) of T-scores were calculated using the mean menarcheal age (12 years) group as a control.

RESULTS

The mean BMI and T-scores were significantly lower in delayed menarche groups (equal to or more than 13 years) compared with early menarche groups (equal to or less than 12 years). The odds ratios of irregular menstrual cycles were 5.9 (95% confidence intervals (CI) 1.7-20.6), 13.7 (95% CI 3.6-51.6), and 73 (95% CI 6.5-813.9) in the 13-, 14-, and more than 14 years menarcheal age groups, respectively. The odds ratio of low peak bone mass less than 87% (- 1SD) was 3.4 (95% CI 1.1-10.3) in the 14 years menarcheal age group.

CONCLUSIONS

Young adult women with delayed menarche may be at high risk for irregular menstrual cycles and low peak bone mass.

The effects of an educational intervention on calcium intake and bone mineral content in young women with low calcium intake

PURPOSE

This study evaluated whether a combined behavioral and dietary intervention would affect young women's calcium intake and bone mineral content (BMC).

DESIGN

The design was a two by three mixed design with one between-subjects factor (treatment vs. control) and one within-subjects factor (time--baseline, 3-month, and 6-month).

SETTING

The study was conducted in a university setting in Memphis, Tennessee.

PARTICIPANTS

A total of 80 premenopausal women (ages 18 to 30) with low baseline calcium intake (< 700 mg/d) were included in the analyses. There were 40 women in the treatment group and 40 women in the control group.

MEASURES

Hertzler and Frary's rapid assessment questionnaire was employed to evaluate calcium intake, and dual-energy x-ray absorptiometry (DEXA) was employed to assess BMC.

RESULTS

Repeated measures analysis of variance (RM ANOVA) was employed to analyze results. Results indicated that women in the treatment group made greater increases in total calcium intake and supplemental calcium than women in the control group and that all women made significant increases in dietary calcium intake. Additionally, analyses of BMC revealed that women in the treatment group did not experience significant changes in total BMC, and women in the control group experienced significant losses in total BMC.

CONCLUSIONS

In the current study, women were losing BMC, and the women who made the largest increases in calcium intake were able to retard this bone loss. There is increasing evidence that dietary calcium intake in young people is extremely low, and the results of the current study highlight the need for much more intensive evaluations investigating the factors that are positively associated with premenopausal bone mineral change.

Dairy-product intake and hip fracture among older women: issues for health behavior

The purpose of this study was to examine the association between dairy-product intake and hip fracture among a national sample of women aged 50 years and older. Univariate analyses using SAS procedures showed dairy-product intake was significantly associated with hip fracture. Women who had suffered hip fracture reported higher dairy use than women who had not experienced these fractures, a finding that is dramatically inconsistent with the literature. This finding may reflect positive behavioral changes resulting from the hip fracture event. Further research must focus on changes in health behavior after fracture, which may assist in understanding the roles of specific theories of health behavior. Application of principles of health behavior could improve the effectiveness of preventive treatment programs for osteoporosis.

Predictors for osteoporosis diagnosis among postmenopausal women: results from a national survey

Osteoporosis is a serious health problem in the U.S. today resulting in premature mortality, deformity, pain, loss of function, and disability. Diagnosis of osteoporosis is key to obtaining treatment. The purpose of this study was to examine risk factors that are correlated with osteoporosis diagnosis among a national sample of postmenopausal women. Factors associated with osteoporosis diagnosis included age, race, and family history. Health care providers, including physicians, dietitians, nurses, physical therapists and social workers, can play a key role in improving diagnoses among at-risk women. They can work together to increase awareness and improve knowledge regarding the risk factors for osteoporosis including body mass index, physical activity, smoking and nutritional status.

Potential application of low-dose doxycycline to treat periodontitis in post-menopausal women

The purpose of this paper is two-fold: (1) to review the evidence that osteoporosis and post-menopausal estrogen deficiency are associated with progressive alveolar bone loss and an elevated risk of tooth loss; and (2) to propose the use of tetracyclines, specifically low-dose doxycycline (LDD) (and, perhaps in the future, the chemically modified tetracyclines), to mitigate alveolar bone loss in post-menopausal osteoporotic/osteopenic women. Design concepts for a randomized clinical trial to study the effects of LDD on progressive alveolar bone loss in this patient population are reviewed. Since osteoporosis affects over 20 million people in the United States, progressive alveolar bone loss in this patient group represents a potentially significant public health problem unique from common adult periodontitis. Stopping progressive alveolar bone loss is essential to prevent both tooth loss and micro-architectural deterioration of alveolar bone.

Osteoporotic fracture among older U.S. women: risk factors quantified

The purpose of this study was to develop a predictive model for osteoporotic fracture among a national sample of 2,325 women ages 50 years and older. Predictors for examination included age, race, heredity, body mass index (BMI), physical activity, smoking status, alcohol use, and dairy product use. Analyses were conducted using Standard Analysis System (SAS) procedures. Strong risk factors predicting osteoporotic fracture included age, race, low BMI, and inactivity. Recommendations emphasize screening of high-risk women, achieving and maintaining health body weights for underweight women, and obtaining moderate physical activity. Promotion of healthy body weights for women of all ages is emphasized. Recommendations also include encouraging widespread physician, patient, and public education regarding osteoporotic fracture.

Estrogen inhibits interleukin-1beta-induced interleukin-6 production by human osteoblast-like cells

Estrogen supplements are the primary pharmacologic intervention therapy to prevent and treat loss of bone mass (osteoporosis) in postmenopausal women. Furthermore, at sites of local inflammation near bone, estrogen-deficient women are significantly more susceptible to bone loss than are estrogen-sufficient women. In the present study, we investigate whether estrogen modulates osteoblast (MG-63) production of interleukin-6 (IL-6), an osteoclast recruitment and differentiation of cytokine, in the presence of the proinflammatory cytokine, IL-1beta. Using enzyme-linked immunosorbent assay (ELISA), we demonstrate that IL-1beta significantly enhances IL-6 secretion into culture supernatants in a dose-dependent and time-dependent manner. Using reverse-transcriptase polymerase chain reaction (RT-PCR) and ELISA respectively, we demonstrate further that levels of 17beta-estradiol (active metabolite of estrogen) > or = those found in serum of estrogen-sufficient women inhibit steady-state IL-6 mRNA levels as well as inhibit secretion of IL-6 into culture supernatants. One mechanism by which estrogen therapy preserves bone mass in areas of inflammation may be via inhibition of IL-1beta-stimulated obsteoblast-derived IL-6.

Osteoporosis risk factors in eighth grade students

This study described the incidence of osteoporosis risk factors and compared gender differences in Midwestern eighth grade students. Non-modifiable risk factors were gender, ethnic heritage, and family history. Modifiable risk factors were calcium intake, physical activity, sodium intake, body mass index (BMI), smoking status, and alcohol intake. One hundred thirty-eight student/ parent pairs were sampled. Descriptive statistics and Chi-square analyses were conducted. The mean student risk factor total was 4.1 for non-modifiable and modifiable (1.9 and 2.3, respectively). Significantly more males had adequate calcium intakes, excessive sodium intakes, and low BMI values. Adolescents with several non-modifiable risk factors in combination with a number of modifiable risk factors may have increased risk for developing osteoporosis by compromising their peak bone mass. Further research should use DEXA analysis for bone density levels to determine if risk factor totals coincided with bone density levels.

Lead in fingerbone: a tool for retrospective exposure assessment

Exposure to inorganic lead may cause many adverse health effects. When absorbed, lead is accumulated in large part in bone. In this study, we investigated the relationship between lead concentration in fingerbone, exposure time, and lead in blood. We also sought to design a model that made it possible to use fingerbone lead as an indicator of earlier exposure. The study comprised 137 active workers from a secondary lead smeltery. Workers had undergone regular determinations of blood lead (i.e., up to 6 times/y) for up to 24 y. In addition, during the period 1979-1992, workers underwent up to four fingerbone lead assessments via noninvasive x-ray fluorescence. We calculated cumulative blood lead, adjusted for time-related reduction of bone lead according to a transfer of lead from bone to blood, for each worker. We obtained the best fit of bone lead to cumulative adjusted blood lead when we assumed a 14-y half-time for the transfer coefficient. This half-time was similar to the terminal half-time for lead in bone in retired smelters, whom we studied earlier by longitudinal in vivo measurements. We described models for the accumulation of bone lead on blood lead and exposure time. The combined data on bone lead and exposure time may be used to estimate a mean blood lead during previous exposure. Such estimates will be valuable in epidemiological studies aimed at evaluating the toxic effects of long-term lead exposure in lead workers for whom data on previous blood lead levels are lacking.

Assessment of lifetime patterns of dairy food intake and physical activity

Patterns of nutrition and exercise throughout the life span may account for differences in health problems of aging. The purpose of this study was to develop and validate a simple life span history questionnaire of dairy food intake and to assess recalled levels of leisure time physical activity over the life span. Volunteers, 98 women and 49 men, completed two nutritional surveys (Criterion Questionnaire, ¿CRIQ¿ and Diary Food Index, ¿INDX¿) and a physical activity questionnaire (P-ACTQ) in a test re-test design. The INDX and P-ACTQ consisted of a one to four scale (low to high intake). Dairy food intake averaged 1.4 to 2.3 servings per day with no significant differences in current dairy food intake between decade age categories. When compared to their own recalled 20's decade, dairy food intake declined slightly with age, except for the 80-89 age group which showed an increased intake. Test retest reliability for the INDX was r = 0.64. Validity of the INDX compared to the CRIQ was r = 0.64. All groups showed a decrease in physical activity levels across the life span. The Dairy Food Index holds promise as a simple "global" assessment of dairy food intake for the study of lifetime trends in advancing our understanding of the role of lifetime habits in chronic "lifestyle" diseases.

Age considerations in nutrient needs for bone health

Age exerts a major influence on the nutritional needs for bone health. Age influences the nutrient requirements for bone health by influencing: the growth and development of bone; the deposition of minerals leading to peak bone mass; the rate of bone loss; the levels of hormones which influence bone; the absorption and retention of nutrients required for optimal bone health, physical activity, food intake, and the level of sun exposure. Adequate calcium intake benefits bones at any age. However, dietary calcium needs vary at different ages. In June 1994, a National Institutes of Health expert panel recommended higher calcium intakes than current Recommended Dietary Allowance for several age groups. Many population groups in the United States, including young girls and women, continue to consume significantly less calcium than current recommended levels. In addition, diets low in calcium are often low in many other essential nutrients important for good bone health, including vitamin D, vitamin B6, and magnesium. Dietary recommendations for bone health should be placed in the full context of the total diet rather than a singular emphasis on calcium. To truly benefit consumers, dietary recommendations for bone health should emphasize consumption of foods high in calcium as part of a healthy diet and a healthy lifestyle.

What do Norwegian women and men know about osteoporosis?

A survey of a random sample of 1514 Norwegian women and men aged 16-79 years was undertaken to investigate knowledge of osteoporosis and attitudes towards methods for preventing this disease. The interviews were carried out by Central Bureau of Statistics of Norway as part of their monthly national poll using a structured questionnaire. Women knew more about osteoporosis than did men (p < 0.001). In both men and women increased knowledge of osteoporosis was correlated to a high level of education. Furthermore it was clearly demonstrated that knowing someone with osteoporosis or suffering from it oneself increased the knowledge of osteoporosis significantly in both women and men. Multiple regression analysis confirmed the univariate analyses, and education was the strongest predictive factor for knowledge. To a hypothetical question as many as two-thirds of the women answered that they would use long-term hormone replacement therapy (HRT) to prevent osteoporosis on the recommendation of their general practitioner. Their attitudes towards the use of estrogen therapy did not show any significant relation to age, but their reluctance towards HRT increased with education (p < 0.001). When asked a question about their preferences regarding the use of physical activity as a means to prevent osteoporosis, older women preferred walking (p < 0.001), whereas younger women wanted more organized athletic activity (p < 0.001). The data demonstrated that there was a high degree of general knowledge of osteoporosis and its consequences in the general population.

Dietary factors related to preservation of oral and skeletal bone mass in women

Skeletal bone loss in adults increases the risk of bone fractures and may contribute to the loss of teeth in healthy postmenopausal women. The relationship of skeletal osteopenia to residual ridge resorption is unclear. Low bone mass in women is attributed to heredity, estrogen deficiency, a low lifetime calcium intake, and lack of regular physical activity. A high calcium intake will promote optimal bone growth in youth and decrease the rate of bone loss in the later postmenopausal period. In early menopause, estrogen is the only effective therapy for conserving bone in women. In older women, a high plasma level of vitamin D enhances calcium absorption, whereas high sodium, protein, alcohol, and caffeine intakes will cause increased urinary losses and negative calcium balance. Women who have a low intake of dairy foods may benefit from a refined calcium carbonate supplement that contains vitamin D. This article focuses on the nutritional factors that influence bone health.