Bone resorption and fracture across the menopausal transition: the Study of Women’s Health Across the Nation.

By London Spine
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Bone resorption and fracture across the menopausal transition: the Study of Women’s Health Across the Nation.

Menopause. 2012 Nov;19(11):1200-7

Authors: Cauley JA, Danielson ME, Greendale GA, Finkelstein JS, Chang YF, Lo JC, Crandall CJ, Neer RM, Ruppert K, Meyn L, Prairie BA, Sowers MR

Abstract
OBJECTIVE: Bone turnover markers (BTMs) predict fracture in older women, whereas data on younger women are lacking. To test the hypothesis that BTMs measured before and after menopause predict fracture risk, we performed a cohort study of 2,305 women.
METHODS: Women attended up to nine clinic visits for an average of 7.6 ± 1.6 years; all were aged 42 to 52 years and were premenopausal or early perimenopausal at baseline. Incident fractures were self-reported. Serum osteocalcin and urinary cross-linked N-telopeptide of type I collagen (NTX) were measured at baseline. NTX was measured at each annual follow-up. Interval-censored survival models or generalized estimating equations were used to test whether baseline BTMs and changes in NTX, respectively, were associated with fracture risk. Hazard ratios (HRs) or odds ratios were calculated with 95% CIs.
RESULTS: Women who experienced fractures (n = 184) had about a 10% higher baseline median NTX (34.4 vs 31.5 nanomoles of bone collagen equivalents per liter per nanomole of creatinine per liter; P = 0.001), but there was no difference in osteocalcin. A 1-SD decrease in lumbar spine bone mineral density (BMD) measured premenopausally was associated with a higher fracture risk during menopause (HR, 1.50; 95% CI, 1.28-1.68). Women with a baseline NTX greater than the median had a 45% higher risk of fracture, multivariable-adjusted (HR, 1.46; 95% CI, 1.05-2.26). The HR of fracture among women with both the lowest spine BMD (quartile 1) and the highest NTX (quartile 4) at baseline was 2.87 (95% CI, 1.61-6.01), compared with women with lower NTX and higher BMD. Women whose NTX increased more than the median had a higher risk of fracture (odds ratio, 1.51; 95% CI, 1.08-2.10). Women who had baseline NTX greater than the median experienced greater loss of spine and hip BMD.
CONCLUSIONS: A higher urinary NTX excretion measured before menopause and across menopause is associated with a higher risk of fracture. Our results are consistent with the pathophysiology of transmenopausal changes in bone strength.

PMID: 22850443 [PubMed – indexed for MEDLINE]

Frequency of FRAX risk factors in osteopenic postmenopausal women with and without history of fragility fracture.

By London Spine
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Frequency of FRAX risk factors in osteopenic postmenopausal women with and without history of fragility fracture.

Menopause. 2012 Nov;19(11):1193-9

Authors: Baró F, Cano A, Sánchez Borrego R, Ferrer J, González Rodríguez SP, Neyro JL, Rodriguez Bueno E, Sancho C, Inaraja V, Fernández C, Corral C, FROSPE Study Group

Abstract
OBJECTIVE: Fractures associated with bone fragility represent a major public health concern. Although the risk of bone fracture is higher among patients with osteoporosis, the number of fractures is usually higher among patients with osteopenia due to its higher prevalence.
METHODS: This is an observational case series study that compares the frequencies of nonskeletal risk factors for osteoporotic fractures in osteopenic postmenopausal women with previous clinical fragility fractures (FFs) and osteopenic postmenopausal women without previous FF. Risk factors included in the FRAX algorithm and other selected risk factors, including asymptomatic vertebral fractures, were evaluated.
RESULTS: A total of 735 (50.3% with prior FF and 49.7% without prior FF) postmenopausal women were evaluated (median age, 60 y; mean bone mineral density [BMD] femoral neck T score of -1.67). The frequency of the following risk factors was significantly higher among women with FF-FRAX algorithm: age, use of corticosteroids, and BMD femoral neck T score; other factors: Hispanic ethnicity, falls during the last year, and BMD lumbar T score. In addition, the frequency of previously undetected asymptomatic vertebral fractures was four times higher among women with a history of FF.
CONCLUSIONS: The results of the present study support the need to assess the presence of asymptomatic vertebral fractures and BMD T scores in osteopenic postmenopausal women. The risk evaluation of this subpopulation can be accomplished by using some of the risk factors included in the FRAX algorithm combined with other conventional risk factors.

PMID: 22948137 [PubMed – indexed for MEDLINE]