Alcohol intake, beverage preference, and risk of hip fracture in men and women. Copenhagen Centre for Prospective Population Studies.
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The authors prospectively studied the association between quantity and type of alcohol intake and risk of hip fracture among 17,868 men and 13,917 women. Analyses were based on pooled data from three population studies conducted in 1964-1992 in Copenhagen, Denmark. During follow-up, 500 first hip fractures were identified in women and 307 in men. A low to moderate weekly alcohol intake (1-27 drinks for men and 1-13 drinks for women) was not associated with hip fracture. Among men, the relative risk of hip fracture gradually increased for those who drank 28 drinks or more per week (relative risk (RR) = 1.75, 95% confidence interval (CI) 1.06-2.89 for 28-41 drinks; RR = 5.28, 95% CI 2.60-10.70 for 70 or more drinks) as compared with abstainers. Women who drank 14-27 drinks per week had an age-adjusted relative risk of hip fracture of 1.44 (95% CI 1.03-2.03), but the association weakened after adjustment for confounders (RR = 1.32, 95% CI 0.92-1.87). The risk of hip fracture differed according to the type of alcohol preferred: preferrers of beer had a higher risk of hip fracture (RR = 1.46, 95% CI 1.11-1.91) than preferrers of other types of alcoholic beverages. The corresponding relative risks for preferrers of wine and spirits were 0.77 (95% CI 0.58-1.03) and 0.82 (95% CI 0.58-1.14), respectively. In conclusion, an alcohol intake within the current European drinking limits does not influence the risk of hip fracture, whereas an alcohol intake of more than 27 drinks per week is a major risk factor for men. (+info)
(2E,6R)-8-hydroxy-2,6-dimethyl-2-octenoic acid, a novel anti-osteoporotic monoterpene, isolated from Cistanche salsa.
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(2E,6R)-8-Hydroxy-2,6-dimethyl-2-octenoic acid [(R)-HDOA], a novel monoterpene from Cistanche salsa, a Chinese herb, was found to be an anti-osteoporotic compound. The extract of Cistanche salsa significantly suppressed the bone weight loss in ovariectomized mice, a postmenopausal osteoporosis model. The active substance was then purified by using this osteoporotic model and the chemical structure was determined. The active compound from Cistanche salsa, (R)-HDOA, suppressed the decrease of bone weight and the mechanical strength in the ovariectomized mice. Furthermore, (R)- and (S)-HDOA were synthesized and the activity of each was evaluated. (R)-HDOA suppressed the bone weight loss, although (S)-HDOA did not showed any activity. (+info)
Strong bones in later life: luxury or necessity?
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Osteoporosis is a global problem which will increase in significance as the population of the world both increases and ages. This report looks at how the demographic changes in different countries of the world will be reflected in the incidence and cost of osteoporotic disease. Comparisons are made between the data collected by the European Union's Report on Osteoporosis in the European Community, issued in June 1998, and some of the data available from other parts of the world. The importance of prevention, early detection and appropriate treatment is stressed, as well as the need for national health services to provide reimbursement of the costs of prevention, diagnosis and treatment for high-risk groups. (+info)
Strong bones in later life: luxury or necessity? The view from Tunisia: need for an inclusive approach.(28/3580)
Is screening for osteoporosis worthwhile?
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Osteoporosis is a common condition, which is recognised by the occurrence of fragility fractures and leads to considerable mortality and morbidity with huge financial implications world-wide. Based on predicted demographic changes, the implications of this disease are set to increasingly affect the healthcare budgets of all nations. The determinants of fracture are skeletal factors, such as peak bone mass, the rate of bone loss and extra-skeletal factors, which include trauma and the response to that trauma. Some of these factors are genetically determined, but several have environmental origins, which could, theoretically, be manipulated. There are two potential means whereby osteoporotic fractures might be prevented. Measures could be targeted at the entire population, with the aim of shifting the distribution of bone mass in a beneficial direction, through modifying the behaviour of all individuals. The alternative is a high risk approach, whereby intervention is targeted only at those considered to have the greatest risk of future fracture. Mass bone density screening falls into the second approach. Bone density is a good predictor of future fracture risk, and cost-effectiveness analyses of the high risk approach suggest economic benefits of policies targeting pharmacological treatment to those individuals at highest risk. However, there are important concerns about the levels of compliance achievable with such therapeutic interventions, the balance of risks and benefits for some of these interventions (for example, hormone replacement therapy), and the outcome when treatment is discontinued. On current evidence, it is certainly not appropriate to target hormone replacement therapy for women at the menopause on the basis of a bone density screening programme. However, newer bone-specific agents are being developed which might be administered at later ages, closer to the time when fracture incidence rates rise steeply. Bone densitometry has been shown to predict fractures even in the elderly, and high risk strategies for the targeting of such agents (for example, the bisphosphonates or selective oestrogen receptor modulators) will remain important research issues for the future. (+info)
Preclinical development of agents for the treatment of osteoporosis.
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Because of the high cost and long time frame of clinical testing, animal models play a crucial role in the identification and selection of agents for the treatment of osteoporosis. The use of animal models early in a program focuses on the establishment of efficacy, while animal models used later in a program to examine bone safety. More specifically, animal models are used to gain information on the skeletal mechanism of action, to examine multiple skeletal sites (axial and appendicular), and to examine the effects of higher doses than will be used in humans. Animal models also predict the usefulness of surrogate markers in clinical trials, such as formation and resorption markers, as well as bone density. The hazard of using surrogate markers for fracture prevention is highlighted by high dose fluoride administration, which can increase bone density (considered a strong predictor of fracture protection) while not protecting against fractures. Estrogen-deficient models are most commonly used to mimic the postmenopausal bone loss in women; these models are characterized by increased bone turnover and a negative bone balance. The timing of the administration of the new therapy in animal models can help determine whether the agent will be more effective in the prevention of osteoporosis or in the treatment of established osteoporosis. New methods for the measurement of bone mass or volume are less invasive, require shorter acquisition time, and have enhanced resolution, resulting in increased knowledge concerning architectural changes and specific sites of bone deposition. Finally, the measurement of biomechanical strength of bones from animal models can be used to predict protective effects on fracture rates in clinical trials. When used in combination with other methods, animal models can greatly increase our understanding of the pathophysiology of osteoporosis and can expedite the development of new therapies. (+info)
OBJECTIVE: To guide family physicians through assessment of why treating elderly people's osteoporosis is necessary, who to treat, and how to treat in a practical way. QUALITY OF EVIDENCE: Evidence of the efficacy of treatment for osteoporosis is shown by a reduced probability of fracture. This can be ascertained by direct evaluation for bisphosphonates, calcium, and calcitonin, or indirectly by ascertaining benefit to bone mineral density for hormone replacement therapy (HRT) and exercise. MAIN MESSAGE: Unless medically contraindicated, all elderly people should take supplementary vitamin D (800 IU/d) and calcium (1500 mg/d). Those with risk factors for osteoporosis (e.g., smoking, thinness, previous fracture when older than 50 years, fracture in first-degree relatives older than 50 years, and steroid use) should have a bone density measurement. Those meeting World Health Organization criteria for osteoporosis should also be treated with HRT or bisphosphonates or possibly with selective estrogen receptor modulators. CONCLUSIONS: Good evidence indicates that adequate treatment of osteoporosis can prevent fractures and thus reduce associated morbidity and mortality among vulnerable elderly people. Because of the prevalence of osteoporosis, the onus falls on family physicians to be the front-line managers. (+info)
Effect of a lifestyle intervention on bone mineral density in premenopausal women: a randomized trial.
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BACKGROUND: The positive association between body weight and bone mineral density (BMD) is well documented; in contrast, the effect of changes in body weight on BMD is not well understood, particularly, in normal-weight populations. OBJECTIVE: We examined the effect of a lifestyle intervention aimed at lowering dietary fat intake and increasing physical activity to produce modest weight loss or prevent weight gain on BMD in a population of 236 healthy, premenopausal women aged 44-50 y. DESIGN: All women were participating in a clinical trial known as The Women's Healthy Lifestyle Project and were randomly assigned to intervention or control groups. Dual-energy X-ray absorptiometry of BMD at the lumbar spine and proximal femur were made before and after 18 mo of participation in the trial. RESULTS: The intervention group (n = 115) experienced a mean (+/-SD) weight loss of 3.2 +/- 4.7 kg over the 18 mo compared with a weight gain of 0.42 +/- 3.6 kg in the control group (n = 121) (P < 0.001). The annualized rate of hip BMD loss was 2-fold higher (P < 0.015) in the intervention group (0.81 +/- 1.3%) than in the control group (0.42 +/- 1.1%); a similar, although nonsignificant pattern was observed for the loss in spine BMD: 0.70 +/- 1.4% and 0.37 +/- 1.5% (P = 0.093) in the intervention and control groups, respectively. Large increases in physical activity attenuated spine BMD loss, but had no significant effect on BMD loss at the hip. CONCLUSIONS: The intervention group, who modified their lifestyle to lose weight, had a higher rate of BMD loss at the hip and lumbar spine than did the weight-stable control group. Recommendations for weight loss must be made with consideration that such an endorsement may result in BMD loss. (+info)