Treatment of Osteoporosis in Postmenopausal Women Who Are At Risk of Fracture

Osteoporosis consists of decreased bone strength and increased risk of fractures due to decreased mass and abnormal bone microarchitecure. Almost 20% of postmenopausal women have osteoporosis as defined by World Health Organization (WHO) criteria (T-score <- 2.5). Besides the bone mineral density (BMD) expressed by T-score, advancing age, premature menopause, low body weight (≤120lbs), maternal history of hip fracture, previous fracture, loss of height (≥3 inches) and the use of glucocorticosteroids are risk factors for bone fractures. Identifying the postmenopausal women at risk include both an evaluation for risk factors (including secondary causes of osteoporosis) and measurement of bone mass density (BMD) by dual X-ray absorbtiometry (DXA).

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Comparison of Bone Mineral Density, T-Scores and Serum Zinc between Diabetic and Non Diabetic Postmenopausal Women with Osteoporosis

Journal of Laboratory Physicians ◽

10.4103/0974-2727.151681 ◽

2015 ◽

Vol 7 (01) ◽

pp. 043-048 ◽

Cited By ~ 7

Author(s):

Priyanka R Siddapur ◽

Anuradha B Patil ◽

Varsha S Borde

Keyword(s):

Bone Mineral Density ◽

Fracture Risk ◽

Postmenopausal Women ◽

Bone Mineral ◽

Mineral Density ◽

T Score ◽

Increased Risk ◽

Serum Zn ◽

Type 2 Diabetic

ABSTRACT Context: Postmenopausal osteoporosis is a public health problem. Diabetics are at increased risk of osteoporosis-related fractures. Zinc (Zn) has a role in collagen metabolism, and its levels are altered in diabetes. Aims: The aim was to compare bone mineral density (BMD), T-score and serum Zn between diabetic and nondiabetic postmenopausal women with osteoporosis to see if they influence increased fracture risk in diabetes. Settings and Design: It is a cross-sectional study conducted at Department of Biochemistry, Jawaharlal Nehru Medical College, Belgaum. Materials and Methods: Thirty type 2 diabetic and 30 age-matched (aged 45-75 years) nondiabetic Dual energy X-ray absorptiometry (DEXA) confirmed postmenopausal osteoporotics were included from January 2011 to March 2012. Serum Zn was analyzed by atomic absorption spectrophotometry. Statistical Analysis Used: Mean and standard deviation of the parameters of the two groups were computed and compared by unpaired Student's t-test. Relationship between variables was measured by Karl Pearson's correlation co-efficient. A statistical significance is set at 5% level of significance (P < 0.05). Results: T-score was significantly higher in diabetics compared with nondiabetics(−2.84 ± 0.42 vs. −3.22 ± 0.74) P < 0.05. BMD and serum Zn of diabetics showed a significant positive correlation with body mass index (BMI). Conclusions: Type 2 diabetic postmenopausal osteoporotics have a higher T-score than the nondiabetics. High BMI in type-2 diabetes mellitus (T2DM) may contribute to high BMD and may be a protective factor against zincuria. Increased fracture risk in T2DM could be due to other factors like poor bone quality due to hyperglycemia rather than BMD. Strict glycemic control is of paramount importance.

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Exemestane for primary prevention of breast cancer in postmenopausal women: NCIC CTG MAP.3—A randomized, placebo-controlled clinical trial.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.18_suppl.lba504 ◽

2011 ◽

Vol 29 (18_suppl) ◽

pp. LBA504-LBA504 ◽

Cited By ~ 3

Author(s):

P. E. Goss ◽

J. N. Ingle ◽

J. Ales-Martinez ◽

A. Cheung ◽

R. T. Chlebowski ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Primary Prevention ◽

Postmenopausal Women ◽

Bone Fractures ◽

Annual Incidence ◽

Controlled Clinical Trial ◽

Breast Cancers ◽

Increased Risk ◽

Prevention Of Breast Cancer

LBA504 Background: Limited efficacy and serious toxicities have limited uptake of tamoxifen or raloxifene as preventatives of breast cancer. Aromatase inhibitors (AIs) prevent contralateral breast cancers more than tamoxifen in adjuvant trials and have fewer serious side effects. This is the first report of an AI used in primary prevention. Methods: NCIC CTG MAP.3 is a randomized trial designed to detect a 65% reduction in annual incidence of invasive breast cancer (IBC) on exemestane (E) versus placebo (P). Eligible postmenopausal women had ≥ one of the following risk factors: Gail score >1.66%, prior ADH, ALH, LCIS or DCIS with mastectomy, age over 60. Health-related and menopause-specific quality of life (QOL) were assessed by SF-36 and MENQOL questionnaires. Results: From 2004-2010, 4,560 women were randomized: age 62.5 yrs (37-90); Gail Score 2.3 % (0.6-21); BMI 28.0 kg/m2 (15.9-65.4). Risk factors included: age >60 yrs (49%); Gail score >1.66 (40%); and prior ADH, ALH, LCIS or DCIS with mastectomy (11%). At median follow-up of 35 months there were 11 IBCs on E and 32 on P (annual incidence 0.19% vs 0.55%; HR= 0.35, 95% CI 0.18-0.70, p = 0.002); ductal (10E/27P), lobular (1E/5P). Most tumors were ER positive (7E/27P); Her2/neu negative (10E/26P); TNM stage T1 (8E/28P), N0 (7E/22P), M0 (11E/30P). E was superior in all subgroups: by Gail score, age, BMI, prior LCIS and DCIS. The annual incidence rate of IBC or DCIS was 0.35% E and 0.77% P (HR=0.47;95% CI 0.27-0.79; p = 0.004) based on 64 IBCs or DCISs (20E/44P). Clinical bone fractures, osteoporosis, hypercholesterolemia or cardiovascular events were equal in both arms. No clinically meaningful differences in QOL were detected. Conclusions: Exemestane significantly reduced invasive and pre-invasive breast cancers in postmenopausal women at increased risk for breast cancer with no serious toxicities. Exemestane should be considered a new option for primary prevention of breast cancer. Supported by the Canadian Cancer Society; Pfizer Inc. PEG supported in part by Avon Foundation.

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Risk Management of Osteoporosis in Postmenopausal Women; A Study of Women In a Teaching Hospital

Global Journal of Health Science ◽

10.5539/gjhs.v8n11p36 ◽

2016 ◽

Vol 8 (11) ◽

pp. 36 ◽

Cited By ~ 1

Author(s):

Chander Kumar Lohana ◽

Nafisa Samir

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Postmenopausal Women ◽

Bone Mineral ◽

Public Awareness ◽

Clinical Manifestations ◽

Radiology Department ◽

Premature Menopause ◽

Mineral Density ◽

History Of

BACKGROUND: Postmenopausal females are susceptible to osteoporosis due to clinical manifestations. It not only causes morbidity; but, is considered to strikingly decline quality of life among patients. Among different developing regions, the prevalence rate of osteoporosis among postmenopausal women is alarming in the face of poor management and awareness about its risk factors.AIM: The aim of this study was to investigate the incidence of osteoporosis and its known risk factors among postmenopausal women appearing for bone mineral density in Karachi.METHODOLOGY: This descriptive cross-sectional study was undertaken from the period of “March 2006 to March 2007” in “Aga Khan University hospital”, Karachi. A total of 245 females, who came to the radiology department at Aga Khan Hospital for DXA scan, were recruited. All the relevant data was collected through questionnaires. Data analysis was undertaken by using SPSS version 11.5 to generate frequencies and proportion percentages.RESULTS: The study demonstrated that 99 females (40%) amongst all subjects were osteopenic, 114 females (47%) were osteoporotic; whereas, 32 females (13%) were normal. A decline was observed in bone mineral density with advancing age and duration of menopause. The distribution of osteoporosis was observed to be common in women, who had more children, low BMI, history of prior fractures, history of premature menopause, and were avoiding exercise.CONCLUSION: This study confirmed a high frequency of osteoporosis and osteopenia in postmenopausal women. Therefore, early screening is required to detect the decrease in bone mineral density among postmenopausal females to prevent fragility fracture. There is an imperative requirement for vast public awareness in this regard.

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Association of osteoporosis and varus inclination of the tibial plateau in postmenopausal women with advanced osteoarthritis of the knee

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04090-2 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Shun-Ping Wang ◽

Po-Kuan Wu ◽

Cheng-Hung Lee ◽

Cheng-Min Shih ◽

Yung-Cheng Chiu ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Lower Extremity ◽

Postmenopausal Women ◽

Tibial Plateau ◽

Osteoarthritis Of The Knee ◽

Varus Malalignment ◽

Mineral Density ◽

T Score ◽

Lower Extremity Alignment

Abstract Background Although varus inclination of the tibial plateau has increasingly been recognized as a major risk factor in the progression of Osteoarthritis of the knee (OA knee), little attention has been placed on the development of the varus inclination of the tibial plateau. Osteoporosis is a disease characterized by low bone mass and may increase the risk of a stress fracture in the proximal tibia. To date, risk factors for varus inclination of the tibial plateau are rarely reported. In this study, we investigated Bone Mineral Density (BMD) as a risk factor of varus inclination of the tibial plateau in postmenopausal women with advanced OA knee. Methods A total of 90 postmenopausal women with varus OA knee who had received a total knee arthroplasty in our department between January 2016 and December 2019 were reviewed. Certain factors may correlate to inclination of the tibial plateau (Medial Tibial Plateau Angle, MTPA), including age, operation side, Kellgren-Lawrence grade of OA knee, BMD, Body Mass Index (BMI), Lateral Distal Femur Angle (LDFA), lower extremity alignment (Hip-Knee-Ankle angle, HKAA), and history of both spinal compression fracture and hip fracture were collected and analyzed. Results Osteoporosis, lower extremity varus malalignment and age were significantly associated with varus inclination of the tibial plateau (MTPA) (P = 0.15, 0.013 and 0.033 respectively). For patients with a lower extremity varus malalignment (HKAA < 175°), osteoporosis (T-score ≤ -2.5) was significantly associated with inclination of the tibial plateau. For patients with a normal lower extremity alignment (HKAA ≥ 175°), no significant association was found between osteoporosis (T-score ≤ -2.5) and varus inclination of the tibial plateau. Conclusions Osteoporosis, lower extremity varus malalignment and age are major risk factors for inclination of the tibial plateau in postmenopausal women with OA knee. More attention needs to be given to the progression of varus OA knee in postmenopausal women who simultaneously has osteoporosis and lower extremity varus malalignment.

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Risk Factors for Systemic Reduced Bone Mineral Density in Premenopausal Female Patients with Early Untreated Rheumatoid Arthritis

Aktuelle Rheumatologie ◽

10.1055/a-0591-2364 ◽

2018 ◽

Vol 45 (04) ◽

pp. 334-340

Author(s):

Hamada S. Ahmed ◽

Sherif E. Farrag ◽

Amr E. Okasha ◽

Gamal Othman ◽

Ibrahim Shady

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Bone Mineral Density ◽

Rheumatoid Factor ◽

Bone Mineral ◽

Early Rheumatoid Arthritis ◽

Mineral Density ◽

T Score ◽

Increased Risk ◽

Treatment Naïve

Abstract Background Systemic osteoporosis (OP) is evident among patients with early rheumatoid arthritis (ERA). This study aimed to investigate the OP risk factors in patients with ERA and who was treatment-naïve at inclusion. Subjects and Methods Systemic bone mineral density (BMD) of the lumbar spine (LS), femoral neck (FN) and total hip (TH) was measured in 135 treatment-naïve premenopausal females with early Rheumatoid Arthritis (ERA). For all patients, demographic data, vitamin D status, and the specific parameters of the disease, including disease activity, serum levels of rheumatoid factor and anti-citrullinated protein antibodies (ACPA) were evaluated. Results T score was<−1.0 in the LS in 16.2%, in the FN in 22.2% and in the TH in 23.7%. Among our patients, 29.6% had below normal T score at any site. Demographic characteristics, RA duration, diseases activity did not significantly impact BMD. However, patients with decreased BMD were more prevalent ACPA- and rheumatoid factor (RF)-positive than patients with normal BMD. Also, high titer ACPA or RF is associated with more marked reduction in BMD. In regression analysis, after adjustment for possible confounders, patient stratification according to ACPA status and RF status (into negative, low-positive and high positive) still a significant independent variable associated with lower BMD values. Conclusion Presence of ACPA or RF is associated with increased risk for development of reduced systemic BMD from very early stage of rheumatoid arthritis. Furthermore, this risk increases more with higher levels of ACPA or RF. Measurement of BMD should be performed for ACPA- or RF-positive patients with early RA.

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Bone mineral density and FRAX as predictors of fracture risk in women with breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.26_suppl.121 ◽

2013 ◽

Vol 31 (26_suppl) ◽

pp. 121-121

Author(s):

Beatrice J. Edwards ◽

William John Gradishar ◽

Maureen Smith ◽

Jennifer A. Pacheco ◽

Jaimee S Holbrook ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

Cancer Therapy ◽

Fracture Risk ◽

Cancer Survivors ◽

World Health ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Mineral Density ◽

T Score

121 Background: The number of cancer survivors is rising in the USA, the 2007 CDC analysis of the SEER database estimated 11 million cancer survivors, with 90% being over the age of 65 years. Of these, 70% are women, and the most common cancer in survivors is breast cancer. Cancer therapy induced bone loss (CTIBL) contributes to an increase in fracture risk in women with breast cancer. Fractures are responsible for considerable morbidity, disability, hopitalizations and mortality in older adults. Fractures are often the cause for nursing home placement in seniors. Our objective was to analyze the prevalence of fractures after breast cancer therapy and to assess the effect of cancer therapy, clinical risk factors, bone density and the World Health Oragnization (WHO) fracture risk assessment [FRAX] as predictors of fracture occurrence. Methods: The study population consisted of breast cancer patients with invasive breast cancer who participated in a genetic databank within a NCI-Comprehensive Cancer Center. Demographic and clinical characteristics were abstracted from the EMR. Participants were followed for 6-12 years. Results: A total of 439 women with breast cancer were assessed; 79 had sustained fractures during the observation period (116 fractures), fractures occurred at multiple skeletal sites in 27 cases. The prevalence of fractures was 18%. Baseline characteristics revealed that women who sustained fractures were mostly Caucasian (91%, p=0.08), and had a family history of osteoporosis (36.9%, p=0.03). The time to fracture was 4.0 years (range 0-12 years) from diagnosis. Fracture cases had lower BMD at the femoral neck 0.86 ± 0.13 gm/cm2 (T-score= -1.0, p=0.04) than non- fracture cases, although BMD was in the low normal range. Eight cases of hip fractures were identified with a median age of 55 years (32-67 years) Median T-score -0.75. Cox proportional hazard analysis failed to identify any specific risk factors for fractures. Conclusions: Fractures occur shortly after commencing cancer therapy. BMD and FRAX risk calculation were not able to identify women who fractured. Occurrence of fractures in breast cancer raises the possibility of cancer-induced impairment in bone quality.

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Prevalence of Risk Factors Among Women With Osteoporosis

Serbian Journal of Experimental and Clinical Research ◽

10.1515/sjecr-2016-0080 ◽

2017 ◽

Vol 18 (3) ◽

pp. 239-243

Author(s):

Dalibor Stajic ◽

Sandra Zivanovic ◽

Ana Miric ◽

Marija Sekulic ◽

Nela Djonovic

Keyword(s):

Risk Factors ◽

Bone Fractures ◽

Cross Sectional Study ◽

Mineral Density ◽

Cross Sectional ◽

T Score ◽

Current State ◽

High Prevalence ◽

History Of ◽

Study Population

Abstract Osteoporosis is a progressive bone disorder that can be influenced by many different factors. A cross-sectional study has been conducted with the aim to assess the prevalence of risk factors as well as to identify the possible causes of improvement of the disease. Th e study population consisted of 97 women older than 35 who had previously been diagnosed with osteoporosis. Dualenergy X-ray Absorptiometry (DXA) scan was used to determine bone mineral density (BMD) in order to assess the current state of the disease. Th e participants were asked to complete a standardized IOF (International Osteoporosis Foundation) questionnaire. According to BMD measurements, 24.7% of women had normal bone density while 18.6% had T-score lower than -2.5. Th ere was a statistically significant correlation between T-score and the history of previous bone fractures. Besides, a relatively high prevalence of certain risk factors (such as underweight, early menopause, oophorectomy, thyroid and parathyroid disorders etc.) was observed in woman with osteoporosis

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Evaluating the performance of the WHO international reference standard for osteoporosis diagnosis in postmenopausal women of varied polygenic score and race

10.1101/2019.12.30.19016154 ◽

2020 ◽

Author(s):

Qing Wu ◽

Xiangxue Xiao ◽

Yingke Xu

Keyword(s):

African American ◽

African American Women ◽

Postmenopausal Women ◽

World Health ◽

Nucleotide Polymorphisms ◽

Mineral Density ◽

Genetic Profiling ◽

Polygenic Score ◽

T Score ◽

Caucasian Women

AbstractBackgroundWhether the bone mineral density (BMD) T-score performs differently in osteoporosis classification in women of different genetic profiling and race background remains unclear.MethodsThe genomic data in the Women’s Health Initiative study was analyzed (n=2,417). The polygenic score (PGS) was calculated from 63 BMD-associated single nucleotide polymorphisms (SNPs) for each participant. The World Health Organization’s (WHO) definition of osteoporosis (BMD T-score≤-2.5) was used to estimate the cumulative incidence of fracture.ResultsT-score classification significantly underestimated the risk of major osteoporotic fracture (MOF) in the WHI study. An enormous underestimation was observed in African American women (POR: 0.52, 95% CI: 0.30-0.83) and in women with low PGS (predicted/observed ratio [POR]: 0.43, 95% CI: 0.28-0.64). Compared to Caucasian women, African American, African Indian, and Hispanic women respectively had a 59%, 41%, and 55% lower hazard of MOF after the T-score was adjusted for. The results were similar when used for any fractures.ConclusionsOur study suggested the BMD T-score performance varies significantly by race in postmenopausal women.

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Osteoporosis in active working women

Journal of Health Sciences ◽

10.17532/jhsci.2012.61 ◽

2012 ◽

Vol 2 (1) ◽

pp. 34-39 ◽

Cited By ~ 3

Author(s):

Amra Mačak Hadžiomerović ◽

Admir Rama ◽

Samir Bojičić ◽

Amila Jaganjac ◽

Bakir Katana ◽

...

Keyword(s):

Bone Fractures ◽

Screening Method ◽

Ultrasound Screening ◽

Mineral Density ◽

Diagnosis Of Osteoporosis ◽

T Score ◽

Metabolic Bone ◽

Increased Risk ◽

Normal Body Weight ◽

High Degree

Introduction: Osteoporosis is a progressive metabolic bone disease characterized by reduction of mineral density of bone, which leads to reduction of bone firmness, increased fragility and increased risk of bonefractures. The aims of this study were to determine the age structure and average values of BMI in female patients with a diagnosis of osteoporosis and osteopenia, to determine the value of T-score before and aftertherapy, and to show a correlation of frequency of fractures in relation to already given diagnosed and the presence of menopause.Methods: A retrospective study was conducted on 50 female respondents with diagnosis of osteoporosis and osteopenia. Included female respondents underwent densitometry or ultrasound screening method ofheels in which high degree of osteopenia and osteoporosis is detected.Results: The average age of the female respondents included in this study was 48.06 ± 11.97 years and all the respondents were in the category of women with normal body weight. There is a difference in the values of T-score of respondents with osteoporosis compared to osteopenia. Value of T-score decreases in relation to increase of number of years, so the older female respondents had lower values of T-score.Conclusion: The incidence of osteoporosis and osteopenia was higher among active working female respondents in menopause. Respondents with osteoporosis had lower values of T-score, physical and medicamenttherapy in combination led to improvement of T-score. Female respondents with a low value of T-score, with diagnosis of osteoporosis and in menopause, mostly had bone fractures.

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Evaluating the Performance of the WHO International Reference Standard for Osteoporosis Diagnosis in Postmenopausal Women of Varied Polygenic Score and Race

Journal of Clinical Medicine ◽

10.3390/jcm9020499 ◽

2020 ◽

Vol 9 (2) ◽

pp. 499 ◽

Cited By ~ 2

Author(s):

Qing Wu ◽

Xiangxue Xiao ◽

Yingke Xu

Keyword(s):

African American ◽

African American Women ◽

Postmenopausal Women ◽

World Health ◽

Nucleotide Polymorphisms ◽

Mineral Density ◽

Genetic Profiling ◽

Polygenic Score ◽

T Score ◽

Health Organization

Background: Whether the bone mineral density (BMD) T-score performs differently in osteoporosis classification in women of different genetic profiling and race background remains unclear. Methods: The genomic data in the Women’s Health Initiative study was analyzed (n = 2417). The polygenic score (PGS) was calculated from 63 BMD-associated single nucleotide polymorphisms (SNPs) for each participant. The World Health Organization′s (WHO) definition of osteoporosis (BMD T-score ≤ −2.5) was used to estimate the cumulative incidence of fracture. Results: T-score classification significantly underestimated the risk of major osteoporotic fracture (MOF) in the WHI study. An enormous underestimation was observed in African American women (POR: 0.52, 95% CI: 0.30–0.83) and in women with low PGS (predicted/observed ratio [POR]: 0.43, 95% CI: 0.28–0.64). Compared to Caucasian women, African American, African Indian, and Hispanic women respectively had a 59%, 41%, and 55% lower hazard of MOF after the T-score was adjusted for. The results were similar when used for any fractures. Conclusions: Our study suggested the BMD T-score performance varies significantly by race in postmenopausal women.

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