Diagnosing osteoporosis in Japanese American women.
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Aged↗
Biomedical subjects
B L Drinkwater
Publications and source records attributed to B L Drinkwater.
Irreversible bone loss in former amenorrheic athletes.
Small gains in bone mineral density (BMD) have been reported in the first year following resumption of menses in amenorrheic athletes but there have been no long-term outcome studies. The purpose of this study was to determine whether the BMD of former oligomenorrheic or amenorrheic athletes normalizes following several years of normal menses or use of oral contraceptives. Twenty-nine athletes first studied in this laboratory 8.1 years (range 6-10 years) ago were available for follow-up. At recruitment (time 1) 29 athletes, mean age of 30.6 years, were non-smokers, exercised 4 or more days/week for at least 45 min, had not used oral contraceptives, and had no medical conditions affecting bone metabolism. At time 1, 9 women (R/R) had always menstruated regularly, 9 (R/O/A) had experienced intermittent oligo/amenorrhea as well as regular menses, and 11 (O/A) had never menstruated regularly. At follow-up (time 2) mean age of the women was 38.2 years and there were no significant changes in height, weight or activity patterns. BMD (g/cm2) was measured at the lumbar vertebrae (L1-4 and femoral neck by dual-energy X-ray absorptiometry and expressed as a percentage of R/R values. Vertebral BMD was significantly lower in the O/A group compared with the R/R group at both time 1 and time 2 (p < 0.05). The R/O/A group had intermediate values and did not differ significantly from R/R or O/A at either time. Differences in technique between machines for determining femoral neck BMD made it difficult to detect the longitudinal effect of menstrual status at that site. Despite several years of normal menses or use of oral contraceptives, the mean vertebral BMD of former oligo-amenorrheic athletes remained low, being 84.4% of the R/R value compared to 84.8% at time 1. Those experiencing menstrual regularity with intermittent oligo/amenorrhea remained at an intermediate position of 94.7% of the R/R mean. Our results suggest early intervention is necessary to prevent irreversible vertebral bone loss in oligo/amenorrheic athletes.
Adult↗
Hormone replacement therapy in postmenopausal women: urinary N-telopeptide of type I collagen monitors therapeutic effect and predicts response of bone mineral density.
PURPOSE: To assess the ability of the urinary N-telopeptide of type I collagen (NTx) to monitor and predict therapeutic effects of hormone replacement therapy (HRT) in postmenopausal women. PATIENTS AND METHODS: To assess the relationship between baseline or change in NTx (predictive variable), and change in lumbar and hip bone mineral density (BMD; outcome variable), we conducted a 2-year randomized controlled study at academic university and private practice medical centers in 236 healthy women 1 to 3 years postmenopausal; 227 women completed the study. Women received estrogen plus progesterone plus calcium (treated group) or calcium alone (control group). RESULTS: In the treated group NTx significantly (P < 0.0001) decreased, and spine and hip BMD significantly (P < 0.00001 and P < 0.005, respectively) increased; in the control group NTx did not change but BMD decreased significantly (P < 0.01). Subjects in the highest quartiles for baseline NTx (67 to 188 units) or decreasing NTx (-66% to -87%) through 6 months demonstrated the greatest gain in BMD in response to HRT (P < 0.05 and P < 0.005). For every increase of 30 units in baseline NTx the odds of gain in BMD in response to HRT increased by a factor of 5.0 (95% confidence interval [CI] 1.9 to 13.3); for every 30% decrease in NTx through 6 months, the odds of gaining BMD in response to HRT increased by a factor of 2.6 (95% CI 1.6 to 4.4). In the control group an increase of 30 units in mean NTx across the study indicated a higher odds of losing BMD by a factor of 3.2 (95% CI 1.6 to 6.5). A high baseline NTx (> 67 units) indicated a 17.3 times higher risk of BMD loss if not treated with HRT. CONCLUSION: These data support the clinical utility of NTx to monitor the antiresorptive effect of HRT in recently postmenopausal women, and to predict changes in BMD in response to HRT.
Absorptiometry, Photon↗
Effect of bone density information on decisions about hormone replacement therapy: a randomized trial.
OBJECTIVE: To determine the effect of bone density information on a woman's decision about hormone replacement therapy (HRT). METHODS: One hundred forty women were assigned randomly to receive either educational information about osteoporosis and a voucher for a bone mineral density test 12 months later or the same educational information plus an immediate dual-energy x-ray absorptiometry test for bone mineral density. Women in both groups were offered prescription for HRT. RESULTS: Of the 93 women who received a bone mineral density test, 63.4% elected HRT and filled their prescription, compared with only 20.0% of the 43 women who did not have a bone mineral density test (P < .01). Women who were classified as osteopenic (between -1 and -2.5 standard deviations [SDs] of the young normal bone mineral density) or osteoporotic (more than 2.5 SDs below young normals) were more likely to choose HRT (69.4%) than were women whose bone mineral density was in the normal range (51.6%) (above -1 SD of the young normal bone mineral density value). CONCLUSIONS: A bone mineral density test, regardless of the result, had a significant effect on women's decisions to accept HRT. Within the group having the test, women with lower bone mineral density were more likely to choose HRT.
Absorptiometry, Photon↗
Bone density at multiple skeletal sites in amenorrheic athletes.
OBJECTIVE: To determine if there is a generalized loss of bone mass at multiple skeletal sites in amenorrheic athletes compared with a group of eumenorrheic athletes. DESIGN: A case-control study examining the differences in bone mineral density (BMD) between amenorrheic and eumenorrheic athletes. SETTING: Seattle, Wash, and surrounding communities. PARTICIPANTS: Forty-nine athletes, aged 17 to 39 years, were selected from those responding to advertisements in local sporting-goods stores and a track-and-field newsletter. Athletes were defined as amenorrheic if they had had fewer than 2 menstrual cycles in the last 12 months or none in the past 6 months, or eumenorrheic if they had had 10 to 13 cycles in the previous year. Only women who met these criteria, confirmed by tests for estradiol and progesterone levels, were enrolled in the study. MAIN OUTCOME MEASURES: Bone mineral density measured by dual-energy x-ray absorptiometry. RESULTS: Amenorrheic athletes had significantly lower BMD (P < .01) at the lumbar spine, femoral neck, trochanter, Ward triangle, intertrochanteric region, femoral shaft, and tibia. No difference was noted at the fibula. Body weight combined with months of amenorrhea and age of menarche predicted the BMD of the lumbar spine for amenorrheic athletes. Duration of amenorrhea and body weight of amenorrheic athletes predicted BMD at the femoral neck, trochanter, intertrochanteric region, and tibia. Weight alone predicted BMD at the femoral shaft and tibia. Age plus weight predicted lumbar BMD of eumenorrheic women. CONCLUSION: Extended periods of amenorrhea may result in low bone density at multiple skeletal sites including those subjected to impact loading during exercise.
Absorptiometry, Photon↗
Physical activity, nutrition, and chronic disease.
Epidemiologic, animal, clinical, and metabolic studies demonstrate the independent roles of physical activity and nutrition in the prevention and treatment of several chronic diseases. Fewer data are available to describe the synergistic effects of exercise and diet, and questions remain as to whether and how these two lifestyle factors work together to promote health and prevent disease. This paper briefly reviews many of the known effects of physical activity and nutrition on the prevention and treatment of coronary heart disease, non-insulin-dependent diabetes mellitus, obesity, and osteoporosis as well as how exercise and diet may work together. A discussion of how to increase physical activity levels and how to improve dietary intake also is included. Finally, current exercise and dietary recommendations are summarized, as are directions for future research.
Animals↗
Exercise and bones. Lessons learned from female athletes.
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Amenorrhea↗
1994 C. H. McCloy Research Lecture: does physical activity play a role in preventing osteoporosis?
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Adult↗
Site of bone density measurement may affect therapy decision.
The purpose of this study was to determine whether bone mineral density (BMD) measurements at the lumbar spine and femoral neck provided comparable information to women planning to use that knowledge to help them make a decision about hormone replacement therapy. Eighty-eight healthy Caucasian women, aged 44-59 and within 0 to 5 years of menopause, participated in the study. BMD measurements were performed at the lumbar spine (L1-L4) and the femoral neck by dual energy X-ray absorptiometry (DXA). Criteria suggested by the National Osteoporosis Foundation were used to categorize women as "at risk" for osteoporosis, bone density more than one standard deviation (SD) below the young adult mean, or as "low risk", bone density at or above this level. The results indicated that 46 women would be classified into the low risk category on the basis of spinal BMD alone. However, 28 of these 46 women would fall into the at risk category when the femoral neck BMD was measured. Sixty-one percent of women informed they were at low risk on the basis of spinal BMD would be considered at risk based on femoral neck BMD. When femoral neck BMD was used as the primary risk indicator, 14% of the women classified as low risk would be at risk if spinal BMD were added. These results suggest that both lumbar spine and proximal femur measurements should be made when women are using bone density measurements as an aid in deciding whether or not to use hormone therapy in their postmenopausal years.
Absorptiometry, Photon↗
Exercise in the prevention of osteoporosis.
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Adolescent↗
Elevated plasma low-density lipoprotein and high-density lipoprotein cholesterol levels in amenorrheic athletes: effects of endogenous hormone status and nutrient intake.
To determine the interactive effects of hormones, exercise, and diet on plasma lipids and lipoproteins, serum estrogen and progesterone levels, nutrient intake, and plasma lipid, lipoprotein, and apolipoprotein concentrations were measured in 24 hypoestrogenic amenorrheic and 44 eumenorrheic female athletes. When compared to eumenorrheic athletes, amenorrheic athletes had higher levels of plasma cholesterol (5.47 +/- 0.17 vs. 4.84 +/- 0.12 mmol/L, P = 0.003), triglyceride (0.75 +/- 0.06 vs. 0.61 +/- 0.03 mmol/L, P = 0.046), low-density lipoprotein (LDL; 3.16 +/- 0.15 vs. 2.81 +/- 0.09 mmol/L, P = 0.037), high-density lipoprotein (HDL; 1.95 +/- 0.07 vs. 1.73 +/- 0.05 mmol/L, P = 0.007), and HDL2 (0.84 +/- 0.06 vs. 0.68 +/- 0.04 mmol/L, P = 0.02) cholesterol. Plasma LDL/HDL cholesterol ratios, very low-density lipoprotein and HDL3 cholesterol, and apolipoprotein A-I and A-II levels were similar in the two groups. Amenorrheic athletes consumed less fat than eumenorrheic subjects (52 +/- 5 vs. 75 +/- 3 g/day, P = 0.02), but similar amounts of calories, cholesterol, protein, carbohydrate, and ethanol. HDL cholesterol levels in amenorrheic subjects correlated positively with the percent of dietary calories from fat (r = 0.42, n = 23, P = 0.045) but negatively with the percent from protein (r = -0.49, n = 23, P = 0.017). Thus, exercise-induced amenorrhea may adversely affect cardiovascular risk by increasing plasma LDL and total cholesterol. However, cardioprotective elevations in plasma HDL and HDL2 cholesterol may neutralize the risk of cardiovascular disease in amenorrheic athletes.
Adult↗
In vitro comparability of dual energy X-ray absorptiometry (DEXA) bone densitometers.
Six Hologic QDR-1000 DEXA bone densitometers at different centers across the USA were compared to determine the intermachine variability. Nine scans in succession were acquired on each machine using a single anthropomorphic lumbar spine phantom (manufactured by Hologic). Values for BMC, area, and BMD were recorded for each measurement. Means, standard deviations (SD), and coefficients of variation (CV) were calculated for each machine. All the CVs (BMC, area, BMD) were less than 1% (range 0.3%-0.6%). The CV of the means at the six sites were 0.4%, 0.6%, and 0.5% for BMC, area, and BMD, respectively. Although several significant differences for BMC, area, and BMD were noted by ANOVA between machines at different sites, the difference between the highest and lowest means of the individual machines was only 1.1%, 1.31%, and 1.07% for BMC, area, and BMD. The small variations between the DEXA systems are encouraging for researchers involved in multicenter trials in which data are pooled.
Absorptiometry, Photon↗
Bone density changes during pregnancy and lactation in active women: a longitudinal study.
Six healthy active women, aged 28-34, had bone mineral density (BMD) measured (DPA & SPA) at seven sites prior to pregnancy, within 6 weeks of parturition, and after 6 months of lactation. Twenty-five nonpregnant women of the same age, height, weight, activity level and calcium intake were tested during the same period. Average calcium intake during pregnancy was 1526 mg/day; during lactation, 1622 mg/day. The nonpregnant women averaged 1756 mg/day. BMD decreased in the femoral neck (P less than or equal to 0.05) and radial shaft (P less than or equal to 0.05) during pregnancy but increased in the tibia (P less than or equal to 0.05). A 3.3% decrease in lumbar BMD during pregnancy returned to pre-pregnancy values during lactation. Bone loss at the femoral neck continued during lactation (P less than or equal to 0.05). Changes in BMD during pregnancy and lactation may represent changes in mechanical stress as a result of weight gain, changes in posture and/or activity, or some other factor specific to this population of active women.
Absorptiometry, Photon↗
Nontraumatic femur fracture in an oligomenorrheic athlete.
Exercise-associated amenorrhea is the cessation of menses in a woman following onset of training or an increase in training intensity. Its physiologic basis is characterized by consistently low levels of gonadotropin and ovarian hormones, but the underlying cause of this phenomenon is unknown. Although osteopenia has been described in amenorrheic women athletes, it has been primarily a laboratory diagnosis. Several recent studies have described a significantly lower bone mineral density (BMD) in the lumbar spine of amenorrheic athletes. Marcus et al. also reported an increased number of metatarsal and tibial stress fractures in a group of amenorrheic women. We report here the first case of a nontraumatic femur fracture in an amenorrheic athlete. A 32-yr-old white female, with four prior fibular stress fractures, suffered a left femoral shaft fracture during the 13th mile of a half-marathon. The fracture was successfully internally fixed. Biochemical studies showed no metabolic abnormality. Bone mineral density of the lumbar spine, femoral neck, tibia, and fibula were below the mean for both eumenorrheic and amenorrheic female athletes. Exercise-associated amenorrhea is a medical problem that may have serious implications for both competitive and high-intensity recreational female athletes.
Adult↗
Menstrual history as a determinant of current bone density in young athletes.
The relationship of prior menstrual irregularities and current menstrual status to the bone density of 97 young athletes was determined at seven sites using single- and dual-photon absorptiometry. Menstrual patterns were ranked on a scale of 1 to 9 in terms of their potential adverse affect on bone. Only vertebral density was significantly related to menstrual patterns (r = -.43). Women who had always had regular cycles had higher lumbar densities (1.27 g/cm2) than those with a history of oligomenorrhea/amenorrhea interspersed with regular periods (1.18 g/cm2). The lumbar density of both groups exceeded that of women who had never had regular cycles (1.05 g/cm2). Body weight became more important as a predictor variable as the severity of menstrual irregularities increased. The combination of menstrual pattern and body weight predicted 43% of the total variation in lumbar density. These data suggest that extended periods of oligomenorrhea/amenorrhea may have a residual effect on lumbar bone density.
Adolescent↗
High serum cortisol levels in exercise-associated amenorrhea.
OBJECTIVE: To determine whether basal cortisol levels are elevated in exercise-associated amenorrhea. DESIGN: Survey, with hormone levels measured weekly for 1 month and patients followed clinically for 6 months. SETTING: Volunteers were recruited through media advertisements and fliers. PARTICIPANTS: Ninety-two women were enrolled; 71 (77%) completed the study. Subjects were grouped by menstrual and activity histories reported by a self-administered questionnaire. After 6 months, final groups were assigned: amenorrheic athletes, 19; eumenorrheic athletes, 35; a transition group of amenorrheic athletes who had resumed menses after entering the study, 7; and normal cyclic nonathletes, 10. INTERVENTIONS: Four weekly resting blood samples (0800 to 1000 hours) were obtained and measured for cortisol, estradiol, progesterone, and prolactin levels. Lumbar bone mineral density was measured by dual-photon densitometry. MEASUREMENTS AND MAIN RESULTS: Mean (+/- SE) cortisol levels were higher in amenorrheic athletes (585 +/- 33 nmol/L) than in eumenorrheic athletes (411 +/- 14 nmol/L), transition athletes (378 +/- 33 nmol/L), or nonathletic women (397 +/- 30 nmol/L) (P less than 0.01). Of nine women with abnormally high cortisol levels (greater than 579 nmol/L), eight were amenorrheic athletes, and one was a eumenorrheic athlete. Bone mineral density was lower in amenorrheic athletes than in the other three groups (P less than 0.01). CONCLUSIONS: Increased glucocorticoid levels may be an etiologic factor in exercise-associated amenorrhea. High cortisol levels could also contribute to decreased bone density. The failure of amenorrheic athletes with hypercortisolemia to regain menses within 6 months suggests that they are at risk for a prolonged acyclic state.
Adult↗
Bone mineral density after resumption of menses in amenorrheic athletes.
Amenorrheic athletes have been found to have a lower vertebral bone mineral density (BMD) than matched groups of eumenorrheic athletes. This study reports changes in BMD over a 15.5 month period in athletes who regained menses, athletes who remained amenorrheic, and athletes with regular cycles. The BMD was measured at two sites on the radius and at the lumbar vertebrae (L-1 through L-4), using single- and dual-photon densitometry, respectively. Changes in vertebral BMD were significant for the amenorrheic group (+6.3%), but not for cyclic women (-0.3%). A slight increase in radial density at S-1 and S-2 was not significant for either group. Two athletes who remained amenorrheic during this period continued to lose bone (-3.4%). We conclude that resumption of menses was the primary factor for the significant increase in the vertebral BMD of the formerly amenorrheic athletes.
Adult↗
Bone mineral content of amenorrheic and eumenorrheic athletes.
This study was designed to determine whether the hypoestrogenic status of 14 amenorrheic athletes was associated with a decrease in regional bone mass relative to that of 14 of their eumenorrheic peers. The two groups of athletes were matched for age, height, weight, sport, and training regimens. Bone mass was measured by dual-photon and single-photon absorptiometry at the lumbar vertebrae (L1 to L4) and at two sites on the radius. Vertebral mineral density was significantly lower in the amenorrheic group (mean, 1.12 g per square centimeter) than in the eumenorrheic group (mean, 1.30 g per square centimeter). There was no significant difference at either radial site. Radioimmunoassay confirmed a lower mean estradiol concentration (amenorrheic group, 38.58 pg per milliliter; eumenorrheic group, 106.99 pg per milliliter) and progesterone peak (amenorrheic group, 1.25 ng per milliliter; eumenorrheic group, 12.75 ng per milliliter) in the amenorrheic women, in four venous samples drawn at seven-day intervals. A three-day dietary history showed no significant differences in nutritional intake, including calcium with and without supplements. The two groups were similar in percentage of body fat, age at menarche, years of athletic participation, and frequency and duration of training but differed in number of miles run per week (amenorrheic group, 41.8 miles [67.3 km]; eumenorrheic group, 24.9 miles [40.1 km]). We conclude that the amenorrhea that is observed in female athletes may be accompanied by a decrease in mineral density of the lumbar vertebrae.
Adult↗