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Biomedical subjects

M C Nevitt

Publications and source records attributed to M C Nevitt.

At least 55 records · Page 3Linked to original sources
PubMed1999

Recreational physical activity and the risk of osteoarthritis of the hip in elderly women.

OBJECTIVE: The relationship between recreational physical activity and the risk of osteoarthritis (OA) of the hip in women is uncertain. We examined the cross sectional association of radiographic OA of the hip and past recreational and sports related physical activity in elderly women who are participants in the Study of Osteoporotic Fractures. METHODS: An anteroposterior pelvic radiograph of 5818 subjects was assessed for hip OA using reliable measurements of individual radiographic features. Hips were graded on a summary scale of 0 (no findings) to 4 (severe OA) based on the number and type of radiographic features present. Logistic regression was used to examine the association of self-reported recreational physical activity (times/week) as a teenager, at age 30, and at age 50 with hip OA. All analyses were adjusted for age and body mass index at age 25 years. RESULTS: The risk of moderate to severe radiographic hip OA in elderly women was modestly increased in elderly women who were in the highest quartile for all physical activities performed as a teenager (odds ratio 1.7, 95% confidence interval 1.1, 2.4), at age 50 (OR 1.4, 95% CI 1.0, 1.9) and weight bearing activities at age 30 (OR 1.4, 95% CI 1.0, 1.9) compared to women in the lowest quartile of activity. The risk of symptomatic hip OA (grade > or =2 hip OA + hip pain) was modestly increased in women who were in the highest quartile for all physical activities as a teenager (OR 2.0, 95% CI 1.2, 3.4), at age 50 (OR 1.6, 95% CI 1.0, 2.4), and weight bearing activities at age 30 (OR 1.6, 95% CI 1.0, 2.4) compared to women in the lowest quartile of activity. CONCLUSION: Recreational physical activities performed by women before menopause may increase the risk of radiographic and symptomatic hip OA.

Age Factors↗
PubMed1999

Falls in older Mexican-American women.

OBJECTIVE: To determine the frequency of falls and identify risk factors for falls among older Mexican-American women. DESIGN: A prospective cohort study with an average follow-up of 2.7 years. SETTING: A clinical center at the Palo Alto Veterans Affairs Medical Center, California. PARTICIPANTS: 152 community-dwelling Mexican-American Caucasian women aged 59 years or older. OUTCOME MEASURES: Falls and injurious falls, as determined by monthly telephone interviews. RESULTS: The rate of falls was 508 per 1000 person-years (95% confidence interval (CI), 440-577). Injurious falls requiring medical attention occurred at a rate of 79 per 1000 person-years (95% CI, 52-107). Factors that were associated independently with an increased risk of falling were older age, a history of arthritis or rheumatism, a history of high thyroid, having fainted at least once in the year before baseline, current use of psychotropic medications, and walking fewer than 5 blocks a day. Those persons with an average time for the chair stand test had a lower risk of falling than those with the slowest times or the fastest times. CONCLUSIONS: The frequency of falls and injurious falls in this cohort of 152 relatively acculturated, healthy, older Mexican-American women was similar or slightly higher than previously reported rates for non-Hispanic Caucasian(s). Many of the factors associated with falls in this study were similar to those reported for non-Hispanic Caucasian women, suggesting that fall prevention measures tested mainly among non-Hispanic Caucasian women would also be appropriate for Mexican-American women.

Accidental Falls↗
PubMed1998

The association of radiographically detected vertebral fractures with back pain and function: a prospective study.

BACKGROUND: Vertebral fractures are a hallmark of postmenopausal osteoporosis and an important end point in trials of osteoporosis treatment, but the clinical significance of these fractures remains uncertain. OBJECTIVE: To determine the association of new vertebral fractures with back pain and back-related functional limitation in older women. DESIGN: Prospective observational study. SETTING: Multicenter Study of Osteoporotic Fractures. PARTICIPANTS: 7223 white women aged 65 years and older. MEASUREMENTS: Lateral spine radiographs were obtained at baseline and at a follow-up examination an average of 3.7 years later. Prevalent and incident radiographic vertebral fractures were assessed by quantitative morphometry. Frequency and severity of back pain, disability in doing six activities involving the back, and days of bed rest and days of limited activity due to back pain were assessed annually by questionnaire during follow-up. RESULTS: Among women without a vertebral fracture at baseline, those with at least one incident vertebral fracture were more likely to have increased back pain (odds ratio [OR], 2.4 [95% CI, 1.7 to 3.3]) and back disability (OR, 2.6 [CI, 1.9 to 3.7]) and at least 1 day of bed rest due to back pain (OR, 6.7 [CI, 4.4 to 10.2]) and 7 days of limited activity due to back pain per year (OR, 3.8 [CI, 2.7 to 5.0]). Among women with a fracture at baseline, those with an incident vertebral fracture also had a greater risk for increased back pain (OR, 2.0 [CI, 1.4 to 2.8]) and back disability (OR, 2.2 [CI, 1.5 to 3.1]) and at least 1 day of bed rest (OR, 7.9 [CI, 4.9 to 12.9]) and 7 days of limited activity per year (OR, 3.5 [CI, 2.4 to 5.0]). Women with incident fracture had about 10 additional limited-activity days and 1 to 2 days of bed rest per year. New vertebral fractures that did not come to medical attention were associated with increased back pain and functional limitation. CONCLUSION: New vertebral fractures, even those not recognized clinically, are associated with substantial increases in back pain and functional limitation due to back pain in older white women. Prevention of new vertebral fractures should reduce the burden of back pain and functional limitation in women with vertebral osteoporosis.

Activities of Daily Living↗
PubMed1998

The effects of estrogen on osteoarthritis.

The prevalence of osteoarthritis is higher in women than men, and in women it increases dramatically in the years after menopause. These observations and others reporting a painful form of hand osteoarthritis after the menopause suggest that loss of estrogen at the time of menopause increases a woman's risk of getting osteoarthritis. This article reviews biologic evidence for hormone sensitivity of cartilage, animal studies testing the effect of estrogen on the joints of ovariectomized animals, and human epidemiologic and clinical studies evaluating endogenous estrogen levels and estrogen replacement therapy and their relation to the occurrence of osteoarthritis. Overall the evidence for a role of estrogen in osteoarthritis is conflicting. Epidemiologic studies of women who take estrogen replacement therapy, however, consistently report that these women have a lower prevalence of osteoarthritis than women not taking estrogen, suggesting a possible therapeutic role for estrogen in osteoarthritis.

Animals↗
PubMed1998

Strength, physical activity, and body mass index: relationship to performance-based measures and activities of daily living among older Japanese women in Hawaii.

OBJECTIVES: Remaining strong, lean, and physically active may contribute to successful aging, both by maintaining function and by enabling more independent living. The study objective was to investigate this hypothesis among a long-lived population of older Japanese women. DESIGN: A cross-sectional study. SETTING: The island of Oahu, Hawaii. PARTICIPANTS: A total of 705 community-dwelling women (mean age, 74; range, 55-93). MEASUREMENTS: As outcomes, 7 physical performance measures including walking speed, the Get Up and Go test, chair stands, functional reach, and hand and foot reaction times, and 8 questions regarding activities of daily living (ADL). As possible predictors, physical activity, body mass index, and quadriceps, grip, and triceps strength. RESULTS: In multivariable models, one or more of the strength tests was associated positively with six of the seven performance-based measures. Among the significant associations, 1-SD increases in strength were associated with 2 to 4% increases in performance compared with the sample mean. Physical activity was independently, and positively associated with the most complex of the tests, the Get Up and Go test. Body mass index (BMI), in contrast to strength and physical activity, was negatively associated with five of the seven performance tests. Among the significant associations, 1-SD increases in BMI were associated with 3 to 8% reductions in performance. In multivariable models strength was also associated positively with seven of the eight ADLs. In the same models, physical activity was positively associated with five and BMI was negatively associated with six of the ADLs. CONCLUSION: The results suggest that remaining strong, lean, and physically active provided wide-ranging benefits for this population of older Japanese women.

Activities of Daily Living↗
PubMed1998

Relationship of neurological function and age in older women. The study of osteoporotic fractures.

The decline of neurological and neuromuscular function with age in older women and in subgroups of older women with selected risk factors for poor function is described using cross- sectional analyses of data on 8,080 women from the multicenter Study of Osteoporotic Fractures. All twelve performance-based tests of muscle strength, balance, gait, somatosensory discrimination and reaction time declined with increasing age. On a percentage scale, vibration threshold declined the most rapidly with age. Participants who were smokers, physically inactive, nonconsumers of alcohol, diabetics and more frequent fallers had poorer age-adjusted performance than those without these attributes. However, with a few exceptions, the rate of decline in performance with age for those with and without these characteristics did not differ significantly.

Aged↗
PubMed1997

Back problems and atherosclerosis. The Study of Osteoporotic Fractures.

STUDY DESIGN: A cross-sectional and prospective study of osteoporotic fractures. OBJECTIVES: To investigate the correlation between lower extremity arterial disease or history of cardiovascular disease and back pain, back function, osteoporosis, and vertebral fractures. BACKGROUND: It has been postulated that atherosclerosis may compromise blood flow to bone and soft tissues in the back, causing pain and disability. Recent studies have presented conflicting results. METHODS: At baseline, information on back pain and function, general functional status, cardiovascular history, and general lifestyle variables was obtained from 1492 elderly white women (mean age, 71 years) enrolled in the Study of Osteoporotic Fractures. Lateral radiographs of the lumbar and thoracic spine were obtained, and lower extremity arterial disease was assessed. Follow-up information was obtained an average of 3.7 years later. RESULTS: At baseline, 82 women had arterial disease, 443 had a history of cardiovascular disease, and 277 had vertebral fractures; 58 women had one or more additional vertebral fractures during the follow-up period. After adjustment for age, women with cardiovascular disease were more likely to have back pain and disability as a result of the back pain than women free of cardiovascular disease; at the follow-up examination, the back-related disability was more than twice as likely to have worsened in the cardiovascular disease group. No correlation was found between arterial disease and back problems. Neither the prevalence of vertebral fractures at baseline, nor the incidence of vertebral fractures was associated with the presence of arterial disease or cardiovascular disease. CONCLUSIONS: Results indicated that back problems in elderly women are associated with self-reported cardiovascular disease, but not with objectively assessed lower extremity arterial disease.

Aged↗
PubMed1997

Calcium intake and fracture risk: results from the study of osteoporotic fractures.

The relation between dietary calcium, calcium, and vitamin D supplements and the risk of fractures of the hip (n = 332), ankle (n = 210), proximal humerus (n = 241), wrist (n = 467), and vertebrae (n = 389) was investigated in a cohort study involving 9,704 US white women aged 65 years or older. Baseline assessments took place in 1986-1988 in four US metropolitan areas. Dietary calcium intake was assessed at baseline with a validated food frequency questionnaire. Data on new nonvertebral fractures were collected every 4 months during a mean of 6.6 years of follow-up; identification of new vertebral fractures was based on comparison of baseline and follow-up radiographs of the spine done a mean of 3.7 years apart. Results were adjusted for numerous potential confounders, including weight, physical activity, estrogen use, protein intake, and history of falls, osteoporosis, and fractures. There were no important associations between dietary calcium intake and the risk of any of the fractures studied. Current use of calcium supplements was associated with increased risk of hip (relative risk = 1.5, 95% confidence interval 1.1-2.0) and vertebral (relative risk = 1.4, 95% confidence interval 1.1-1.9) fractures; current use of Tums antacid tablets was associated with increased risk of fractures of the proximal humerus (relative risk = 1.7, 95% confidence interval 1.3-2.4). There was no evidence of a protective effect of vitamin D supplements. Although a true adverse effect of calcium supplements on fracture risk cannot be ruled out, it is more likely that our findings are due to inadequately controlled confounding by indications for use of supplements. In conclusion, this study did not find a substantial beneficial effect of calcium on fracture risk.

Aged↗
PubMed1997

Correlates of fear of falling and activity limitation among persons with rheumatoid arthritis.

OBJECTIVES: To examine factors associated with fear of falling, activity limitation due to fear of falling, and how persons modified their activities in response to fear of falling, among older persons with rheumatoid arthritis (RA). METHODS: Participants in a panel study of RA who were over age 50 (n = 570) were questioned about whether they experienced fear of falling and whether and how they limited activities due to fear of falling. RESULTS: Fifty percent reported fear of falling, and 38% modified activities due to fear of falling. Correlates of fear of falling included female gender, depressive symptoms, poor physical functioning, minor fall-related injuries, and a greater number of painful joints. Correlates of limiting activities due to fear of falling included worse self-rated health, poor physical functioning, and high painful joint count. Activities commonly affected included stair climbing, walking, and outings. CONCLUSIONS: Fear of falling and limiting activities are common problems for persons with RA. Persons at risk should be targeted for appropriate interventions.

Accidental Falls↗
PubMed1997

Body size and hip fracture risk in older women: a prospective study. Study of Osteoporotic Fractures Research Group.

PURPOSE: To determine the relationship between measures of body size and the risk of hip fracture in elderly women. PARTICIPANTS AND METHODS: The association between measures of body size and hip fracture risk was assessed in 8,011 ambulatory, nonblack women 65 years of age or older enrolled in the Study of Osteoporotic Fractures with measurements of total body weight, percent weight change since age 25, hip girth, lean mass, fat mass, percent body fat, body mass index, modified body mass index, and femoral neck bone mineral density (BMD) at the second examination. These 8,011 women were followed prospectively for incident hip fractures occurring after the second examination, which were confirmed by review of x-ray films. RESULTS: During an average of 5.2 years after the second examination, 236 (2.9%) women experienced hip fractures. Similar associations were observed between hip fracture risk and all measures of body size including total body weight, percent weight change since age 25, hip girth, lean mass, fat mass, percent body fat, body mass index, and modified body mass index. Women with smaller body size had a higher risk of subsequent hip fracture compared with those with larger body size, while women with average and larger body sizes shared similarly lower risks of subsequent hip fracture. For example, the incidence rate of hip fracture was 9.35 per 1000 woman-years in women in the lowest quartile of total weight compared with 4.63 per 1000 woman-years in women in the highest quartile of total weight (age-adjusted relative risk 1.93, 95% confidence interval (CI) 1.34 to 2.80), while rates of hip fracture among women in the second and third quartiles of total weight (5.22 and 4.32 per 1000 woman-years, respectively) were not significantly different from the rate among women in the highest quartile (P > 0.64). The increased risk of hip fracture among women of smaller body size remained after further adjustment for additional potential confounding factors including height at age 25, smoking status, physical activity, health status, estrogen use, and diuretic use. After further adjustment for femoral neck BMD, women with smaller body size were no longer at significantly increased risk of hip fracture compared with those with larger body size. For example, after adjustment for height at age 25, smoking status, physical activity, health status, estrogen use, and diuretic use, thin women had a 2.5-fold increase in the risk of hip fracture (multivariate relative risk 2.51, 95% CI 1.69 to 3.73) compared with the referent group composed of the heaviest women. After further adjustment for femoral neck BMD, the multivariate relative risk of hip fracture among thin women compared to heaviest women was 0.98 (95% CI, 0.64 to 1.50). CONCLUSION: Older women with smaller body size are at increased risk of hip fracture. This effect is because of lower hip BMD in women with smaller body size. Assessment of body size for prediction of hip fracture risk can be accomplished by measuring total body weight.

Aged↗
PubMed1997

Incidence rates of falls among Japanese men and women living in Hawaii.

Japanese people in both Japan and in Hawaii have a lower incidence of hip fractures than white people in Hawaii or on the mainland of the United States. Hip fractures usually occur after a fall, and differing incidence rates of falls might contribute to the observed differences in hip fracture rates. To investigate this possibility we undertook a prospective study of falls among elderly Japanese men and women living in Hawaii using intensive surveillance methods similar to those used in studies of predominantly white populations. For our Japanese participants, the incidence rates of total falls were 139 per 1000 person years for men and 276 per 1000 person years for women. Age adjusted rate ratios of falls for predominantly white populations compared with our Japanese participants ranged from 1.8 to 2.3 for women and from 2.6 to 4.7 for men. The risk of injuries when they did fall, however, was not lower for our Japanese participants than reported for white participants. For our Japanese population, past falls, female gender, and daytime hours were associated with an increased incidence of falls.

Accidental Falls↗
PubMed1997

Bone mineral density and aortic calcification: the Study of Osteoporotic Fractures.

OBJECTIVE: To investigate the relationship between bone mineral density (in the axial and appendicular skeleton) and calcification of the aorta. DESIGN: Cross-sectional study. SETTING: Community-based study. PARTICIPANTS: A total of 2051 women aged 65 years and older enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS: Bone mineral density (BMD) at the hip, spine, calcaneus, proximal and distal radius; calcification of the aorta (AC); demographic and lifestyle variables; dietary history; functional status; blood pressure; anthropomorphic measures. RESULTS: The prevalence of AC increased with age, ranging from 60% at ages 65 to 69 years to 96% at 85 years and older. BMD in women with calcified arterial plaques was lower (P < .001) when compared with those with no plaques, at all sites measured except the lumbar spine. After adjustment for age, BMD at the hip, spine and calcaneus was not associated with the presence of plaques; only a weak association between BMD and AC remained at the distal and proximal radius. The independent correlates of AC were age, smoking status, systolic blood pressure, coffee drinking, central obesity and a history of diabetes or stroke; current estrogen use was protective. CONCLUSIONS: The results of this study indicate that osteopenia and the deposition of calcific plaques in the wall of the aorta are independent processes that occur as women age. They are probably not causally linked.

Age Distribution↗
PubMed1997

Acetabular dysplasia and osteoarthritis of the hip in elderly white women.

OBJECTIVES: To examine the association of acetabular dysplasia and osteoarthritis (OA) of the hip among elderly white women. METHODS: Pelvic radiographs from a sample of 165 white women aged 65 and above with radiographic hip OA and 88 white women aged 65 and above without radiographic changes of hip OA were read for evidence of acetabular dysplasia by a single trained investigator. Acetabular dysplasia was assessed using measurements of the centre edge angle and the acetabular depth, which are both reduced in this condition. Odds ratios for the association between acetabular dysplasia and hip OA were estimated using logistic regression analysis. RESULTS: Fourteen (3.4%) hips had a centre edge angle < 25 degrees, 46 (11.2%) hips had an acetabular depth of < 9 mm, and 54 (13.2%) hips had acetabular dysplasia defined as either of the above. Hips with OA had a small, but not statistically significant, increased prevalence of abnormal centre edge angle (odds ratio: 1.43; 95% confidence intervals: 0.46, 4.46), abnormal acetabular depth (1.47; 0.78, 2.77) and acetabular dysplasia (1.33; 0.74, 2.40). CONCLUSION: These results do not support the hypothesis that mild acetabular dysplasia accounts for a substantial proportion of hip OA in elderly white women. A study with a much larger sample size would be required to rule out a weak association between dysplasia and hip OA of the magnitude actually observed in our study.

Acetabulum↗
PubMed1997

Low thyrotropin levels are not associated with bone loss in older women: a prospective study.

The relationship between excess thyroid hormone and bone loss is controversial. To determine whether low TSH levels, indicating excessive thyroid hormone, are associated with low bone mass or accelerated bone loss in older women, we performed a prospective cohort study of 458 women over age 65 yr participating in the multicenter Study of Osteoporotic Fractures. Three hundred and twenty-three women were randomly selected from the entire cohort of 9704; an additional 135 randomly selected thyroid hormone users were studied. Medical history, medication use, and calcaneal bone mineral density (BMD) were assessed at the baseline visit. Serum was collected and stored at -190 C. Hip and spine BMD were measured approximately 2 yr later, and follow-up calcaneal and hip BMD measurements were obtained after mean follow-up periods of 5.7 and 3.5 yr, respectively. TSH levels were determined in baseline serum samples using a third generation chemiluminescent assay. After adjustment for age, weight, previous hyperthyroidism, and use of estrogen, bone loss over 4-6 yr was similar in women with low, normal, or high TSH. For example, femoral neck bone loss was -0.3%/yr (95% confidence interval, -0.8%, 0.3%) among women with low TSH (< or = 0.1 mU/L) and -0.5%/yr (95% confidence interval, -0.7%, -0.3%) in those with normal TSH (0.1-5.5 mU/L). There were no statistically significant differences in baseline bone mass of the calcaneus, spine, or femoral neck or trochanteric hip subregions. Baseline total hip BMD was 6% lower (P = 0.01) in women with low TSH. Similar results were obtained in analyses confined to women not taking estrogens. We found no consistent evidence that low TSH, a sensitive biochemical marker of excess thyroid hormone, was associated with low BMD or accelerated bone loss in older ambulatory women.

Aged↗
PubMed1997

Bone mineral density and blood flow to the lower extremities: the study of osteoporotic fractures.

This study tests the hypothesis that reduced blood flow to the lower extremities may affect bone remodeling, resulting in a decrease in bone mineral density (BMD). BMD was measured in the axial and appendicular skeleton of 1292 elderly women (mean age, 71 years) enrolled in the Study of Osteoporotic Fractures. The ratio of the posterior tibial and brachial systolic blood pressures, the ankle/arm index, was used as a measure of blood flow to the legs. In the cross-sectional analysis, this index was positively correlated with BMD at the radius, calcaneus, and hip, but not at the spine. A decrease in the index of 2 standard deviations (SD) (as might occur in patients with moderate arterial disease) was associated with a decrease of 3.7% (95% CI, 1.7%, 5.8%) in hip BMD. The effect size at the hip decreased from 3.7 to 1.8% (and was not statistically significant) when adjustment was made for smoking and/or body mass index (BMI). In the prospective analysis, the rate of bone loss at the hip and calcaneus was greater (p < 0.05) among women whose annual decrease in ankle/arm index was more than 1 SD greater than the mean decrease. This increase was independent of estrogen use, smoking, BMI, pattern of fat distribution, history of diabetes, exercise, and ability to walk. The results from this prospective community-based study provide the first evidence that among relatively healthy older women decreased vascular flow in the lower extremities may be associated with an increased rate of bone loss at the hip and calcaneus.

Aged↗
PubMed1997

Calcium for prevention of osteoporotic fractures in postmenopausal women.

A systematic review of the literature was conducted to assess the effectiveness of calcium supplements and/or dietary calcium for the prevention of osteoporotic fractures in postmenopausal women. Studies were identified by conducting a Medline search using the text words "fracture" and "calcium" for the period 1966 to March 1997 and by reviewing articles known to the authors. Only studies with fracture outcomes were eligible. There were 14 studies of calcium supplements (including 4 randomized trials), 18 studies of dietary calcium and hip fracture (no randomized trials), and 5 studies of dietary calcium and other fracture sites (no randomized trials). The 4 randomized trials of calcium supplements (mean calcium dose: 1050 mg) found relative risk (RR) reductions between 25% and 70%. Meta-analytic techniques for dose-response data were used to investigate and pool the findings of 16 observational studies of dietary calcium and hip fracture. These hip fracture studies were not consistent and heterogeneity of study findings (p = 0.02) was not easily explained by subject characteristics or study design. Pooling study results gave an odds ratio (OR) of 0.96 (95% confidence interval, (CI) 0.93-0.99) per 300 mg/day increase in calcium intake (the equivalent of one glass of milk). This is likely to be an underestimate of calcium's true effect because of inaccurate measurement of dietary calcium in observational studies. This review supports the current clinical and public health policy of recommending increased calcium intake among older women for fracture prevention.

Adult↗
PubMed1997

Aspirin and nonsteroidal antiinflammatory drug use in elderly women: effects on a marker of bone resorption. The Study of Osteoporotic Fractures Research Group.

OBJECTIVE: Epidemiological studies suggest nonsteroidal antiinflammatory drug (NSAID) and aspirin use is associated with a modest increase in bone mineral density of the hip and lumbar spine. The ability of NSAID to block prostaglandin E2 production has been shown to impair osteoclast activity in animal models. To determine if regular use of these compounds inhibits bone resorption, we assessed NSAID or aspirin use and N-telopeptide crosslink excretion in elderly postmenopausal women. METHODS: N-telopeptide crosslink excretion was assessed from a consecutive sample of 499 women from the Study of Osteoporotic Fractures, age > 65 years, who provided a morning urine sample. Questionnaire, examination, and bone mineral density data were obtained at the same visit. RESULTS: In unadjusted models, daily use of NSAID or aspirin was associated with a reduction of 12.5% (95% CI 0.5, 24.5) in N-telopeptide crosslink excretion (p < 0.05). After adjustment for potential confounders, N-telopeptide crosslink excretion was -4.8% (95% CI -24.4, 14.8) in NSAID users and +7.6% (-9.3, 24.5) in aspirin users compared to nonusers. CONCLUSION: Regular use of either NSAID or aspirin by elderly women was not associated with reduction in N-telopeptide crosslink excretion compared to nonusers.

Aged↗