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Biomedical subjects

M Sowers

Publications and source records attributed to M Sowers.

At least 19 recordsLinked to original sources
PubMed2005

Weight, fat mass, and central distribution of fat increase when women use depot-medroxyprogesterone acetate for contraception.

OBJECTIVE: To compare longitudinal changes in weight, body fat, and ratio of central to peripheral fat mass among first-time depot-medroxyprogesterone acetate (DMPA) users to women using no hormonal contraception, and to evaluate user characteristics associated with that change. DESIGN: Prospective longitudinal study. SUBJECTS: Healthy women, aged 18-35 y, using DMPA for contraception (n=178) and women using no hormonal contraception (n=145). MEASUREMENTS: Weight, body fat, and the central distribution of fat, measured at 3-month intervals for 30 months, by electronic scale and dual-energy X-ray absorptiometry (DEXA). The ratio of central to peripheral distribution of body fat was computed by dividing the body fat in the conventional DEXA trunk region of interest (ROI) by the ROI's that encompass the arms, hips and legs. RESULTS: Women using DMPA had a significantly greater increase in all measures of fatness than women using no hormonal method of contraception (P<0.03). The observed weight of DMPA users increased from a mean of 69.4 kg (s.d.=16.9) at baseline to 75.5 kg (s.d.=25.0) at 30 months; an increase of 6.1 kg (8.8.%). Fat mass increased from a mean of 25.3 kg (s.d.=12.6 kg) at baseline to 31.4 kg (s.d.=17.8); an increase of 6.1 kg (23.6%) in DMPA users. The ratio of central to peripheral fat mass in DMPA users changed from 0.95 (s.d.=0.155) at baseline to 1.01(s.d.=0.198) at 30 months. In contrast, weight, fat mass and the ratio of central to peripheral fat mass of control participants remained virtually unchanged over the same time period. Women with higher baseline physical activity levels had a smaller increase in body fat (P=0.003) and the fat ratio (P=0.03), but not weight (P=0.48). No other user characteristics including, smoking, past oral contraceptive use or previous pregnancies predicted change in level of fatness. CONCLUSIONS: This study has demonstrated a change in body composition toward greater fatness and toward a central redistribution of fat among DMPA users as compared to controls and provides important information to be used when counseling women regarding contraceptive methods. Given the potential long-term implication of these changes, further study is recommended to determine whether the gains in fatness are reversed following DMPA discontinuation and to examine the role of progestins in the development and maintenance of obesity.

Absorptiometry, Photon↗
PubMed2002

Assessing menstrual cycles with urinary hormone assays.

The Study of Women's Health Across the Nation (SWAN) is a multiethnic cohort study of middle-aged women enrolled at seven US sites. A subset of 848 women completed a substudy in which their urinary gonadotropins and sex steroid metabolites were assessed during one complete menstrual cycle or up to 50 consecutive days. Urine was analyzed for LH, FSH, estrone conjugates (E1c), and pregnanediol glucuronide (Pdg). To prepare for serial analysis of this large, longitudinal database in a population of reproductively aging women, we examined the performance of algorithms designed to identify features of the normal menstrual cycle in midreproductive life. Algorithms were based on existing methods and were compared with a "gold standard" of ratings of trained observers on a subset of 396 cycles from the first collection of Daily Hormone Substudy samples. In evaluating luteal status, overall agreement between and within raters was high. Only 17 of the 396 cycles evaluated were considered indeterminate. Of the 328 cycles rated as containing evidence of luteal activity (ELA), 320 were considered ELA by use of a Pdg threshold detection algorithm. Of 51 cycles that were rated as no evidence of luteal activity, only 2 were identified by this algorithm as ELA. Evaluation of the day of the luteal transition with methods that detected a change in the ratio of E1c to Pdg provided 85-92% agreement for day of the luteal transition within 3 days of the raters. Adding further conditions to the algorithm increased agreement only slightly, by 1-8%. We conclude that reliable, robust, and relatively simple objective methods of evaluation of the probability and timing of ovulation can be used with urinary hormonal assays in early perimenopausal women.

Algorithms↗
PubMed2001

Maternal glucose concentration influences fetal growth, gestation, and pregnancy complications.

Using 1990-1995 data, the authors examined the influence of post-challenge maternal glucose concentration on pregnancy outcome in 1,157 nondiabetic US gravidas. After control for potential confounding variables and comparing gravidas with lower glucose concentrations (<99 mg/dl) with the others, they found that mean birth weight increased by 50 g and 200 g with glucose concentrations of 99-130 mg/dl and >130 mg/dl, respectively. Increased maternal glucose concentration also was associated with an increased risk of large-for-gestation fetuses (p for trend < 0.001) and a decreased risk of fetal growth restriction (p for trend < 0.05). The association between glucose and gestation was inverse and significantly shortened when glucose concentrations were higher. Maternal complications increased twofold or more with high glucose concentrations and included cesarean section and clinical chorioamnionitis. Chorioamnionitis in combination with high maternal glucose concentration increased the risk of very preterm delivery almost 12-fold. These observations extend Pedersen's hypothesis-that high concentrations of maternal glucose give rise to increased nutrient transfer to the fetus and increase fetal growth, beyond the model of maternal diabetes (Acta Endocrinol 1954;16:330-42). They raise the question of whether higher, but seemingly normal maternal glucose concentration predisposes to or is a marker for placental inflammation and infection.

Adolescent↗
PubMed2001

Magnitude and variability of sequential estradiol and progesterone concentrations in women using depot medroxyprogesterone acetate for contraception.

OBJECTIVE: To describe the magnitude and variability of sequential serum estradiol and progesterone concentrations throughout one depot medroxyprogesterone (DMPA) injection interval. DESIGN: Prospective study. SETTING: Family planning and women's health clinics. PATIENT(S): Thirty-one women, ages 19 to 46, using DMPA for contraception. INTERVENTION(S): Serum for estrogen and progesterone was collected weekly throughout one DMPA injection interval. MAIN OUTCOME MEASURE(S): Serum estradiol and progesterone concentrations; estradiol patterns produced from data plotted across the entire DMPA injection interval. RESULT(S): The average daily estradiol concentrations ranged from 7.9 to 69.1 pg/mL, with a mean of 18.9 +/- 12.9 and a median of 15.4 pg/mL. Average daily progesterone concentrations ranged from 0.14 to 1.1 ng/mL, with a mean of 0.40 +/- 0.19 ng/mL and a median of 0.36 ng/mL. Two general patterns of estradiol concentrations were identified. One pattern, observed in approximately one third of the participants, reflected estradiol concentrations that were extremely low (mean, 12.7 +/- 3.6 pg/mL; median, 13.4 pg/mL) and consistently flat across the DMPA injection interval. The second pattern, seen in the remaining participants, reflected estradiol concentrations that were higher (mean, 22.2 +/- 14.9 pg/mL; median, 17.3 pg/mL) and quite variable. CONCLUSION(S): This study demonstrated that estradiol concentrations were lower than the 40 to 50 pg/mL reported in most studies and, for the majority of women, varied substantially across the DMPA injection interval.

Adult↗
PubMed2001

The association of menopause and physical functioning in women at midlife.

OBJECTIVES: To determine whether the characteristics of menstrual bleeding and the menopausal transition are associated with physical functioning in women age 40 to 55, after considering ethnicity, ability to pay for basics, body size, and age. DESIGN: Cross-sectional study. SETTING: Seven geographically dispersed community samples in the United States. PARTICIPANTS: The 14,427 respondents were Caucasians (46.9%), African Americans (28.7%), Chinese (4.0%), Japanese (5.3%), and Hispanics (12.6%) from the Study of Women's Health Across the Nation (SWAN) Cross-sectional Study, a study of the menopausal transition, including surgical menopause. MEASUREMENTS: The dependent variable was a three-category variable based on the physical functioning scale of the Medical Outcomes Study. Explanatory variables included menstrual and menopausal status. RESULTS: Eighty percent (80.8%) of women reported no limitation in physical functioning, whereas 10% of women had some limitation, and 9.2% of women indicated having substantial limitation. Women with substantial limitation in physical functioning had double the prevalence odds ratio (POR = 2.02; 95% confidence interval (CI) = 1.64-2.49) of having surgical menopause and 76% greater odds (POR = 1.76; 95% CI = 1.38-2.24)) of using hormones, compared with women with no limitation. Compared with those without limitation, women with substantial limitation in physical functioning had 56% greater odds (POR = 1.56; 95% CI = 1.23-1.97)) of being naturally postmenopausal and a 41% greater odds (POR = 1.41; 95% CI = 1.17-1.70) of being perimenopausal, relative to being premenopausal and after adjusting for other variables. CONCLUSION: Even at the relatively early age of 40 to 55, approximately 20% of women self-reported limitation in physical functioning. Surgical menopause and the use of hormones were more frequently observed in women with some and substantial physical limitation than in women with no limitation, even after adjusting for economic status, age, body mass index, and race/ethnicity.

Activities of Daily Living↗
PubMed2001

The experience of pain and emergent osteoarthritis of the knee.

UNLABELLED: Discrepancies exist between radiographic osteoarthritis of the knee (OAK) and report of knee joint pain. Little is known about how these two definitions of osteoarthritis (OA) and their correlates differ between African American (AA) and Caucasian (CA) women. OBJECTIVE: We compared the prevalence of radiographic OAK and knee joint pain in AA and CA women, and the congruency of these outcomes according to age, body size, and knee injury. DESIGN: A cross-sectional study of African American and Caucasian women aged 40-53 years (N=829) in Southeast Michigan used the Kellgren and Lawrence Atlas of Standard Radiographs of Arthritis to characterize radiographs of both knee joints (weight bearing) and self-report of knee pain. RESULTS: Current pain was a significantly more sensitive predictor of radiographic OAK among AA women (Se=0.51) compared to CA women (Se=0.35). Specificity was similar between AA women (Sp=0.77) and CA women (Sp=0.82). Positive predictive value was significantly greater for AA compared with CA women (PV+=0.40 and PV+=0.15, respectively). The odds of having radiographic OAK increased with BMI >32 kg/m(2) in both groups. Knee pain was related to BMI in CA women, but not AA women. Previous knee injury was associated with knee pain in both AA and CA women (OR=3.0 and OR=2.4). CONCLUSIONS: Joint pain in AA women was more likely to be associated with radiographic OAK as compared with CA women. This suggests differences in these two groups in both how pain is experienced in the OAK process and in the prevalence of non-OAK related pain in knee joints.

Adult↗
PubMed2001

Epidemiology of risk factors for osteoarthritis: systemic factors.

Osteoarthritis (OA) appears to be a mechanically driven but chemically mediated disease process in which there is attempted (or aberrant) repair. Well established risk factors for OA include aging, obesity, gender, and, in selected subgroups, congenital anomalies. This review addresses less well established risk factors for OA that can impact joints through their effect on systemic metabolism rather than their contribution to local joint geometry and structure. These systemic risk factors include obesity; bone and bone density; nutrients, particularly those that function as antioxidants; and genetic factors. There is great opportunity for new prevention and intervention strategies as we expand our understanding of the role of these systemic risk factors.

Adult↗
PubMed2001

IGF-I, osteocalcin, and bone change in pregnant normotensive and pre-eclamptic women.

Pre-eclampsia is a pregnancy disorder of uncertain etiology that affects 5-10% of all pregnancies, with symptoms typically presenting around or after 20 wk gestation. We hypothesized that IGF-I, osteocalcin, and bone loss would be different among women with pre-eclampsia compared with normotensive pregnant women. There were 962 pregnant healthy women, aged 12-35, who were assessed at entry to care, at 28 wk, and at delivery for osteocalcin and IGF-I concentrations. Bone ultrasound was measured at entry to care and at 6 wk postpartum, whereas bone mineral density was measured by dual x-ray densitometry at delivery. There were 64 women (6.7%) among the women being followed who developed pre-eclampsia. In women with pre-eclampsia, IGF-I concentrations were 74% greater in the third trimester compared with the first trimester, whereas there was little change in osteocalcin concentrations. In contrast, normotensive women had an average increase of 43% in IGF-I concentrations accompanied by a 63% decline in osteocalcin concentrations. In women with pre-eclampsia, IGF-I and osteocalcin concentrations were significantly correlated (r = 0.48 and 0.43) at both the first and third trimester time points, but only in the third trimester among normotensive women (r = 0.27). The bone change difference between the two groups was not statistically significant. Women with pre-eclampsia appear to have an exaggerated IGF-I responsiveness compared with women who are normotensive; however, the strong correlation between IGF-I and osteocalcin in women with pre-eclampsia suggests that the IGF-I is able to retain its role as a local regulator of bone remodeling, as indicated by the osteocalcin concentrations.

Adult↗
PubMed2000

Osteoarthritis: new insights. Part 1: the disease and its risk factors.

Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors (such as genetics, dietary intake, estrogen use, and bone density) and of local biomechanical factors (such as muscle weakness, obesity, and joint laxity). These risk factors are particularly important in weight-bearing joints, and modifying them may present opportunities for prevention of osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 1 of a two-part summary of a National Institutes of Health conference. The conference brought together experts on osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 1 focuses on a new understanding of what osteoarthritis is and on risk factors that predispose to disease occurrence. It concludes with a discussion of the impact of osteoarthritis on disability.

Age Distribution↗
PubMed2000

Radiographically defined osteoarthritis of the hand and knee in young and middle-aged African American and Caucasian women.

UNLABELLED: Osteoarthritis (OA) has been characterized as a slowly evolving degenerative disease affecting cartilage and bone, with a multifactorial etiology that may differ depending on the joint site. Because OA has been considered a disease of the elderly, few population-based studies have examined its frequency and characteristics in persons under the age of 45. OBJECTIVE: In this cross-sectional study, we examined X-rays of both knees and the dominant hand in a population of younger black and white pre- and perimenopausal women in southeastern Michigan (N = 1053) for evidence of osteoarthritis, and reported these outcomes according to the risk factors of age, body size, injury, and smoking behavior. DESIGN: Sixteen joints of the dominant hand as well as both knee joints (weight bearing) were evaluated using the Kellgren and Lawrence Atlas of Standard Radiographs of Arthritis. RESULTS: By age 40, radiographically-defined osteoarthritis emerges in both the hands and knees. These age characteristics are observed in both black and white women, however prevalence of knee OA was higher in black females (23.1%) compared with white females (8.5%), and although prevalence of hand OA was more comparable between black (25.5%) and white females (19.2%), the joint sites affected differed. The major risk factors reported in studies of older populations are present in this younger population where OA is newly emerging. CONCLUSIONS: This study provides strong evidence that primary prevention of OA must be implemented in young adulthood to curtail the emergence of radiographically-defined OA at the mid-life.

Adult↗
PubMed2000

Bone mineral density in grand multiparous women with extended lactation.

OBJECTIVE: We sought to assess whether the accumulation of multiple, frequent pregnancies and the accompanying repeated extended lactation events was a risk factor for low bone mineral density and osteoporosis. STUDY DESIGN: The study population consisted of 30 grand multiparous women who had borne at least 6 children and lactated for at least 6 months with each child, as well as 6 nulliparous, premenopausal women from a population of Finnish American women associated with the Laestadian Church in Washington State. The Church membership has not embraced contraception or extensive bottle-feeding, resulting in a group of women who are either pregnant or lactating during most of their adult reproductive lives. The medical history included the delivery date, birth outcome, infant birth weight, and number of months lactated for each pregnancy, as well as other health information. Bone mineral density of the lumbar spine, femoral neck, and radius was measured with the Hologic QDR 4500-C dual-energy x-ray absorptiometry scanner. Proc Genmod, SAS version 6.14 (Statistical Analysis Systems, Inc, Cary, NC), was used to perform a Wilcoxon test for a nonparametric analysis of covariance and significance adjusted for age and body size. RESULTS: The 2 study groups did not differ in terms of body mass index, history of smoking, or family history of osteoporosis and fracture, although the parous group was, on average, 8 years older than the nulliparous group (P <.05). The accumulation of repeated pregnancy and lactation events without a recovery interval was not associated with lowered bone mineral density or the presence of osteoporosis or osteopenia. CONCLUSIONS: This study suggests that bone mineral density levels can be sustained in the presence of the rapidly changing hormone environment associated with multiple pregnancies accompanying lactation events without a "recovery" interval.

Adult↗
PubMed2000

Functional status and hearing impairments in women at midlife.

OBJECTIVES: The aim of this study was to address the prevalence of clinically assessed high-frequency hearing impairment (HFHI) and self-reported hearing impairment (SRHI) and examine the association of these hearing assessments with physical and mental functioning in African American and Caucasian women at midlife. METHODS: The sample included 467 women who participated in the Michigan Functioning Substudy of the Study of Women's Health Across the Nation. Outcomes examined were physical and mental functioning from the Medical Outcomes Trust SF-12 Health Survey. HFHI was defined as threshold averages of 25 dB or greater over 4000, 6000, and 8000 Hertz. RESULTS: Prevalence of unilateral HFHI was 26.6% (n = 68), and prevalence of bilateral HFHI was 12.0% (n = 56). Prevalence of SRHI was 16.7% (n = 78), with minimal overlap between HFHI and SRHI (n = 36). In multiple variable logistic regression analyses, HFHI in one ear only was not associated with physical or mental functioning and bilateral HFHI was associated with limited mental functioning only. SRHI was associated with limited physical and mental functioning. DISCUSSION: Poor correlation of HFHI and SRHI in this population, combined with the significant association of SRHI with both measures of functioning, indicates that the two methods may be measuring different aspects of impairment. SRHI may facilitate early identification of individuals with hearing-related functional limitations.

Activities of Daily Living↗
PubMed2000

Semiparametric regression for periodic longitudinal hormone data from multiple menstrual cycles.

We consider semiparametric regression for periodic longitudinal data. Parametric fixed effects are used to model the covariate effects and a periodic nonparametric smooth function is used to model the time effect. The within-subject correlation is modeled using subject-specific random effects and a random stochastic process with a periodic variance function. We use maximum penalized likelihood to estimate the regression coefficients and the periodic nonparametric time function, whose estimator is shown to be a periodic cubic smoothing spline. We use restricted maximum likelihood to simultaneously estimate the smoothing parameter and the variance components. We show that all model parameters can be easily obtained by fitting a linear mixed model. A common problem in the analysis of longitudinal data is to compare the time profiles of two groups, e.g., between treatment and placebo. We develop a scaled chi-squared test for the equality of two nonparametric time functions. The proposed model and the test are illustrated by analyzing hormone data collected during two consecutive menstrual cycles and their performance is evaluated through simulations.

Biometry↗
PubMed1999

Complex relation between increasing fat mass and decreasing high density lipoprotein cholesterol levels: evidence from a population-based study of premenopausal women.

High density lipoprotein (HDL) cholesterol levels can be used to predict cardiovascular disease risk in women. To better understand variability in HDL cholesterol levels, the authors examined the relation with three domains (body size and type, sex hormone status, and carbohydrate metabolism) in a cross-sectional population-based 1993-1994 study of 402 premenopausal women from Tecumseh, Michigan. They found that these domains explained 27% of the total variation in HDL cholesterol levels; waist-to-hip ratio was the term that explained the highest proportion of variability (6% after fat mass, sex hormone binding globulin, and insulin levels were added to the model). In analyses restricted to women whose body mass index was > or = 32 kg/m2, which constituted 19% of this population, neither body mass index nor fat mass was a significant predictor of variability in HDL cholesterol levels. Significant variables were insulin levels, waist-to-hip ratio, and smoking. This finding suggests that there is a saturation of the relation between increasing fat mass and lower HDL cholesterol levels, as evidenced by the lack of a relation between the two among the heaviest women. Meanwhile, among the heaviest women, increasing insulin levels and a higher waist-to-hip ratio remained predictors of low levels of HDL cholesterol.

Adult↗
PubMed1999

The associations of bone mineral density and bone turnover markers with osteoarthritis of the hand and knee in pre- and perimenopausal women.

OBJECTIVE: To determine whether Caucasian women ages 28-48 years with newly defined osteoarthritis (OA) would have greater bone mineral density (BMD) and less bone turnover over time than would women without OA. METHODS: Data were derived from the longitudinal Michigan Bone Health Study. Period prevalence and 3-year incidence of OA were based on radiographs of the dominant hand and both knees, scored with the Kellgren/Lawrence (K/L) scale. OA scores were related to BMD, which was measured by dual-energy x-ray absorptiometry, and to serum osteocalcin levels, which were measured by radioimmunoassay. RESULTS: The period prevalence of OA (K/L grade > or =2 in the knees or the dominant hand) was 15.3% (92 of 601), with 8.7% for the knees and 6.7% for the hand. The 3-year incidence of knee OA was 1.9% (9 of 482) and of hand OA was 3.3% (16 of 482). Women with incident knee OA had greater average BMD (z-scores 0.3-0.8 higher for the 3 BMD sites) than women without knee OA (P < 0.04 at the femoral neck). Women with incident knee OA had less change in their average BMD z-scores over the 3-year study period. Average BMD z-scores for women with prevalent knee OA were greater (0.4-0.7 higher) than for women without knee OA (P < 0.002 at all sites). There was no difference in average BMD z-scores or their change in women with and without hand OA. Average serum osteocalcin levels were lower in incident cases of hand OA (>60%; P = 0.02) or knee OA (20%; P not significant). The average change in absolute serum osteocalcin levels was not as great in women with incident hand OA or knee OA as in women without OA (P < 0.02 and P < 0.05, respectively). CONCLUSION: Women with radiographically defined knee OA have greater BMD than do women without knee OA and are less likely to lose that higher level of BMD. There was less bone turnover among women with hand OA and/or knee OA. These findings suggest that bone-forming cells might show a differential response in OA of the hand and knee, and may suggest a different pathogenesis of hand OA and knee OA.

Adult↗
PubMed1999

Vitamins and arthritis. The roles of vitamins A, C, D, and E.

There are at least four mechanisms whereby the nutrient vitamins A, C, D, and E may be related to the processes that impede or give rise to OA. These nutrient vitamins have major roles in modulating oxidative stress, participating in immune responses, and contributing to cell differentiation. There is a substantial need to understand the contribution of these nutrients to OA, because they may provide important insight into ameliorating the initiation and progression of the disease. Simultaneously, greater understanding will add rationality to an area of potential intervention that is often based on anecdote. Investigation will be complex; there is the need to select appropriate systems. Typical animal model systems used in the study of OA are inappropriate because most animals can synthesize ascorbic acid. There is the need to disaggregate, as much as possible, the numerous subsets of OA and the plethora of processes that contribute to that heterogeneity. Certainly, there is the need to recognize the interdependency of the actions of each of these nutrients at the cellular level. Furthermore, humans rarely consume these nutrients as independent products. For example, watermelon is a primary source of both ascorbic acid and beta-carotene. Failure to address these complexities denies the scientist the opportunity to advance our understanding of health and disease processes. More importantly, failure to address these complexities denies the person with OA the opportunity to address his or her own health.

Animals↗
PubMed1999

Genetic markers, bone mineral density, and serum osteocalcin levels.

We evaluated five genetic markers for products that contribute to skeletal mineralization including the Sp1 polymorphism for type I collagen Ai (COLIA1), the vitamin D receptor (VDR) translation initiation site polymorphism, the promoter of the osteocalcin gene containing a C/T polymorphism, the estrogen receptor (ER) gene containing a TA repeat, and the polymorphic (AGC)n site in the androgen receptor. These markers were evaluated for their potential relationship with bone mineral density (BMD), measured by dual-energy X-ray densitometry, or its 3-year change. Additionally, potential associations of these genotypes and with baseline osteocalcin concentration or its 3-year change (assessed using radioimmunoassay) were evaluated. The study was conducted in 261 pre- and perimenopausal women of the Michigan Bone Health Study, a population-based longitudinal study of musculoskeletal characteristics and diseases. The polymorphic (AGC)n site in the androgen receptor showed a strong association with BMD of the femoral neck (FN) and lumbar spine and remained highly significant after adjusting for body mass index (BMI), oophorectomy/hysterectomy, oral contraceptive (OC) use and hormone replacement use (p < 0.001). The TA repeat at the 5' end of the ER gene was associated with total body calcium (p < 0.05) after adjusting for BMI, oophorectomy and hysterectomy, and OC use. The frequency of oophorectomy and hysterectomy within selected genotypes explained much of the statistically significant association of the ER genotypes with BMD of the FN and spine. There was no association of measures of BMD or bone turnover with the Sp1 polymorphism for COLIA1, the VDR translation initiation site polymorphism, or the C/T promoter polymorphism of the osteocalcin gene. These findings suggest that sex hormone genes may be important contributors to the variation in BMD among pre- and perimenopausal women.

Adult↗