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Biomedical subjects

S R Cummings

Publications and source records attributed to S R Cummings.

At least 127 records · Page 7Linked to original sources
PubMed1994

Kyphosis in older women and its relation to back pain, disability and osteopenia: the study of osteoporotic fractures.

To test the hypothesis that thoracic kyphosis is associated with substantial pain, disability, and height loss, we measured thoracic curvature, using an architect's flexicurve, of 610 women aged 65-91 years who were recruited from population-based listings. We assessed study subjects for back pain, back-related disability, height loss since age 25 years, perceived state of health, and bone mineral density (BMD) at the spine, calcaneus, proximal radius, and distal radius. Compared with the rest of the cohort, the 10% of women with the most severe kyphosis had 7%-17% lower BMD (p < 0.001) and had lost an additional 2.4 cm height (p < 0.001). However, kyphotic women had no greater back pain, disability caused by back problems, or poorer health. This cross-sectional study suggests that kyphosis is associated with decreased BMD and loss of height but does not cause substantial chronic back pain, disability, or poor health in older women.

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PubMed1994

Correlates of impaired function in older women.

OBJECTIVE: To determine the factors associated with impaired function in older women. DESIGN: Cross-sectional analysis of baseline data collected for a multicenter, prospective study of risk factors for osteoporotic fractures. SETTING: Four clinical centers in Portland, Oregon, Minneapolis, Minnesota, Baltimore, Maryland, and the Monongahela Valley, Pennsylvania. PARTICIPANTS: A total of 9,704 ambulatory, non-black women, aged 65 years and older, recruited from population-based listings. MEASUREMENTS: Independent variables, including demographic and historical information (medical conditions, health habits, and medications) and physiologic measures (anthropometry, blood pressure, mental status, vision, and neuromuscular performance) were obtained from a baseline questionnaire, interview, and examination. Measurement of function was assessed by self-reported ability to perform six physical and instrumental activities of daily living (ADL) and impaired function (dependent variable) was defined as difficulty performing three or more physical and instrumental ADLs. RESULTS: In order of decreasing strength of association, hip fracture, osteoarthritis, parkinsonism, slower walking speed, lower hip abduction force, back pain, greater Quetelet index, osteoporosis, former alcohol use, stroke, never drinking alcohol, lower mental status, use of anxiolytics and/or sleeping medications, inability to hold the tandem position, postural dizziness, cataracts, greater waist to hip ratio, lower physical activity in the past year, greater lifetime cigarette consumption, and lower grip strength were independently associated with impaired function in multivariate analyses. Age, low educational level, diabetes, current heavy alcohol use, postural hypotension, depth perception, and contrast sensitivity were not independent predictors. A combination of neuromuscular performance measures, including decreased muscle strength and impaired balance and gait, appeared to account for the effect of age on disability. CONCLUSION: A combination of many factors, including medical conditions, health habits such as obesity, smoking, alcohol abstinence, and physical inactivity, and direct measures of neuromuscular performance are associated with impaired function in older women.

Activities of Daily Living↗
PubMed1994

Morphometric X-ray absorptiometry of the spine: correlation in vivo with morphometric radiography. Study of Osteoporotic Fractures Research Group.

The diagnosis of vertebral fractures has been based on lateral thoracic and lumbar spine films and entails the determination of crush, endplate and wedge deformities of the vertebral bodies, generally between T4 and L4. Accuracy and precision of X-ray based morphometry are limited by geometric distortion and other technique-related factors. This paper proposes the use of morphometric X-ray absorptiometry (MXA) as a method which overcomes many of the limitations of morphometric radiography. MXA generates paired anteroposterior and lateral images of the spine using a scanning fan beam geometry that significantly reduces distortions inherent in the cone beam geometry used in conventional X-rays. Intra-observer precision of MXA on 41 subjects aged 65 years and older was 1 mm for vertebral height assessments and 4.7% for vertebral wedge parameters. Linear correlation with vertebral heights and wedge parameters on 32 subjects evaluated by both MXA and morphometric radiography demonstrated a root of the mean squared error of 2.1-2.4 mm and 7.0%, respectively. Vertebral deformities could be identified by MXA. The study documents the feasibility of MXA for the assessment of vertebral deformities. However, further investigation is needed to document the ability of MXA to diagnose prevalent and incident fractures.

Absorptiometry, Photon↗
PubMed1994

Bone mass, rates of osteoporotic fractures, and prevention of fractures: are there differences between China and Western countries?

Fractures are one of the most common causes of disability in older women. The quantity and density of bone decreases with age. Most types of fractures increase as bone density declines. But most of the knowledge about causes and prevention of fractures comes from studies performed in Western countries. Asian women appear to have similar or slightly lower bone density that may be a result of their smaller size. They appear to have a lower risk of hip fracture than Whites, which may be a result of their shorter hip axis. The risks of other types of fractures in Chinese women is less well defined and reasons for differences in the rates of osteoporotic fractures between China and Western countries remain to be explored. A study is underway in Beijing to describe the risks and potential causes of fractures among older women in urban China. Randomized trials in Western countries have demonstrated that calcium and vitamin D, estrogen, calcitonin, or bisphosphonates can reduce the rate of fractures. increased intake of calcium and vitamin D may be the most effective approach to preventing fractures in China, but this should be tested in a randomized trial.

Asian People↗
PubMed1993

Factors associated with appendicular bone mass in older women. The Study of Osteoporotic Fractures Research Group.

OBJECTIVE: To determine the factors associated with appendicular bone mass in older women. DESIGN: Cross-sectional analysis of baseline data collected for a multicenter, prospective study of osteoporotic fractures. SETTING: Four clinical centers in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela valley, Pennsylvania. PATIENTS: A total of 9704 ambulatory, nonblack women, ages 65 years or older, recruited from population-based listings. MEASUREMENTS: Demographic and historical information and anthropometric measurements were obtained from a baseline questionnaire, interview, and examination. Single-photon absorptiometry scans were obtained at three sites: the distal radius, midradius, and calcaneus. Multivariate associations with bone mass were first examined in a randomly selected half of the cohort (training group) and were then tested on the other half of the cohort (validation group). RESULTS: In order of decreasing strength of association, estrogen use, non-insulin-dependent diabetes, thiazide use, increased weight, greater muscle strength, later age at menopause, and greater height were independently associated with higher bone mass. Gastric surgery, age, history of maternal fracture, smoking, and caffeine intake were associated with lower bone mass (all P < 0.05). For example, we found that 2 or more years of estrogen use was associated with a 7.2% increase in distal radius bone mass, whereas gastrectomy was associated with an 8.2% decrease in bone mass. The associations between bone mass and dietary calcium intake and rheumatoid arthritis were inconsistent. Alcohol use, physical activity, use of calcium supplements, pregnancy, breast-feeding, parental nationality, and hair color were among the many variables not associated with bone mass. Multivariate models accounted for 20% to 35% of the total variance of bone mass. CONCLUSIONS: A large number of factors influence the bone mass of elderly women; however, age, weight, muscle strength, and estrogen use are the most important factors.

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PubMed1993

Effects of thiazide diuretic therapy on bone mass, fractures, and falls. The Study of Osteoporotic Fractures Research Group.

OBJECTIVE: To determine the relation between the use of thiazide diuretics and bone mass, fractures, and falls in older women. DESIGN: Cross-sectional study of thiazide diuretics, bone mass, and prevalent vertebral deformities; cohort analysis of thiazide diuretics and nonspinal fractures and falls. SETTING: Four clinical centers located in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, Pennsylvania. PARTICIPANTS: A total of 9704 ambulatory, nonblack women who were 65 years or older. MEASUREMENTS: Information on thiazide use, demographic data, medical history, and anthropometric measurements were obtained by questionnaire, interview, and examination. Appendicular bone mass was measured by single-photon absorptiometry. Incident falls and fractures were ascertained every 4 months. RESULTS: Women using thiazide diuretics for more than 10 years had significantly higher bone mass than women who had never used thiazide diuretics (for example, 0.381 g/cm2 compared with 0.355 g/cm2 for the distal radius [P < 0.001]). Current users of thiazide diuretics had an incidence of falls (relative risk, 1.06; 95% CI, 0.90 to 1.25) that was similar to that of those who had never used these drugs. After adjusting for age, body weight, functional status, total calcium intake, duration of estrogen replacement therapy, and self-reported health status, we found that current users of thiazide diuretics who had taken these drugs for more than 10 years had a risk for nonspinal (relative risk, 0.99; CI, 0.81 to 1.20) and osteoporotic (relative risk, 0.98; CI, 0.79 to 1.22) fractures that was similar to that of women who had never used thiazides; however, thiazide users did have a lower risk for fractures of the hip (relative risk, 0.63; CI, 0.34 to 1.16) and wrist (relative risk, 0.66; CI, 0.40 to 1.08), neither of which was significant. CONCLUSIONS: Thiazide diuretics have no effect on a women's risk for falling or for experiencing nonspinal fractures. The trend toward a lower risk for hip and wrist fractures is consistent with findings in previous cohort studies but may reflect selection factors for the use of thiazide diuretics. A randomized trial is needed to determine the effect ot thiazide diuretics on the incidence of fractures.

Accidental Falls↗
PubMed1993

Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group.

Women with low bone density in the radius or calcaneus are at increased risk of hip fracture. To see whether bone density of the hip measured by dual X-ray absorptiometry is a better predictor of hip fracture than measurements of other bones, we assessed bone density at several sites in 8134 women aged 65 years or more. 65 women had hip fractures during a mean follow-up of 1.8 years. Each SD decrease in femoral neck bone density increased the age-adjusted risk of hip fracture 2.6 times (95% CL 1.9, 3.6). Women with bone density in the lowest quartile had an 8.5-fold greater risk of hip fracture than those in the highest quartile. Bone density of the femoral neck was a better predictor than measurements of the spine (p < 0.0001), radius (p < 0.002), and moderately better than the calcaneus (p = 0.10). Low hip bone density is a stronger predictor of hip fracture than bone density at other sites. Efforts to prevent hip fractures should focus on women with low hip bone density.

Absorptiometry, Photon↗
PubMed1993

Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures.

Based on engineering principles, geometric measurements of femoral size should be related to femoral strength and the risk for hip fracture. To evaluate whether a simple measurement of femoral geometry is associated with hip fracture risk, we obtained dual x-ray absorptiometry scans of the proximal femur on 8074 white women age 67 or older. During an average of 1.6 years of follow-up, 64 participants suffered hip fractures. In all fracture cases and in a random sample of 134 women who did not subsequently suffer a hip fracture, we measured hip axis length (the distance from greater trochanter to inner pelvic brim), neck width, and the neck/shaft angle on the scan printout, with the observer blinded to subsequent fracture status of the participant. Results were analyzed using multiple logistic models, and odds ratios were determined. After adjustment for age, each standard deviation decrease in femoral neck bone mineral density increased hip fracture risk 2.7-fold (95% confidence interval 1.7, 4.3), and each standard deviation increase in hip axis length nearly doubled the risk of hip fracture (odds ratio = 1.8; 95% CI 1.3, 2.5). The relationship between hip axis length and fracture risk persisted even after adjustment for age, femoral neck density, height, and weight. A longer hip axis length was associated with an increased risk of both femoral neck (OR = 1.9; 95% CI 1.3, 3.0) and trochanteric fractures (1.6; 1.0, 2.4). We found no significant association between the neck width (1.1; 0.8, 1.5) or the neck/shaft angle (1.4; 0.9, 2.2) and risk of hip fracture.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1993

Design of the Fracture Intervention Trial.

The Fracture Intervention Trial (FIT) is a randomized, double-masked, placebo-controlled trial designed to test the hypothesis that alendronate, an amino-bisphosphonate, will reduce the rate of fractures in women aged 55-80 years with low hip bone marrow density (< 0.68 gm/cm2 at the femoral neck). It is being conducted at 11 clinical centers around the United States with a coordinating center at UC San Francisco. The goal was to randomize 6000 women. When recruitment was completed (in May 1993), 6457 women had been randomized, amounting to 108% of goal. The women were assigned to one of two substudies. The first (Vertebral Deformity study) includes 2023 women who have at least one vertebral deformity, and will test the hypothesis that alendronate reduces the rate of new vertebral deformities during 3 years of follow-up. This substudy has a power of 0.90 to detect a 32% reduction in the incidence of new vertebral deformities, assuming a 6.5% annual incidence of new vertebral deformities in the placebo group. The second study (Clinical Fracture study) includes 4434 women without vertebral deformities at baseline and will test the hypothesis that alendronate reduces the rate of clinically recognized fractures of all types over an average of 4.25 years of follow-up. This substudy has a 0.90 power to detect a 25% reduction in the rate of all clinical fractures, assuming 4% annual incidence in the placebo group. To our knowledge, this is the largest prospective, randomized, controlled study undertaken to determine the effectiveness of a treatment in reducing the risk of fractures in postmenopausal women.

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PubMed1993

Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. The Study of Osteoporotic Fractures Research Group.

OBJECTIVE: To determine the causes of hip or wrist fractures. DESIGN: Case-control analysis nested in a prospective cohort study. SETTING: Four clinical centers in Baltimore, Maryland, Minneapolis, Minnesota, Portland, Oregon, and Monessen, Pennsylvania. PARTICIPANTS: Non-black women age 65 and older living in the community. MEASUREMENTS: We measured bone density, arm strength, and anthropometric characteristics at a baseline examination. Those who subsequently suffered hip (n = 130) or wrist (n = 294) fractures as a result of a fall and a consecutive sample of those who fell without a fracture (n = 467) were interviewed about their falls. RESULTS: In multivariate analyses, those who suffered hip fractures were more likely to have fallen sideways or straight down (odds ratio 3.3; 95% confidence interval 2.0 to 5.6) and to have landed on or near the hip (32.5; 9.9, 107.1) than women who fell without a fracture. Among women who fell on the hip, those with hip fractures were taller (1.5; 1.2, 2.2 per SD increase), less likely to have landed on a hand (0.3; 0.1 to 0.6) or to break the fall by grabbing or hitting an object (0.4; 0.2, 0.9), had weaker triceps (1.7; 1.2, 2.5 per SD decrease), and were more likely to land on a hard surface (2.8; 1.4, 5.5) than those without fractures. Women with wrist fractures were more likely to have fallen backward (2.2; 1.3, 3.8) and to have landed on a hand (20.4; 11.5, 36.0) than those who fell without a fracture. Among women who fell on the hand, those with wrist fractures were taller (1.4; 1.1, 1.8 per SD increase) and less likely to break the fall by grabbing or hitting an object (0.4; 0.2, 0.7). Among women who fell on their hip or hand, the risk of fracturing that site more than doubled for each standard deviation decrease in bone density at the site of fracture. CONCLUSIONS: The nature of the fall determines the type of fracture, while bone density and factors that increase or attenuate the force of impact of the fall determine whether a fracture will occur when a faller lands on a particular bone. These findings have important implications for prevention of fractures in older women.

Accidental Falls↗
PubMed1993

Association between low bone density and stroke in elderly women. The study of osteoporotic fractures.

BACKGROUND AND PURPOSE: To determine whether women with low bone mineral density are at increased risk of stroke, the present study was conducted. METHODS: We studied 4024 ambulatory women aged 65 years or older participating in the prospective Study of Osteoporotic Fractures. Bone mineral density was measured at baseline using single photon absorptiometry; strokes were ascertained using a computerized Medicare data base and death certificates. RESULTS: During a mean of 1.98 years of follow-up, 83 women suffered first strokes (five fatal). Osteopenia was associated with an increased stroke risk: Each SD decrease in bone mineral density at the calcaneus (0.09 g/cm2) was associated with a 1.31-fold increase in stroke (95% confidence interval, 1.03-1.65), adjusted for age, follow-up time, and several potential confounders, including diabetes, systolic blood pressure, use of alcohol, cigarettes or postmenopausal estrogens, cognitive ability, grip strength, and functional ability. The observed relation between bone density and stroke was strongest for intracerebral hemorrhages and occlusions. CONCLUSIONS: Most likely, low bone density does not cause stroke; some other process probably results in both osteopenia and cerebrovascular disease.

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PubMed1993

Bone mass and bone loss in the elderly: a special case?

Elderly women and men lose bone at a rate of < or = 1% per year. This results in an increasing risk of most fractures, of which hip fractures account for the greatest proportion of death, disability, and medical costs. Falls are the immediate precipitating factor for about 90% of hip fractures and 80% of other types of fractures in women. Since the rate of bone remodeling increases with age, antiresorptive therapies are likely to be at least as effective in the elderly as in younger adults. Calcium supplementation, for example, slows bone loss more effectively in older women than in those within 5 years of menopause, although the effectiveness of calcium for prevention of fractures remains uncertain. Vitamin D deficiency is more common in the elderly, and supplementation of deficient women appears to slow bone loss, at least during winter. Calcium plus vitamin D may substantially reduce the risk of hip fracture in the frail elderly. A randomized trial showed that estrogen remains effective in preventing vertebral fractures in older women. There is no reason to believe that the effectiveness of other agents would diminish with age. Preventive therapy offers greatest and most immediate benefit to those who have the highest risk of fracture: the elderly, those with previous fractures, those at increased risk of falling, and those with lowest bone mass. Since the relationship between bone mass and risk of fracture remains strong in elderly women, bone mass measurements may also be as useful in the elderly as in younger adults.

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PubMed1992

Hormone therapy to prevent disease and prolong life in postmenopausal women.

PURPOSE: To critically review the risks and benefits of hormone therapy for asymptomatic postmenopausal women who are considering long-term hormone therapy to prevent disease or to prolong life. DATA SOURCES: Review of the English-language literature since 1970 on the effect of estrogen therapy and estrogen plus progestin therapy on endometrial cancer, breast cancer, coronary heart disease, osteoporosis, and stroke. We used standard meta-analytic statistical methods to pool estimates from studies to determine summary relative risks for these diseases in hormone users and modified lifetable methods to estimate changes in lifetime probability and life expectancy due to use of hormone regimens. RESULTS: There is evidence that estrogen therapy decreases risk for coronary heart disease and for hip fracture, but long-term estrogen therapy increases risk for endometrial cancer and may be associated with a small increase in risk for breast cancer. The increase in endometrial cancer risk can probably be avoided by adding a progestin to the estrogen regimen for women who have a uterus, but the effects of combination hormones on risk for other diseases has not been adequately studied. We present estimates for changes in lifetime probabilities of disease and life expectancy due to hormone therapy in women who have had a hysterectomy; with coronary heart disease; and at increased risk for coronary heart disease, hip fracture, and breast cancer. CONCLUSIONS: Hormone therapy should probably be recommended for women who have had a hysterectomy and for those with coronary heart disease or at high risk for coronary heart disease. For other women, the best course of action is unclear.

Breast Neoplasms↗
PubMed1992

Results of bone densitometry affect women's decisions about taking measures to prevent fractures.

OBJECTIVE: To describe how the results of bone densitometry affect women's decisions about measures to prevent fractures and to determine whether labeling women as having below-normal bone density has adverse effects. DESIGN: Mail survey of a random sample of women. SETTING: Four community hospitals in the San Francisco Bay area. PATIENTS: A total of 261 women (response rate, 81.3%) who had undergone bone densitometry. MEASUREMENTS: Bone densitometry and self-report of changes in attitude and behaviors. RESULTS: Fifty-three percent of the women reported that their first bone density measurements were below normal, and 44% said that they were diagnosed as having osteoporosis on the basis of their test results. Women who reported that their bone density measurements were below normal were much more likely than women with normal results to begin some type of measure to prevent fractures (94% compared with 56%; P less than 0.01), to start hormone therapy (38% compared with 8%; P less than 0.01), and to take precautions to avoid falling (50% compared with 9%; P less than 0.01). Women reporting low bone density, however, also became more fearful of falling (38% compared with 2%; P less than 0.01) and limited their activities to avoid falling (24% compared with 2%; P less than 0.01). CONCLUSIONS: The results of bone densitometry substantially influence women's decisions about beginning estrogen replacement therapy and other preventive measures for osteoporotic fractures. The potential effects of labeling a woman as having below-normal bone density need to be considered before densitometry is widely used for unselective screening of women.

Absorptiometry, Photon↗
PubMed1992

Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group.

The Study of Osteoporotic Fractures is a prospective cohort study begun in 1986 that includes 9,704 women aged 65 years and older from Maryland, Minnesota, Oregon, and Pennsylvania. A total of 171 women suffered fractures of the distal forearm, and 79 women had fractures of the proximal humerus during the first 2.2 years of follow-up. Most fractures at both sites occurred as a result of a fall. Low bone mineral density was a strong predictor of these fractures; comparing those in the lowest quintile of bone mineral density in the distal radius with those in the highest quintile, the rate ratio was 4.1 for fractures of the distal forearm and 7.5 for fractures of the proximal humerus. Other factors associated with an increased rate of distal forearm fracture independently of low bone mineral density included poor visual acuity, number of falls in the year before baseline, and frequent walking. Factors that appeared to be independently associated with an increased rate of fracture of the proximal humerus included a recent decline in health status, insulin-dependent diabetes mellitus, infrequent walking, and several indicators of neuromuscular weakness such as inability to stand with feet in a tandem position for more than a few seconds. These data support the hypothesis that distal forearm fractures often occur as a result of a fall in women with low bone mineral density who are relatively healthy and active and have good neuromuscular function, while fractures of the proximal humerus tend to occur as a result of a fall in women with low bone mineral density who are less healthy and less active than average and who have poor neuromuscular function.

Age Factors↗
PubMed1992

The accuracy of self-report of fractures in elderly women: evidence from a prospective study.

The authors compared self-reports of non-spine fractures in a cohort of elderly white women with radiologic reports and medical records. Subjects (n = 9,704) were recruited between 1986 and 1988 in Baltimore, Pittsburgh, Minneapolis, and Portland, Oregon. Eleven percent (95% confidence interval 9-13%) of self-reports of fracture were false-positive (radiographs were negative) and a total of 20% (18-23%) could not be confirmed (radiographs were negative, uncertain, or not available). Report by proxy respondent was more accurate than self-report. There were no confirmed fractures in the medical records of a random sample of 283 participants who did not report a fracture. The percent of false-positives varied by the site of the injury and was low for self-reported fractures of the shoulder or upper arm (5%; 1-13%), wrist (8%; 4-11%), and hip (11%; 5-19%), but was high for hand or finger (20%; 12-30%), rib (23%; 15-32%), and face or skull (33%; 17-54%). Having a college education was associated with increased accuracy, while a history of falls and self-reported osteoporosis were associated with decreased accuracy. The authors conclude that elderly women overreport fractures, but that self-report is relatively accurate for several important osteoporotic fractures, including those of the hip, wrist, and humerus. Self-report of "any" fracture, rib, distal extremity, and head fracture, and fractures in women with a tendency to fall or with osteoporosis should be verified by a radiologic diagnosis.

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PubMed1992

Genetic variation in two bone-related proteins: is there an association with bone mineral density or skeletal size in postmenopausal women?

In an effort to determine if structural variation in proteins important in bone metabolism might influence bone mineral density (BMD) and thus be a determinant of susceptibility to osteoporosis in older women, the authors typed a group of 258 non-Black women (age 65-90) participating in the Study of Osteoporotic Fractures (SOF) for two polymorphic bone-related proteins, group specific component (Gc), also known as vitamin D-binding protein, and alpha 2HS glycoprotein (AHSG). These two proteins exhibit common structural variation in populations that can be detected by isoelectric focusing/immunoblotting of serum. An important function of Gc is the binding, solubilization, and transport of vitamin D sterols in the bloodstream while AHSG is a glycoprotein constituent of calcified cortical bone matrix. There are six common phenotypes of Gc and four of AHSG. Using Gc or AHSG phenotypes as categorical variables, statistical analyses were done to determine if bone mineral density of the proximal or distal radius or calcaneus differed by phenotype. Neither Gc nor AHSG phenotype demonstrated a statistically significant relationship with BMD at any site. Adjustments for age and degree of obesity did not substantively affect these results. Subsequent analyses to determine if phenotype of either of these proteins was associated with variables related to skeletal size showed an association of AHSG with height (P less than .02). This may indicate that AHSG phenotype is related to postmenopausal loss of height, or it may be a chance statistical finding.

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