Determinants of radial bone density as measured by PQCT in pre- and postmenopausal women: the role of bone size

OBJECTIVE: To investigate characteristics of children and adolescents with a history of combined pharmacotherapy (CPT) and compare them with a group with no history of CPT. METHOD: Eighty-three consecutive admissions to a residential treatment center were divided into a CPT and a no-CPT group based on treatment history and compared by chart review. Prevalence of lifetime psychiatric medication use and CPT exposure were assessed. Demographic, diagnostic, treatment, behavioral, and medication variables were compared across the two groups. RESULTS: Medication use was present in the treatment history for 89.2% and a history of CPT was found for 60.3% of subjects. Admission to current placement from inpatient psychiatry, lifetime number of psychiatric placements, lifetime number of psychiatric diagnoses, and nonseizure neuropsychiatric comorbidity were significantly associated with CPT. Aggression and neuroleptic use were also significantly associated with CPT. Admission psychiatric diagnostic comorbidity was not associated with CPT. CONCLUSIONS: A high prevalence of psychiatric medication use and CPT was found in this population. Variables assessing illness severity, aggressive behavior, and nonseizure neuropsychiatric comorbidity may identify youths in psychiatric treatment settings with a high prevalence of past or current CPT exposure. Further research on the CPT of aggression is warranted.     

Not all postmenopausal women on chronic steroid and estrogen treatment are osteoporotic: predictors of bone mineral density

Electronic mail (e-mail) offers the potential for near-instantaneous transfer of messages and files across thousands of miles. The same message can be sent simultaneously to multiple recipients and forwarded without retyping. Messages can be sent or read at any time, eliminating "telephone tag," and, because the system is paperless, lost, blurred, and incomplete, facsimile transmissions can be minimized. Additionally, e-mail is less expensive than overnight letter services or long-distance faxes. All healthcare epidemiologists should enter the information superhighway using e-mail. This article provides basic information needed to understand and begin using e-mail.     

Nutrition and bone mineral density in premenopausal women

Environmental factors have an important role in osteoporosis. Diet and, in particular, nutrients like calcium, vitamin D or phosphorus were extensively studied as determinants of bone mineral density, but the results remain conflicting and there is no clear evidence for an independent effect of such factors in the bone density of premenopausal women. We studied 66 healthy premenopausal women (20-40 years-old) aiming to relate bone mineral density, as measured in three different sites (distal forearm, lumbar spine and femoral neck) using single X ray and dual energy X-ray absorptiometry, with nutritional intake as estimated by a semi-quantitative food frequency questionnaire. Demographic, anthropometric and other life style variables were also assessed. There was a significant correlation between distal forearm and femoral neck (r = 0.57) or lumbar spine (r = 0.45) bone mineral density. No significant effect of age was observed for distal forearm bone mineral density in these women. In a stepwise multiple linear regression model, evaluating the contribution of all the variables studied, only body mass index (p=0.038) and vitamin A ingestion (p = 0.020) had an independent contribution for the variation in distal forearm bone mineral density. Mean bone mineral density, assessed in the femoral neck (p = 0.003) or the lumbar spine (p = 0.056) was different across tertiles of alcohol ingestion, being higher in non-drinkers. However, among regular drinkers there was a significant positive correlation between alcohol ingestion and femoral neck bone mineral density (Spearman's r = 0.53, p = 0.015). This study shows that the effect of nutrition seems dependent on the anatomical site assessed and that there is a weak correlation between nutritional intake and the actual bone mineral density.     

Reproductive and menstrual factors in relation to mammographic parenchymal patterns among perimenopausal women

The relationship between mammographic patterns and reproductive and menstrual factors was examined in 3640 Norwegian women, aged 40-56 years, participating in the Third Troms? study conducted in 1986-87. Epidemiological data were obtained from questionnaires. The mammograms were categorised into five groups. This categorisation is based on anatomic-mammographic correlations, following three-dimensional (thick slice technique) histopathologic-mammographic comparisons, rather than simple pattern reading. Patterns 1-3 were combined into a low-risk group and patterns 4 and 5 into a high-risk group for analysis. Women who had more than four children were 90% less likely to have a high-risk pattern than nulliparous women (OR = 0.09, 95% CI 0.04-0.16) controlling for age, weight, height and menopausal status. Furthermore, those who first gave birth over 34 years of age were more than twice as likely to have a high-risk pattern than those giving birth in their teens (OR = 2.37, 95% CI 1.23-4.56) adjusting for parity. Among post-menopausal women, age at menarche was negatively (P for trend = 0.015) and late age at menopause positively (P for trend = 0.072) related to high-risk patterns. Among premenopausal women, age at menarche was positively related to high-risk patterns (P for trend = 0.001). Also, menopausal status rather than age was associated with high-risk patterns. These findings support the opinion that reproductive and menstrual factors are involved in determining the mammographic parenchymal pattern among perimenopausal women.     

Factors affecting peak bone density in Japanese women

The mouse gene Punc encodes a member of the immunoglobulin superfamily of cell surface proteins. It is highly expressed in the developing embryo in nervous system and limb buds. At mid-gestation, however, expression levels of Punc decrease sharply. To allow investigation of such a regulatory mechanism, the genomic locus encompassing the Punc gene was cloned, characterized, and mapped. Fluorescent in situ hybridization was used to determine the chromosomal location of the Punc gene of mouse and human. Mouse Punc maps to Chromosome (Chr) 9 in the region D-E1, whereas the human PUNC gene is localized to Chr 15 at 15q22.3-23, a region known to be syntenic to mouse 9D-E1. The human PUNC gene therefore maps close to a genetic locus that is linked to Bardet-Biedl Syndrome, an autosomal recessive human disorder. Confirmation for the location of human PUNC was obtained through sequence relationships between mouse Punc cDNA, human PUNC cDNA, genomic sequence upstream of the murine Punc gene, and human STS markers that had been previously mapped on Chr 15. The STS sequence WI-14920 is in fact derived from the 3'-untranslated region of the human PUNC gene. WI-14920 had been placed at 228cR from the top of the Chr 15 linkage group, which provided positional information for the human PUNC gene at high resolution. Thus, this study identifies PUNC as the gene corresponding to a previously anonymous marker and serves as a basis to investigate its role in genetic disorders.     

Associations between body morphology and bone mineral density in premenopausal women

To investigate whether body morphology, obesity and its long time evolution were associated with lumbar and femoral bone mineral density (BMD) in premenopausal women of the same age. DESIGN: Cross-sectional study. SUBJECTS: 72 healthy premenopausal women born in 1950 (42 years) with a regular physical activity. MEASUREMENTS: BMD measured by dual-X-ray absorptiometry (DEXA) at lumbar spine and proximal femur; body weight, body mass index (BMI), BMI at 20 years (BMI-20), increase in BMI since age of 20 (BMI->20), body circumferences (breast, waist, hip) and their ratios (WHR, BHR, WBR), smoking and alcohol intake. RESULTS: Lumbar spine BMD did not correlate with any anthropometric measurement. Femoral BMDs correlated positively with weight, BMI, BMI-20, breast, waist, WHR and BHR. The BMI-20 explained the 5% and the current BMI the 13% of variance of total femur BMD. After adjustment for weight or BMI, breast circumference and BHR remained significantly correlated with all femoral BMDs sites except neck. Weight was the best predictor for neck BMD (R2 = 0.08; p < 0.02), and BHR for Ward's triangle (R2 = 0.12; p < 0.01) and trochanter (R2 = 0.10; p < 0.001). Alcohol intake, cigarette smoking, and age of menarche were not related to BMDs. CONCLUSION: In premenopausal women of the same age, lumbar spine BMD was not associated with any anthropometric measurement. Greater BHR and its long time of evolution may be determinants of greater femoral BMD (trabecular), whereas body weight may be determinant of femoral neck BMD (cortical). Further studies are needed to determine whether large breast to hip ratio may be considered as a protective factor for femoral osteoporosis.     

Regional bone mineral density interrelationships in normal and osteoporotic postmenopausal women

We describe a prospective study in which bone mineral density (BMD) was measured in total body and regions, proximal femur, lumbar spine, and forearm in 84 apparently normal postmenopausal women with normal spinal radiographs and in 47 women with 1-10 wedged or compressed vertebrae. There was a history of peripheral fracture in 35 of the 84 controls and 30 of the 47 osteoporotics (p < 0.02) but there was no association between vertebral fracture and wrist fracture. At all sites and regions, the differences in BMD between the "normal"and "osteoporotic" women was highly significant and all but "ribs" and "arms" remained significant after correction for menopausal age. In the whole set, and in both subgroups, the coefficients of correlation between sites and regions were all highly significant (p < 0.001). Nonetheless, some sites discriminated better between the two groups than others. Standardized odds ratios (OR) for vertebral fracture versus no-fracture were calculated by logistic regression and expressed as the rise in OR for each standard deviation (SD) fall in bone density. This ratio was greatest (3.4) in "pelvis" and weakest (1.7) in "ribs" but all were statistically significant. Geometric mean regression equations were calculated for all the 78 possible pairs of sites and regions in the 84 normal subjects and the deviations of the osteoporotic women from these normal slopes calculated. In most pairs of sites and regions, the vertebral fracture cases were scattered around the normal group's slope but fell lower down on both axes. The bone deficits in the osteoporotics compared with young normal women ranged from -14% in "head" to -40% in Ward's triangle and the T-scores ranged from -1.9 in "ribs" to -3.9 in the forearm. Sensitivity ranged from 17% in "ribs" to 36.2% in Ward's triangle. Specificity varied between 88 and 94% and the percent correctly classified ranged from 62.6% in "ribs" to 72.5% in Ward's triangle. We conclude that primary postmenopausal osteoporosis affects the entire skeleton but that some sites discriminate better between vertebral fracture and nonfracture cases regardless of whether they represent cortical or trabecular bone.     

Longitudinal predictors of attitudes toward aging among women with multiple sclerosis.

The purpose of the study was to explore the impact of change in functional limitation (FL), controlling for social support (SS), on attitudes toward aging using longitudinal survey data collected over a 7-year period. The 503 women with multiple sclerosis (MS; age, M = 57 years, SD = 10.25) were mostly Anglo (93%) and married (69%). First, the authors identified a quadratic growth model as the best for describing change in FL. Next, they considered SS as a time-varying covariate of FL to assess both within- and between-individual effects of SS on FL over time. Within individuals, higher FL levels were associated with lower SS levels. Between individuals, level of but not change in FL was associated with average SS level. Finally, average SS and response level and change in FL were studied as predictors of attitudes toward aging, accounting for 38% of the variance. Women with higher FL and lower SS scores had more negative views of aging. Negative views of aging among women with MS may have long-term consequences for their health outcomes as well as for the quality of their later years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Partner support and other determinants of smoking cessation maintenance among women.

Conducted a prospective examination of the effects of naturally occurring partner support on smoking cessation maintenance with 125 newly abstinent female smokers (mean age 41.8 yrs). 123 of the Ss were married, and 2 were living with a partner. Six days after smoking cessation, Ss supplied demographic and smoking habit data and ratings of a variety of their own and their partners' attributes and behaviors. Factor analysis of partner ratings revealed a dominant factor, Partner Facilitation, which accounted for 74% of the common variance, encompassed both quitting-related and general interactions, and loaded on the following behaviors: problem solving, rewarding quitting, understanding, listening, and facilitating the enactment of coping and nonsmoking skills. Results indicate that when the Partner Facilitation factor was entered into a stepwise discriminant analysis with 19 other variables, it emerged as the primary predictor of smoking cessation maintenance, accounting for 32% of the variance in outcome at 6–8 wks and accurately identifying more than 80% of both successful and unsuccessful outcomes. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body weight and bone mineral density in postmenopausal women with primary hyperparathyroidism

OBJECTIVE: To assess bone mineral density and body composition in postmenopausal women with primary hyperparathyroidism. DESIGN: Cross-sectional study with an age-matched control group. SETTING: University teaching hospital. PATIENTS: 41 postmenopausal women with mild primary hyperparathyroidism and 43 eucalcemic, age-matched controls. MEASUREMENTS: Total body, lumbar spine, and proximal femoral (femoral neck, Ward's triangle, and trochanter) bone mineral density; body composition; and fat distribution were measured using dual-energy x-ray absorptiometry. RESULTS: Women with primary hyperparathyroidism were heavier (75.5 kg compared with 66.3 kg; difference, 9.2 kg [95% CI, 3.7 to 14.7 kg]; P = 0.002), had a higher fat mass (33.3 kg compared with 26.1 kg; difference, 7.2 kg [CI, 3.0 to 11.4 kg]; P = 0.001), and had a more android pattern of fat distribution (android-to-gynoid fat ratio, 1.05 compared with 0.84; difference, 0.21 [CI, 0.1 to 0.32]; P = 0.0004) than the controls. Unadjusted bone mineral density was similar in patients and controls at all sites: total body, 0.990 compared with 1.023 g/cm2 (difference, 0.033; CI, -0.004 to 0.070); posteroanterior lumbar spine, 1.032 compared with 1.018 g/cm2 (difference, 0.014; CI, -0.031 to 0.059); lateral lumbar spine, 0.569 compared with 0.528 g/cm2 (difference, 0.041; CI, -0.022 to 0.104); femoral neck, 0.799 compared with 0.825 g/cm2 (difference, 0.026; CI, -0.072 to 0.124); Ward's triangle, 0.653 compared with 0.677 g/cm2 (difference, 0.024; CI, -0.035 to 0.089); trochanter, 0.734 compared with 0.733 g/cm2 (difference, 0.001; CI, -0.024 to 0.026); and arms, 0.720 compared with 0.739 g/cm2 (difference, 0.019; CI, -0.015 to 0.053). After adjustment for body weight, bone mineral density in women with primary hyperparathyroidism was lower than that in controls for total body (P = 0.0004), femoral neck (P = 0.001), Ward's triangle (P = 0.01), trochanter (P = 0.02), and arms (P = 0.0006). Spinal bone mineral density did not differ between groups. CONCLUSIONS: Body weight, total body fat mass, and proportion of android fat are increased in postmenopausal women with primary hyperparathyroidism; these unexplained factors may be relevant to the increased incidence of cardiovascular disease in this condition. Unadjusted bone mineral density values are similar in patients with primary hyperparathyroidism and in controls, suggesting that this condition is not associated with an increased risk for fracture.     

Geometric variables and bone mineral density as potential predictors for mechanical properties of the radius of Greyhounds

OBJECTIVE: To determine cross-sectional geometry and bone mineral density of the Greyhound radius and correlate these values with torsional failure load and torsional stiffness in an ex vivo model. DESIGN: 3 regions, proximal, middle, and distal portions of the diaphysis, were studied. 5 levels of cross section were evaluated geometrically within each region. SPECIMENS: 10 paired radiuses from skeletally mature Greyhounds. PROCEDURE: Cortical area and area moment of inertia were measured from plain radiographic views and from digitized computed tomographic images. Bone mineral density was measured, using dual-energy x-ray absorptiometry. Torsional stiffness and torsional failure load were then determined mechanically. RESULTS: Minimum area moment of inertia and area moment of inertia estimated from plain radiographic views were significantly different in different regions of interest (P < 0.05). Significant bivariate correlations (P < 0.05) between torsional mechanical parameters and bone properties of the radius were identified for the distal portion of the diaphysis in particular. When independent variables for the distal portion were analyzed, estimate of area moment of inertia was entered into the model for torsional failure load as a predictor and minimum area moment of inertia was entered into the model for torsional stiffness as a predictor. Bone mineral density of the distal portion of the diaphysis was not a significant predictor. CONCLUSION: If accurate noninvasive predictors of bone failure load can be identified, further study of fracture risk should be possible.     

Safer sex: Social and psychological predictors of behavioral maintenance and change among heterosexual women.

Women of diverse backgrounds from 4 community health clinics in southern Connecticut were involved in a longitudinal, prospective study (n?=?189). Data from interviews 3 months apart were used for the current analyses. The purpose of this study was to develop predictive models of safer sexual behavior among heterosexual women. Specifically, there was an interest in identifying factors to predict the maintenance or initiation of safer behavior over time. Relationship involvement and attitudes toward condoms were important in both models. Beyond this, differences in explanatory models emerged, reflecting the importance of examining behavior maintenance and change independently. Depression, health locus of control, and outcome efficacy belief made significant contributions to understanding the maintenance of safer sexual behavior. HIV counseling and testing, partner risk, and optimism helped to explain the initiation of safer sexual behavior. Implications for future interventions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of lactation and lifestyles including food intake on bone density of lactating women

Ultrasonic bone densities were measured in 131 lactating women, aged 21 to 42 years, at 6-590 days postpartum. STIFFNESS Calculated from the combined value of speed of sound and broadband ultrasound attenuation at the calcaneus was used as an index of bone density. The relationships of STIFFNESS with period of lactation, current and past consumption of cow's milk, various food intake frequency, history of participating in sports, daily physical activity, using calcium drugs and sun exposure were examined using stepwise multiple regression analysis, including age and weight as independent variables. 1) The mean (SD) of STIFFNESS was 79.8 (11.9). Thirty-three women (25% of subjects) showed STIFFNESS less than 70. 2) Period of lactation showed a significant negative effect on STIFFNESS (p < 0.05). However, no such effect appeared for women with cow's milk intake of less than 100 ml per day. This result suggests a protection of calcium levels in bone. 3) Current daily cow's milk intake showed significant positive effect on STIFFNESS (p < 0.05). For women lactating less than 150 days, this relation between cow's milk intake and STIFFNESS was clear (r = 0.44, p < 0.01). 4) Significant relation between STIFFNESS and food intake frequencies was found in milk and milk products only among various foods. This result indicates that cow's milk and milk products are important sources of calcium during lactation.     

Low spinal and pelvic bone mineral density among individuals with Down syndrome

The efficacy of intrauterine insemination with husband's semen (AIH) is well established for some types of infertility. Results that had been reported previously were Dwing difficult to assess owing to the low number of patients or treatment cycles as well as an inadequate definition of the indications in most cases. In this study, we report our experience with intrauterine insemination (IUI) using post-treated sperm suspension from husband's semen in the treatment of infertility. A total of 328 treatment cycles were completed from January to December in 1991. The indications for AIH/IUI were male infertility (130 cycles), unexplained infertility (87 cycles), sex selection (72 cycles) and anovulatory disorder (39 cycles). Sixty-eight pregnancies were achieved. The clinical usefulness of AIH/IUI with or without concomitant hMG regimens were established according to diagnostic subgroups. In our results, the cycle fecundity of pregnancy was higher in patients with ovulatory disturbance. The importance of sperm motility confirmed by our results that have compared by the serial sperm parameters. The motile sperm count may appear to be a highly consistent parameter that serves as a sensitive indicator of sperm function and correlation of successful pregnancy in our results. In conclusion, this study indicates that AIH with controlled ovarian hyperstimulation can result in higher viable pregnancy rate, and it is also a non-invasive and relatively easy procedure. We believe that this is a transient useful method for the treatment of non-organic infertility, prior to any attempt of aggressive assisted reproductive procedures.     

Relative contributions of age and menopause to the vertebral bone density of healthy Japanese women

The relative contributions of age and menopause to vertebral bone mineral density were evaluated based on the estimated weights for age- and menopause-related bone loss components using a mathematical model in 177 healthy female volunteers ages 35-81 years, living in a community in Fukui, Japan. Bone mineral density was determined by dual X-ray absorptiometry. The model used was that which afforded the best fit among the eight possible models to the data observed. Each model was composed of a linear function for the age-related component and a different type of function for the menopausal component, without interaction between them. The weights for these components in each model were estimated by the least-squares method. The coefficient of determination and Akaike information criterion disclosed that among the eight models tested, the model affording the best fit was composed of a logarithmic decrease in bone density with an increase in years since menopause, up to 10 years postmenopausal, with no further decline thereafter. In this model, the weights for both components were statistically significant and the type III sum of squares of the menopausal component was greater than that of the age-related component. We suggest that both age and menopause made significant contributions to the decline in vertebral bone mineral density, with the contribution of menopause being greater than that of age.     

Incidence of ovulation in perimenopausal women before and during hormone replacement therapy

Once hormone replacement therapy (HRT) has been commenced, it becomes extremely difficult to advise women approaching the menopause on the need for contraception. In this study of twenty women, neither the regularity of their pre-existing menstrual cycle nor a random FSH concentration predicted the likelihood of subsequent ovulation whilst taking HRT. HRT is not reliably contraceptive and women commencing HRT whilst still menstruating spontaneously must be advised on the need for additional contraception.     

Nutritional influences on bone mineral density: a cross-sectional study in premenopausal women

The association between current and past dietary intake and bone mineral density (BMD) was investigated in 994 healthy premenopausal women aged 45-49 y. BMD was measured with dual-energy X-ray absorptiometry (DXA). Dietary intake was assessed with a food-frequency questionnaire (FFQ). Energy-adjusted nutrient intakes were grouped into quartiles and mean BMD at the lumbar spine (LS), femoral neck (FN), femoral trochanter (FT), and femoral Wards (FW) were calculated. With higher intakes of zinc, magnesium, potassium, and fiber, LS BMD was significantly higher (P < 0.05-0.006), and a significant difference in LS BMD was also found between the lowest and highest quartiles for these nutrients and vitamin C intake (P < 0.05-0.01). These results remained significant after adjustment for important confounding factors. LS BMD and FT BMD were lower in women reporting a low intake of milk and fruit in early adulthood than in women with a medium or high intake (P < 0.01). High, long-term intake of these nutrients may be important to bone health, possibly because of their beneficial effect on acid-base balance.