Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women

Abstract

OBJECTIVE: To estimate the prevalence and analyze risk factors associated to osteoporosis and low-trauma fracture in women. METHODS: Cross-sectional study including a total of 4,332 women older than 40 attending primary care services in the Greater São Paulo, Southeastern Brazil, between 2004 and 2007. Anthropometrical and gynecological data and information about lifestyle habits, previous fracture, medical history, food intake and physical activity were obtained through individual quantitative interviews. Low-trauma fracture was defined as that resulting from a fall from standing height or less in individuals 50 years or older. Multiple logistic regression models were designed having osteoporotic fracture and bone mineral density (BMD) as the dependent variables and all other parameters as the independent ones. The significance level was set at p<0.05. RESULTS: The prevalence of osteoporosis and osteoporotic fractures was 33% and 11.5%, respectively. The main risk factors associated with low bone mass were age (OR=1.07; 95% CI: 1.06;1.08), time since menopause (OR=2.16; 95% CI: 1.49;3.14), previous fracture (OR=2.62; 95% CI: 2.08;3.29) and current smoking (OR=1.45; 95% CI: 1.13;1.85). BMI (OR=0.88; 95% CI: 0.86;0.89), regular physical activity (OR=0.78; 95% CI: 0.65;0.94) and hormone replacement therapy (OR=0.43; 95% CI: 0.33;0.56) had a protective effect on bone mass. Risk factors significantly associated with osteoporotic fractures were age (OR=1.05; 95% CI: 1.04;1.06), time since menopause (OR=4.12; 95% CI: 1.79;9.48), familial history of hip fracture (OR=3.59; 95% CI: 2.88;4.47) and low BMD (OR=2.28; 95% CI: 1.85;2.82). CONCLUSIONS: Advanced age, menopause, low-trauma fracture and current smoking are major risk factors associated with low BMD and osteoporotic fracture. The clinical use of these parameters to identify women at higher risk for fractures might be a reasonable strategy to improve the management of osteoporosis.

Prevalência de doenças musculoesqueléticas autorreferidas segundo variáveis demográficas e de saúde: estudo transversal de idosos de Goiânia/GO

“…Estudos prévios realizados no Brasil 22, 24,25 , no Paquistão 26 e no Irã 27 mostraram que a prevalência de osteoporose nas mulheres é quase o dobro em relação aos homens. Outra justificativa é porque as mulheres apresentam maior velocidade de perda óssea após a menopausa devido à diminuição hormonal significativa nos níveis de estrogênio 9 .…”

Statins, bone formation and osteoporosis: hope or hype?

“…3 In addition to this, post-menopausal women suffer from osteoporosis and osteoporotic fractures at a higher frequency than pre-menopausal women. 4 Through adult life there is a dynamic progress which is called "bone remodeling". Bone remodeling is well established throughout the literature and involves both systemic and non-systemic factors.…”

Physical activity during the early years of life and osteoporosis in adulthood: study among users of the Brazilian National Health System

“…Concerning the association between osteoporosis and abdominal obesity, previous studies reported negative relationships between measurements of abdominal obesity and lower bone mass 33,34 . The pathways by which abdominal obesity affects bone tissue are not completely understood yet, but involve the action of inflammatory markers produced by adipose tissues, which affect the osteoblasts/osteoclasts ratio in the bone matrix 35 , leading to lower bone mass. In regards to lifestyle factors, current physical activity was associated with lower occurrence of osteoporosis, findings similar to those of other studies 16,36 .…”