Risk factors for decreased bone density in premenopausal women

Abstract

Osteoporosis is a major health problem. Little is known about the risk factors in premenopause. Sixty 40-50-year old patients with regular menses were studied cross-sectionally. None of the patients were on drugs known to interfere with bone mass. Patients answered a dietary inquiry and had their bone mineral density (BMD) measured. The Z scores were used for the comparisons. A blood sample was taken for the determination of FSH, SHBG, estradiol, testosterone, calcium and alkaline phosphatase. Calcium and creatinine were measured in 24-h urine. A Z score less than -1 was observed for the lumbar spine of 14 patients (23.3%), and for the femur of 24 patients (40%). Patients with a Z score less than -1 for the lumbar spine were older than patients with a Z score ≥-1 (45.7 vs 43.8 years) and presented higher values of alkaline phosphatase (71.1 ± 18.2 vs 57.1 ± 14.3 IU/l). Multiple regression analysis showed that a lower lumbar spine BMD was associated with higher values of alkaline phosphatase, lower calcium ingestion, a smaller body mass index (BMI), less frequent exercising, and older age. The patients with a Z score less than -1 for the femur were shorter than patients with a Z score ≥-1 (158.2 vs 161.3 cm). Multiple regression analysis showed that a lower femoral BMD was associated with lower BMI, higher alkaline phosphatase and caffeine intake, and less frequent exercising. A lower than expected BMD was observed in a significant proportion of premenopausal women and was associated with lower calcium intake, relatively lower physical activity and lower BMI. We conclude that the classical risk factors for osteoporosis may be present before ovarian failure, and their effect may be partly independent of estrogen levels. Correspondence

Bone mass density in adults with sickle cell disease

“…In accordance with the literature (Soliman et al , 1998; Miller et al , 2006), the present study found a strong relationship between lower BMI and lower BMD in young SCD adults. A study of risk factor for decreased BMD in premenopausal women showed the significant influence of low BMI (Krahe et al , 1997). BMI is decreased in adult SCD because of increased protein turnover and caloric expenditure compensating for a hyperactive marrow in chronic haemolysis (Borrel et al , 1998).…”

“…Calcium is a major factor in determining BMD from an early age (Krahe et al , 1997; Lal et al , 2005). Lal et al (2005) found that children with sickle cell anaemia have a low calcium intake.…”

Avaliação da densidade mineral ossea em mulheres na pós-menopausa ex-usuarias do contraceptivo medroxiprogesterona de deposito

“…A osteoporose é considerada um problema de saúde pública (Riggs e Melton, 1995;Krahe et al, 1997). É responsável por mais de 1,5 milhão de fraturas por ano nos EUA, com um gasto anual de 14 bilhões de dólares (NIH, 2005).…”

“…Uma baixa DMO na coluna vertebral foi associada com altos valores de fosfatase alcalina, baixa ingestão de cálcio, menor índice de massa corpórea (IMC= kg/m 2 ), baixa freqüência de atividade física e idade avançada. Portanto, os fatores de risco para osteoporose podem estar presentes antes da falência ovariana após a menopausa e serem particularmente independentes dos níveis de estrógeno (Krahe et al, 1997).…”

“…A perda mais acentuada de massa óssea que ocorre nas mulheres a partir da perimenopausa está associada à insuficiência de estrogênio, condição característica da pós-menopausa (Sowers et al, 1998). Pouco se sabe quanto ao efeito dos contraceptivos hormonais sobre o risco de fraturas na pré e pós-menopausa (Krahe et al, 1997). O único estudo que avaliou o risco de fraturas entre usuárias de AMP-D foi com recrutas do exército americano, durante o treinamento básico, e associou o uso do AMP-D ao aumento no risco de fraturas somente em mulheres brancas não hispânicas.…”