Cross-Sectional Versus Longitudinal Evaluation of Bone Loss in Men and Women

Melton, L. Joseph; Khosla, Sundeep; Atkinson, Elizabeth J.; O’Connor, Michael K.; O’Fallon, W. Michael; Riggs, B. Lawrence

doi:10.1007/s001980070080

Cited by 108 publications

(73 citation statements)

References 14 publications

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“…Even women aged 50-54, among whom we observed the greatest bone loss, experienced a rate of loss of only 1.3% per year. Although this rate is lower than estimates derived from crosssectional studies, 32 it is consistent with the rates of loss reported among women in other longitudinal studies.…”

Section: Discussionsupporting

confidence: 88%

Change in bone mineral density as a function of age in women and men and association with the use of antiresorptive agents

Berger

Langsetmo²,

Joseph

et al. 2008

Canadian Medical Association Journal

136

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Change in bone mineral density as a function of age in women and men and association with the use of antiresorptive agents Background: Measurement of bone mineral density is the most common method of diagnosing and assessing osteoporosis. We sought to estimate the average rate of change in bone mineral density as a function of age among Canadians aged 25-85, stratified by sex and use of antiresorptive agents. Methods:We examined a longitudinal cohort of 9423 participants. We measured the bone mineral density in the lumbar spine, total hip and femoral neck at baseline in 1995-1997, and at 3-year (participants aged 40-60 years only) and 5-year follow-up visits. We used the measurements to compute individual rates of change.Results: Bone loss in all 3 skeletal sites began among women at age 40-44. Bone loss was particularly rapid in the total hip and was greatest among women aged 50-54 who were transitioning from premenopause to postmenopause, with a change from baseline of -6.8% (95% confidence interval [CI] -7.5% to -4.9%) over 5 years. The rate of decline, particularly in the total hip, increased again among women older than 70 years. Bone loss in all 3 skeletal sites began at an earlier age (25-39) among men than among women. The rate of decline of bone density in the total hip was nearly constant among men 35 and older and then increased among men older than 65. Use of antiresorptive agents was associated with attenuated bone loss in both sexes among participants aged 50-79. Interpretation:The period of accelerated loss of bone mineral density in the hip bones occurring among women and men older than 65 may be an important contributor to the increased incidence of hip fracture among patients in that age group. The extent of bone loss that we observed in both sexes indicates that, in the absence of additional risk factors or therapy, repeat testing of bone mineral density to diagnose osteoporosis could be delayed to every 5 years.

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Section: Discussionsupporting

confidence: 88%

Change in bone mineral density as a function of age in women and men and association with the use of antiresorptive agents

Berger

Langsetmo²,

Joseph

et al. 2008

Canadian Medical Association Journal

136

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“…At the distal forearm Rey et al [26] found a T-score reduction of -3.0 SD between 30 and 75 years of age. However, one must keep in mind the limitations of cross-sectional data in assessing bone loss compared with longitudinal evaluation [28].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Low Forearm Bone Density in a Bulgarian Female Referral Population

Boyanov

Popivanov

2002

Osteoporos Int

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Osteoporosis is one of the leading causes of morbidity and mortality in the elderly population. The prevalence of osteoporosis and osteopenia in Bulgaria is unknown except for preliminary data. We tried to determine retrospectively the prevalence of osteopenia and osteoporosis in a referral female population; 8869 consecutive Bulgarian women (age 20-87 years) were included. Information about known risk factors for low bone mass was recorded. Forearm bone mineral density was measured at the distal radius+ulna site by single X-ray absorptiometry (DTX-100 device). T- and Z-scores were calculated from Bulgarian reference data. In the total study sample 15.16% had osteoporosis and 28.8% had osteopenia. In women aged 50 years and over the corresponding prevalence was 20.45% and 32.5%. Age-adjusted prevalence of osteoporosis and osteopenia started rising after age 55 years. Corresponding mean T-scores also declined and the osteoporosis threshold of -2.5 SD was reached in the age group 70-74 years. Z-scores in all age groups were between 0 and -0.6, thus excluding major selection bias. This is the first large-scale Bulgarian study designed to look for the prevalence of osteopenia and osteoporosis in a referral population. It may become the starting point for future screening and intervention strategies in our country.

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“…Thus, while men lack the rapid phase of bone loss present at menopause in women, they lose substantial amounts of bone with aging (11)(12)(13)(14). In addition, population-based studies have shown that bone resorption increases with age in Young adult males who cannot produce or respond to estrogen (E) are osteopenic, suggesting that E may regulate bone turnover in men, as well as in women.…”

Section: Introductionmentioning

confidence: 99%

Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men

et al. 2000

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IntroductionWhile the role of estrogen (E) in regulating bone metabolism in women is well established, the relative contributions of E versus testosterone (T) in regulating bone turnover in men remain unclear. Since T is the dominant sex steroid secreted in men, the traditional belief has been that E is the major sex steroid regulating bone metabolism in women and T is the major sex steroid regulating bone metabolism in men. This concept has been challenged, however, by the description of several "experiments of nature." A male carrying homozygous mutations in the E receptor-α (ER-α) gene (who was unable to respond to E) (1) and two males with homozygous mutations in the aromatase gene (who were unable to synthesize E) (2-4) had osteopenia, unfused epiphyses, and elevated indices of bone turnover. Moreover, E therapy in the two aromatasedeficient males corrected these abnormalities (3-5).These reports have led to a reconsideration of the possible role of E in regulating the male skeleton, although several questions remain. The major unresolved issue is whether E acts on the male skeleton mainly to enhance bone mass during growth and maturation, or whether it also acts to retard bone loss in aging individuals. Thus, since the ER-α mutant and aromatase-deficient males had immature skeletons, it is possible that E primarily plays a role in determining skeletal modeling and the acquisition of peak bone mass, but not in regulating bone turnover (and hence, bone loss) in aging men.Several cross-sectional observational studies (6-10) have attempted to address this issue by relating bone mineral density (BMD) to sex steroids in elderly men. In these studies, E (and in particular, the bioavailable or non-sex hormone binding globulin [non-SHBG] bound fraction) did correlate better with BMD than T. However, since both T and E levels are correlated with each other (7), these observational data could not conclusively separate the relative contributions of each to skeletal metabolism in elderly men. In addition, since BMD in elderly men is a function both of peak bone mass and bone loss with aging, they also could not dissociate the effects of E on the acquisition of peak bone mass in early adulthood from its effects on continued bone loss later in life.In addition to its intrinsic importance for our understanding of skeletal physiology, this issue also has significant practical implications. Thus, while men lack the rapid phase of bone loss present at menopause in women, they lose substantial amounts of bone with aging (11)(12)(13)(14). In addition, population-based studies have shown that bone resorption increases with age in Young adult males who cannot produce or respond to estrogen (E) are osteopenic, suggesting that E may regulate bone turnover in men, as well as in women. Both bioavailable E and testosterone (T) decrease substantially in aging men, but it is unclear which deficiency is the more important factor contributing to the increased bone resorption and impaired bone formation that leads to their bone loss. Thus...

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Cross-Sectional Versus Longitudinal Evaluation of Bone Loss in Men and Women

Cited by 108 publications

References 14 publications

Change in bone mineral density as a function of age in women and men and association with the use of antiresorptive agents

Change in bone mineral density as a function of age in women and men and association with the use of antiresorptive agents

Prevalence of Low Forearm Bone Density in a Bulgarian Female Referral Population

Relative contributions of testosterone and estrogen in regulating bone resorption and formation in normal elderly men

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