Trajectories of femoral neck strength in relation to the final menstrual period in a multi-ethnic cohort

Ishii, Shinya; Cauley, Jane A.; Greendale, Gail A.; Crandall, Carolyn J.; Huang, Mei‐Hua; Danielson, Michelle E.; Karlamangla, Arun S.

doi:10.1007/s00198-013-2293-x

Cited by 23 publications

(23 citation statements)

References 38 publications

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“…Taken together with an earlier study that showed that femoral neck strength relative to load does not change substantially before the menopause transition [34], these findings suggest that physical activity that occurs as a part of daily routine such as at home, at work, and simply being active in life can positively influence peak femoral neck strength relative to load in women, and lower their risk for osteoporosis and fragility fractures later in life. They also highlight the importance of expanding our focus beyond only sports and leisure-time exercise to include other domains of daily life where women can be physically active, and gain health benefits.…”

Section: Discussionsupporting

confidence: 69%

Physical activity as determinant of femoral neck strength relative to load in adult women: findings from the hip strength across the menopause transition study

et al. 2013

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Purpose Our objective was to examine the associations of physical activity in different life domains with peak femoral neck strength relative to load in adult women. Composite indices of femoral neck strength integrate body size with femoral neck size and bone mineral density to gauge bone strength relative to load during a fall, and are inversely associated with incident fracture risk. Methods Participants were 1919 pre- and early perimenopausal women from the Study of Women’s Health Across the Nation. Composite indices of femoral neck strength relative to load in three failure modes (compression, bending, and impact) were created from hip DXA scans and body size. Usual physical activity within the past year was assessed with the Kaiser Physical Activity Survey in four domains: sport, home, active living, and work. We used multiple linear regression to examine the associations. Results Greater physical activity in each of the four domains was independently associated with higher composite indices, adjusted for age, menopausal transition stage, race/ethnicity, SWAN study site, smoking status, smoking pack-years, alcohol consumption level, current use of supplementary calcium, current use of supplementary vitamin D, current use of bone-adverse medications, prior use of any sex steroid hormone pills or patch, prior use of depo-provera injections, history of hyperthyroidism, history of previous adult fracture, and employment status: standardized effect sizes ranged from 0.04 (p<0.05) to 0.20 (p<0.0001). Conclusions Physical activity in each domain examined was associated with higher peak femoral neck strength relative to load in pre- and early perimenopausal women.

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Section: Discussionsupporting

confidence: 69%

Physical activity as determinant of femoral neck strength relative to load in adult women: findings from the hip strength across the menopause transition study

et al. 2013

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“…Thus, the low strength of elderly male radii arose through different strength-decline trajectories: The narrow radii showed low strength for young adults that was maintained with age, whereas the wide radii showed high strength for young adults, much of which was lost with age. Whole bone strength of elderly individuals varies with many factors such as sex, (49)(50)(51)(52) ethnicity/race, (53) weight loss and frailty, (54) and rates of bone loss. (55) The current study provided evidence that external bone size also affects the strength of elderly male radii by influencing bone strength-decline trajectories.…”

Section: Discussionmentioning

confidence: 99%

External Bone Size Is a Key Determinant of Strength-Decline Trajectories of Aging Male Radii

Bigelow

Patton

Ward

et al. 2019

Journal of Bone and Mineral Research

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Given prior work showing associations between remodeling and external bone size, we tested the hypothesis that wide bones would show a greater negative correlation between whole‐bone strength and age compared with narrow bones. Cadaveric male radii (n = 37 pairs, 18 to 89 years old) were evaluated biomechanically, and samples were sorted into narrow and wide subgroups using height‐adjusted robustness (total area/bone length). Strength was 54% greater (p < 0.0001) in wide compared with narrow radii for young adults (<40 years old). However, the greater strength of young‐adult wide radii was not observed for older wide radii, as the wide (R2 = 0.565, p = 0.001), but not narrow (R2 = 0.0004, p = 0.944) subgroup showed a significant negative correlation between strength and age. Significant positive correlations between age and robustness (R2 = 0.269, p = 0.048), cortical area (Ct.Ar; R2 = 0.356, p = 0.019), and the mineral/matrix ratio (MMR; R2 = 0.293, p = 0.037) were observed for narrow, but not wide radii (robustness: R2 = 0.015, p = 0.217; Ct.Ar: R2 = 0.095, p = 0.245; MMR: R2 = 0.086, p = 0.271). Porosity increased with age for the narrow (R2 = 0.556, p = 0.001) and wide (R2 = 0.321, p = 0.022) subgroups. The wide subgroup (p < 0.0001) showed a significantly greater elevation of a new measure called the Cortical Pore Score, which quantifies the cumulative effect of pore size and location, indicating that porosity had a more deleterious effect on strength for wide compared with narrow radii. Thus, the divergent strength–age regressions implied that narrow radii maintained a low strength with aging by increasing external size and mineral content to mechanically offset increases in porosity. In contrast, the significant negative strength–age correlation for wide radii implied that the deleterious effect of greater porosity further from the centroid was not offset by changes in outer bone size or mineral content. Thus, the low strength of elderly male radii arose through different biomechanical mechanisms. Consideration of different strength–age regressions (trajectories) may inform clinical decisions on how best to treat individuals to reduce fracture risk. © 2019 American Society for Bone and Mineral Research.

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“…Both lumbar spine and femoral neck BMD begin declining rapidly 1 year before the final menstrual period [44]. Indices of femoral neck strength relative to load also decline significantly during the menopausal transition, beginning 1 to 2 years before the final menstrual period [45]. …”

Section: Discussionmentioning

confidence: 99%

Socioeconomic status in relation to incident fracture risk in the Study of Women’s Health Across the Nation

et al. 2014

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Summary We examined baseline and annual follow-up data (through annual follow-up visit 9) from a cohort of 2,234 women aged 42 to 52 years at baseline. Independent of financial status, higher educational level was associated with lower fracture incidence among non-Caucasian women but not among Caucasian women. Introduction This study was conducted to determine the associations of education and income with fracture incidence among midlife women over 9 years of follow-up. Methods We examined baseline and annual follow-up data (through annual follow-up visit 9) from 2,234 participants of the Study of Women’s Health Across the Nation, a cohort of women aged 42 to 52 years at baseline. We used Cox proportional hazards regression models to examine the associations of socioeconomic predictors (education, family-adjusted poverty-to-income ratio, and difficulty paying for basics) with time to first incident nontraumatic, nondigital, noncraniofacial fracture. Results Independent of family-adjusted poverty-to-income ratio, higher educational level was associated with decreased time to first incident fracture among non-Caucasian women but not among Caucasian women (pinteraction 0.02). Compared with non-Caucasian women who completed no more than high school education, non-Caucasian women who attained at least some postgraduate education had 87 % lower rates of incident nontraumatic fracture (adjusted hazard ratio 0.13, 95 % confidence interval [CI] 0.03–0.60). Among non-Caucasian women, each additional year of education was associated with a 16 % lower odds of nontraumatic fracture (adjusted odds ratio 0.84, 95 % CI 0.73–0.97). Income, family-adjusted poverty-to-income ratio, and degree of difficulty paying for basic needs were not associated with time to first fracture in Caucasian or non-Caucasian women. Conclusions Among non-Caucasian midlife women, higher education, but not higher income, was associated with lower fracture incidence. Elucidation of the mechanisms underlying the possible protective effects of higher educational level on nontraumatic fracture incidence may allow us to better target individuals at risk of future fracture.

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Trajectories of femoral neck strength in relation to the final menstrual period in a multi-ethnic cohort

Cited by 23 publications

References 38 publications

Physical activity as determinant of femoral neck strength relative to load in adult women: findings from the hip strength across the menopause transition study

Physical activity as determinant of femoral neck strength relative to load in adult women: findings from the hip strength across the menopause transition study

External Bone Size Is a Key Determinant of Strength-Decline Trajectories of Aging Male Radii

Socioeconomic status in relation to incident fracture risk in the Study of Women’s Health Across the Nation

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