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Osteoporosis in 84 year old white woman

A questionnaire addressing socio-demographic, reproductive and lifestyle-related risk factors was employed previously to bone mineral density measurements. The independent variables were age, ethnicity, body mass index BMIage at menarche, time elapsed since menopause TESMuse and length of hormone replacement therapy HRTlifestyle habits smoking, exercising, coffee consumption and history of previous fracture.

Univariated analysis employed the x2 test and linear trend x2 test. Multivariate analyses were performed with logistic regression.

Osteoporosis in 84 year old white woman

The mean time elapsed since menopause was 13. Osteoporosis prevalence was 32. The following variables were associated to osteoporosis: The greater BMI, the lower the risk of osteoporosis. Osteoporosis is regarded as "a disease characterized by microarchitectural deterioration of the bone tissue, with bone mass reduction to insufficient levels for providing support, having as a consequence a high risk of fracture" 3.

Many factors are regarded as risks for osteoporosis: A cross-sectional national study with 473 menopausal women showed an osteoporosis prevalence of 14. The objective of this study is to measure the prevalence of osteoporosis and its correlation with risk factors socio-demographic and lifestylein a sample of women above the age of 49.

Only the test results of women above 49 years old were included in the study.

A questionnaire asking for socio-demographic and lifestyle data was applied by a trained individual previously to the tests. The form addressed a question about Hormonal Replacement Therapy HRT kind and duration in months and previous fractures history. Bone densitometry was measured by a Lunar brand machine, where femoral and lumbar spine sites were assessed. Osteoporosis was defined as the bone mass reduction of at least 2. The prevalence of osteoporosis was estimated along with the confidence interval.

  • The use of fracture predictor models including BMD measurements with anthropometric data is advocated by a number of authors 9;
  • One risk factor frequently described in literature is previous history of fractures.

The statistical analysis was performed by using the Stata 8 software. The study was approved by the Committee on Ethics in Research. The vast majority of women were Caucasians 93. The average menarche age was 12. The average amenorrhea time was 13.

BMI ranged from 16. Three hundred twenty women 32. The ratio of women with and without HRT use history was 3: In the univariate analysis, the following variables were correlated to osteoporosis: Increasing BMI ranges 20.

In the final model after logistic regression, the following variables were shown to be significant: This endpoint was correlated to older age groups, longer amenorrhea durations, lower BMI, Caucasian ethnicity and late menarche. The other variables concerned to lifestyle, such as sedentariness, tobacco use and coffee drinking were not shown to be statistically significant in the final logistic model. Only previous fracture and HRT were marginally correlated to osteoporosis in the univariate analysis.

The results show an increased significance of the reproductive and anthropometric variables over factors related to lifestyle. Women above the age of 70 and in amenorrhea for more than 10 years osteoporosis in 84 year old white woman three times more susceptible to osteoporosis. Late menarche after 16 years old was shown to increase the risk of the endpoint by two-fold.

Before discussing results, some considerations must be made about the limitations of the study. First, this was a longitudinal study thus limiting considerations on cause-effect relationship. We could not distinguish cases of primary osteoporosis post-menopausal osteoporosis and senile osteoporosis from secondary osteoporosis, usually resulting from other diseases and factors, such as endocrine-metabolic disorders, rheumatic, renal, digestive, neoplasic conditions and use of certain drugs steroids, anticonvulsants, antacids, among others.

Thus the results cannot be generalized for other groups of women. The women in this sample were referred to this service by their gynecologists or GPs for BMN assessment, according to their clinical criteria, which are not addressed by our analysis. Because this is a private clinical and imaging laboratory, one may assume that these women should have risk factors to osteoporosis in their clinical histories that ultimately led their physicians to request a densitometry test.

In this case, the prevalence of osteoporosis may have been overestimated compared to other populations. We must also consider that, because this is a private laboratory designed for women counting on health insurances, the socio-demographic profile of this sample are not representative of other Brazilian women groups.

However, osteoporosis in this segment, as shown by the results of the present study, is also a highly prevalent issue. Second, our results are based on data collected osteoporosis in 84 year old white woman means of interviews. Many women may have forgotten to mention some information. Moreover, it would be easier for women who are supposedly aware of their osteoporosis diagnosis to remember the so-called risk factors, such as previous fractures and HRT use, thus enhancing the power of the correlation among studied variables and osteoporosis.

The questionnaire employed here addressed the major risk factors to osteoporosis. Finally, the number of missing data varied according to the explicative variables, with age at menarche, ethnicity and time of amenorrhea, with 945, 956 and 982 reports, respectively, presenting the highest number of missing data. Nevertheless, the percentage of missed data was 4.

Despite of these limitations, sample size and standardized criteria adopted for densitometry-based diagnosis of osteoporosis, in tests performed by the same team, are positive aspects of the present study. The authors concluded that the BMD measurement van predict fractures, but is not able to identify which individual will have the condition, not recommending a systematic osteoporosis tracking program for menopausal women 8.

The use of fracture predictor models including BMD measurements with anthropometric data is advocated by a number of authors 9. The subject is controversial, and the suggestion of limiting BMD measurement to populations presenting risk factors is also questioned by Sheldon 1995.

The author questions aspects related to the cost-benefit ratio for taking BMD measurements, arguing that there are no data supporting the idea that decisions on osteoporosis treatment that include BMD measurements can improve outcomes or reduce costs 10. Apparently, there is a consensus among authors that although BMD is clearly correlated to risks of fractures in elderly women, other clinical factors are also important predictors of long-term risks. Preventive strategies should include these 11.

Regarding clinical risk factors, the results of the present study show the importance of socio-demographic and body measurement data. In that study, consistent to our results, the prevalence of factors such as tobacco and alcohol use was also low 12.

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It may be assumed that an obese individual is less susceptible to develop osteoporosis, since BMI is directly related to BMD 5. A Brazilian study assessing 724 women reported that body weight is important for gaining and losing body mass, and causes an impact on BMD-age relationship 13. Another well-determined risk factor is ethnicity. Black women present a lower risk potential to develop osteoporosis, as opposite to Caucasian and Asian women.

An American study based on hospital discharge data showed that Afro-American women present lower risk for hip fractures 14. Nonetheless, other authors found osteoporosis prevalence of 40.

  • The subject is controversial, and the suggestion of limiting BMD measurement to populations presenting risk factors is also questioned by Sheldon 1995;
  • The study was approved by the Committee on Ethics in Research;
  • If an 84 year old thin small boned white woman had any of these conditions the from en 3220 at itt technical institute jacksonville campus.

Regarding lifestyle-related factors, our data showed no correlation to osteoporosis. However, some studies did not show correlation between those variables and osteoporosis.

A prospective study with 9516 women with ages above 64 and no previous history of osteoporosis in 84 year old white woman addressed risk factors to hip fracture reporting that the incidence ranged from 1. According to the authors, many risk factors act by reducing bone mass.

Nevertheless, in the final logistic model, after calcaneal bone density adjustment, the relative risk for hip fracture was not significantly changed for coffee drinking, walking exerciseweight variations and history of fracture 15.

The effect of drinking coffee on osteoporosis seems to be influenced by the amount ingested, by genetic heritage, and so on. This risk is higher for women with vitamin D receptor gene polymorphism 16. However, the effect of tow cups of coffee a day on hip and lumbar spine BMD among post-menopausal women aged 50-98 years, is minimized by lifetime milk drinking history 17.

The impact of tobacco use over bone mass is more acceptable to a number of authors. In order to study the effects of lifestyle and bone mass in women above the age of 60, 1080 men and women were prospectively assessed, in a population-based study DOES. Tobacco use was correlated to a reduced BMD at the femur and spine in both genders, this effect being independent of calcium intake and body size. Ex-smokers presented an intermediate BMD rate compared to active smokers and non-smokers, suggesting that cigarette influence is partially reversible 18.

Other studies assessed, concurrently, risk factors such as tobacco use and physical activity. Thus, the bone hardness degree as evaluated by ultrasound in a group of 2727 pre-menopausal women is determined by age, weight at the age of 25, and daily calcium intake.

Physical activity was positively correlated to bone resistance, while tobacco use showed an opposite effect 19. On the other hand, a cross-sectional study with 9704 65 year-old Caucasian women reported that BMD was not correlated to physical activity, but only to the number of cigarettes and tobacco use 20.

A prospective study with 9704 Caucasian women older than 65 showed that higher levels of leisure and sports activities and less time on sat position significantly correlated to a lower relative risk of hip fracture after adjustment for age, diet, number of falls and health status.

However, this data was not significant for wrist or vertebral fractures 21. One risk factor frequently described in literature is previous history of fractures. In that study, tobacco use did not correlate to increased risk of fracture 22. Although there is a large number of studies showing reduced osteoporosis risk in HRT users, our data can potentially reflect the kind of treatment that many women with osteoporosis are receiving.

In this sense, the low duration of HRT use among the 495 users calls our attention. Concerns towards developing cancer and future complications are the causes most frequently mentioned for dropping out HRT. If, on one hand, women are influenced to initiate HRT and change their lifestyles, after an unfavorable bone densitometry outcome, there is a great chance to drop out treatment after a short period of time.

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In that study with 320 women above the age of 50, those with the highest number of risk factors were the ones who changed their lifestyles the least. Moreover, the women most willing to receive information about osteoporosis were those presenting the lowest risk to develop the disease. World-wide projections for hip fracture. The burden of osteoporosis in Latin America. Lifestyle factors for promoting bone health in older women. Rev Bras Ginecol Obstet. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis.

Noninvasive assessment of bone mineral and structure: J Bone Miner Res.

  • Only previous fracture and HRT were marginally correlated to osteoporosis in the univariate analysis;
  • It is well known that loss of estrogen causes osteoporosis in women 51- to 70-year-old females;
  • N Engl J Med.

Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures.