Osteoporosis in elderly women in primary health care
Author: Salminen, Helena
Date: 2007-11-09
Location: Föreläsningssalen 4-263, entréplan, Alfred Nobels allé 12, Huddinge
Time: 09.00
Department: Institutionen för neurobiologi, vårdvetenskap och samhälle / Department of Neurobiology, Care Sciences and Society
View/ Open:
thesis.pdf (592.9Kb)
Abstract
Objective: All the studies are parts of the PRIMOS (Primary Health Care
and Osteoporosis) project. Study I investigates the relationship between
central Dual X-ray Absorptiometry (DXA) measurements of the hip and spine
and peripheral measurements of the calcaneus using Dual X-ray and Laser
(DXL) technique. Study II investigates the association between the
nutritional status of elderly free-living women, as determined by the
Mini Nutritional Assessment (MNA) method, and the women's bone mineral
density measured with DXA. Study III investigates the relationship to
osteoporosis of calcium-regulating hormones and the IGF-I and IGFBP-1
status in the cohort. Study IV is an RCT evaluating the effect of
ultra-low dose of estradiol on bone mineral density.
Methods: Study population: The participants in all studies come from the
same population of approximately 940 women born between 1920 and 1930
living in the same primary care region in the southern part of Stockholm.
Study I has 393 participants (388 included in the statistical analysis).
Of these women, 351 were recruited by first inviting a random sample of
300, and then inviting all the rest of the women born 1926 and 1930.
These 351 women are the population in study II and (with the exception of
one woman excluded) in study III. The remaining 42 participants in study
I and all 115 participants of study IV were included if eligible for a
randomised controlled clinical trial (RCT) with estradiol. The design of
the RCT was an open-label, randomised, parallel-group study with two
treatment arms, one arm treated with a vaginal ring releasing 17
beta-estradiol (average dose 7.5 μg/day) and a daily tablet containing
500 mg of calcium and 400 IU of vitamin D3, the other arm receiving
treatment with 500 mg of calcium and 400 IU of vitamin D3. Bone mineral
density measurements: The bone mineral densities (BMD) of the hip and
lumbar spine (L1 L4) were determined using Hologic QDR 4500 equipment for
DXA. The peripheral measurements on the calcaneus were performed with
Calscan DEXA-T. Mini Nutritional Assessment (MNA): The nutritional status
was determined with the MNA test consisting of 18 questions in four
categories: anthropometric measurements, clinical and functional
evaluations, assessment of dietary intake and self-assessment of health.
The maximum score obtainable is 30 points, a score of <17 indicates
malnutrition, 17 23.5 a risk of malnutrition and > 24 adequate
nutritional status. Laboratory measurements: Parathyroid hormone (PTH),
25-hydroxy vitamin D, IGF-I, IGFBP-1, glucose and calcium-status were
measured in all participants. Estradiol, SHBG, CTx, U-Dpd and other
markers were followed in the RCT.
Results: Study I showed that measurements of the heel bone with DXL
technique correlated fairly well to central measurements of the hip and
spine on the group level. The same WHO cut-off point, 2.5 SD, was also
applicable for the heel BMD when comparing with most central sites or
combinations of sites with the exception of total hip. The change of
reference population had a great influence on the amount of subjects
classified as osteoporotic, which varied between 7% and 53% depending on
the chosen reference population and site. Study II showed that women with
an MNA score under the median score of 27 points had a twofold increased
risk of having osteoporosis compared to women with MNA scores above the
median. Very few women (7.4%) were assessed as at risk of malnutrition
and only one woman was classified as malnourished. Study III showed a
significant inverse relation of IGFBP-1 to the BMD values and a
significant positive relation of IGF-I values to the BMD values at all
sites with the exception of the lumbar spine. The use of loop diuretics
was a more important cause of secondary hyperparathyroidism than the
vitamin D status of the women. Study IV showed a small but significant
effect on BMD of 7.5 μg/day estradiol administered through a vaginal ring
during a follow-up of two years.
Conclusions: Bone mineral density measurements of the calcaneus with DXL
technique correlate fairly well with central measurements. Adequate
reference populations are important for T-scores. Elderly women with only
a slight deterioration in their nutritional status have an increased risk
of osteoporosis. IGF-I and IGFBP-1 are related to the BMD values.
Secondary hyperparathyroidism may have other more clinically important
causes than the vitamin D status in elderly women, i.e. treatment with
loop diuretics. Estradiol doses of 7.5 μg/day seem to have a small but
significant effect on BMD of elderly women.
List of papers:
I. Salminen H, Sääf M, Ringertz H, Strender LE (2005). "Bone mineral density measurement in the calcaneus with DXL: comparison with hip and spine measurements in a cross-sectional study of an elderly female population." Osteoporos Int 16(5): 541-51. Epub 2004 Sep 21
Pubmed
II. Salminen H, Sääf M, Johansson SE, Ringertz H, Strender LE (2006). "Nutritional status, as determined by the Mini-Nutritional Assessment, and osteoporosis: a cross-sectional study of an elderly female population." Eur J Clin Nutr 60(4): 486-93
Pubmed
III. Salminen H, Saaf M, Ringertz H, Strender LE (2007). "The role of IGF-I and IGFBP-1 status and secondary hyperparathyroidism in relation to osteoporosis in elderly Swedish women. " Osteoporos Int Sep 14: Epub ahead of print
Pubmed
IV. Salminen HS, Sääf ME, Johansson SE, Ringertz H, Strender LE (2007). "The effect of transvaginal estradiol on bone in aged women: a randomised controlled trial." Maturitas 57(4): 370-81. Epub 2007 May 9
Pubmed
I. Salminen H, Sääf M, Ringertz H, Strender LE (2005). "Bone mineral density measurement in the calcaneus with DXL: comparison with hip and spine measurements in a cross-sectional study of an elderly female population." Osteoporos Int 16(5): 541-51. Epub 2004 Sep 21
Pubmed
II. Salminen H, Sääf M, Johansson SE, Ringertz H, Strender LE (2006). "Nutritional status, as determined by the Mini-Nutritional Assessment, and osteoporosis: a cross-sectional study of an elderly female population." Eur J Clin Nutr 60(4): 486-93
Pubmed
III. Salminen H, Saaf M, Ringertz H, Strender LE (2007). "The role of IGF-I and IGFBP-1 status and secondary hyperparathyroidism in relation to osteoporosis in elderly Swedish women. " Osteoporos Int Sep 14: Epub ahead of print
Pubmed
IV. Salminen HS, Sääf ME, Johansson SE, Ringertz H, Strender LE (2007). "The effect of transvaginal estradiol on bone in aged women: a randomised controlled trial." Maturitas 57(4): 370-81. Epub 2007 May 9
Pubmed
Issue date: 2007-10-19
Rights:
Publication year: 2007
ISBN: 978-91-7357-371-9
Statistics
Total Visits
Views | |
---|---|
Osteoporosis ...(legacy) | 801 |
Osteoporosis ... | 144 |
Total Visits Per Month
October 2023 | November 2023 | December 2023 | January 2024 | February 2024 | March 2024 | April 2024 | |
---|---|---|---|---|---|---|---|
Osteoporosis ... | 3 | 2 | 0 | 1 | 6 | 0 | 0 |
File Visits
Views | |
---|---|
thesis.pdf(legacy) | 957 |
thesis.pdf | 455 |
thesis.pdf.txt(legacy) | 2 |
Top country views
Views | |
---|---|
United States | 336 |
Sweden | 99 |
Germany | 69 |
China | 59 |
South Korea | 31 |
France | 12 |
United Kingdom | 12 |
Ireland | 12 |
Denmark | 10 |
Finland | 10 |
Top cities views
Views | |
---|---|
Sunnyvale | 35 |
Kiez | 27 |
Seoul | 26 |
Beijing | 20 |
Romeo | 19 |
Ballerup | 10 |
Stockholm | 10 |
Baghdad | 9 |
London | 8 |
Dublin | 6 |