AbstractsWomens Studies

Osteoporosis in elderly women in primary health care

by Helena Salminen




Institution: Karolinska Institute
Department:
Year: 2007
Record ID: 1334235
Full text PDF: http://hdl.handle.net/10616/39288


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…