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Dietary Factors and Fracture in Postmenopausal Women: A Case-Control Study
Abstract
Kreiger N (Department of Preventive Medicine and Biostatistics, 12 Queens Park Crescent West, 3rd Floor, McMurrich Building, University of Toronto, Toronto, Ontario M5S 1A8 Canada), Gross A and Hunter G. Dietary factors and fracture in postmenopausal women: A case-control study. International Journal of Epidemiology 1992; 21: 953–958.
This case-control study examined the effect of diet on the risk of postmenopausal fracture of the hip and wrist. Cases, women aged 50–84 years, were admitted to one of four Metropolitan Toronto hospitals during the period September 1983 through May 1985. Controls were women of the same age, admitted to the same hospitals, and seen for orthopaedic or general surgical complaints. Data were collected through the use of a standardized structured questionnaire administered by trained female interviewers, and included dietary, sociodemographic, medical, and behavioural variables. Data analysis was conducted on 102 hip fracture cases, 154 wrist fracture cases, and 277 controls.
Higher dietary calcium intake only slightly increased the risk of hip fracture; however, it was associated with a significantly decreased risk for fracture of the wrist, at the level ≥1 g/day. Coffee and tea consumption appeared to be unrelated to fracture risk. Finally, alcohol intake was associated with a statistically nonsignificant increased risk in both fracture types.
These findings point to the importance of dietary factors on fracture risk, and indicate a need for future studies to stratify analysis on the basis of fracture type.
... Estrogen is thought to slow resorption and remodeling of bone; progesterone promotes remodeling and formation of new bone (5). Many studies have shown an association between menstrual irregularities or infertility and bone density (6)(7)(8)(9)(10)(11)(12)(13)(14). Other studies have not found an association (11,14,15). ...
... Many studies have shown an association between menstrual irregularities or infertility and bone density (6)(7)(8)(9)(10)(11)(12)(13)(14). Other studies have not found an association (11,14,15). ...
... A case-control study found that postmenopausal women with a history of oligomenorrhea had a significantly increased risk of vertebral osteoporosis relative to women with no history of menstrual disturbances (9). However, some studies have not found a relation between menstrual history and postmenopausal bone mass (11,14,15). For example, Fox et al. (11) found no differences in bone density in elderly women (65 years and older) with and without a history of regular menstrual cycles. ...
The authors examined prospectively between 1986 and 1997 the relation of irregular menstrual cycles and irregular menstrual bleeding duration earlier in life with risk of hip fracture in 33,434 postmenopausal Iowa women. Over the 318,522 person-years of follow-up, 523 hip fractures were reported. Adjusted for age, smoking, body mass index, waist/hip ratio, and estrogen use, the relative risk of hip fracture in women who reported always having irregular menstrual cycles, compared with women who never had irregular cycles, was 1.36 (95% confidence interval (Cl): 1.03, 1.78). Women who reported having irregular menstrual bleeding duration had a 1.40-fold (95% Cl: 1.10, 1.78) increased risk of hip fracture compared with women with regular bleeding duration. In addition, women who reported having both irregular menstrual cycles and irregular menstrual bleeding had a 1.82-fold (95% Cl: 1.55, 2.15) higher risk of hip fracture than did women who reported neither irregularity. Women who reported only one menstrual disturbance did not have a risk of hip fracture that was significantly different from women who reported no menstrual disturbances. The authors conclude that women with menstrual irregularities are at increased risk of hip fracture, probably because they are estrogen or progesterone deficient.
... Fifteen reports, including 9 cohort studies [12][13][14][15][16][17][18][19][20] and 6 casecontrol studies [35][36][37][38][39][40], were included in the meta-analysis. The main characteristics are summarized in Table 1 for the cohort studies and in Table 2 for the case-control studies. ...
... Excluded articles (n = 32): Letters or reviews (n = 2) Not conducted on coffee consumption (n = 15) Insufficient data for analysis (n = 6) Only unadjusted results (n = 2) Did not discriminate between coffee and other caffeinated drinks (n = 4) Conducted on the same study populations as other included studies (n = 2) Used the same study results as another included study (n = 1) The majority of the studies included in the meta-analysis were from Western countries (United States, Canada, and Europe), although 2 studies were from Asia-Pacific countries [15,39]. Six of the 16 studies [12][13][14][15][16][17][18][19][20][35][36][37][38][39][40]] -4 studies conducted in women [12,14,17,38], 1 study conducted in men [17], and 1 study conducted in both men and women [39] fulfilled the definition of osteoporotic fracture. The average duration of follow-up in the 9 cohort studies included in the meta-analysis was 12.9 years (range, 6-30 years). ...
... f The study by Ma et al. [15] was classified as the Asia-Pacific region considering the ethnicity of the study population (Hawaiian Japanese). g The study by Kreiger et al. [37] was included in the forearm/wrist fracture analysis due to the scarcity of studies on forearm/wrist fractures. difference that may exist in the effects of coffee on the risk of fractures. ...
The data on the association between coffee consumption and the risk of fractures are inconclusive. We performed a comprehensive literature review and meta-analysis to better quantify this association.
We identified all potentially relevant articles by searching MEDLINE, EMBASE, Cochrane Library, Web of Science, SCOPUS, and CINAHL (until February 2013). The keywords "coffee," "caffeine," "drink," and "beverage" were used as the exposure factors, and the keyword "fracture" was used as the outcome factor. We determined the overall relative risk (RR) and confidence interval (CI) for the highest and lowest level of coffee consumption. A dose-response analysis was performed to assess the risk of fractures based on the level of coffee consumption.
We included 253,514 participants with 12,939 fracture cases from 9 cohort and 6 case-control studies. The estimated RR of fractures at the highest level of coffee consumption was 1.14 (95% CI: 1.05-1.24; I(2)=0.0%) in women and 0.76 (95% CI: 0.62-0.94; I(2)=7.3%) in men. In the dose-response analysis, the pooled RRs of fractures in women who consumed 2 and 8 cups of coffee per day were 1.02 (95% CI: 1.01-1.04) and 1.54 (95% CI: 1.19-1.99), respectively.
Our meta-analysis suggests that daily consumption of coffee is associated with an increased risk of fractures in women and a contrasting decreased risk in men. However, future well-designed studies should be performed to confirm these findings.
... It has been hypothesised that coffee consumption could increase individual susceptibility to fracture by decreasing bone mineral density and bone mechanical strength, but results from earlier research have been conflicting. A total of eight case-control studies (5,(10)(11)(12)(13)(14)(15)(16) and twelve prospective cohort studies (6,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) have explored associations between coffee consumption and hip fracture risk, among which eight studies showed positive association (6,11,18,(21)(22)(23)(24)27) and one study in Sweden found that coffee consumption could increase hip fracture risk for non-drinkers (19) . Another study in Norway showed that women with an intake of at least nine cups of coffee daily tended to have an increased risk of hip fracture, but only 6·8 % of women consumed so much coffee per d (20) . ...
... The full text of the total articles were reviewed, and fifteen studies were excluded for the following reasons: two studies were reviews (32,33) , eight studies could not provide the OR and their CI (6,15,16,(23)(24)(25)(26)(27) , and five studies had irrelevant endpoints and exposures (34)(35)(36)(37)(38) . The remaining twelve studies included six case-control studies (5,(10)(11)(12)(13)(14) and six prospective studies (17)(18)(19)(20)(21)(22) , among which two studies (20,22) reported their results separately by sex, and thus each study was regarded as two separate studies, so fourteen datasets were extracted. The selection progress of papers is displayed in Fig. 1. ...
... Protein from non-dairy animal sources is likely to affect Ca excretion (43) . Although several studies (12,13,20) had demonstrated that low Ca intake and short sunlight exposure (5,10,11) could increase hip fracture risk, only limited studies had stratified their results according to the level of Ca intake (12) or menopausal status (12,13) . At present, as the selected papers in the present review could not provide more available evidence about the above factors, we failed to further analyse the effect of those factors on the relationship between coffee and hip fracture, and research concerning those factors is needed in the future. ...
To investigate the effect of coffee consumption on hip fracture risk, a meta-analysis was conducted. The PubMed database was screened for all published studies about coffee consumption and hip fracture through to November 2011. Reviews, PubMed option ‘related articles’ and references of retrieved papers were also searched for potentially relevant papers. Only studies that contained OR with 95 % CI for the association between coffee consumption and hip fracture risk were included. The summary risk estimates were calculated by fixed- and random-effects models. Subgroup analyses were carried out stratified by study designs and participant characteristics, respectively. A total of six prospective cohort studies and six case–control studies were included in the final analysis. The pooled OR displayed increased risk of hip fracture by 29·7 % (95 % CI 0·960, 1·751; P = 0·09) for the highest compared with the lowest coffee consumption by the random-effects model (P for heterogeneity = 0·000; I
2 = 84·0 %), but the result had no statistical significance. Subgroup analyses showed that coffee consumption significantly increased hip fracture risk by 54·7 % (95 % CI 1·152, 2·077; P = 0·004) among women, by 40·1 % (95 % CI 1·015, 1·935; P = 0·040) for elderly participants aged over 70 years, and by 68·3 % for Northern Americans (95 % CI 1·492, 1·899; P = 0·000). Other subgroup analyses according to data published before the year 2000 showed a positive association between coffee and hip fracture risk, and follow-up duration also positively affected hip fracture risk, especially when the follow-up length was less than 13 years. Although our meta-analysis has provided insufficient evidence that coffee consumption significantly increases hip fracture risk, coffee intake may increase hip fracture risk among women, elderly participants and Northern Americans. No dose–response pattern was observed.
... On the contrary, several studies could not show tea to be effective for BMD improvement or fracture reduction. In a case-control study examining 277 controls, 154 wrist fracture patients, and 102 hip fracture patients in Canadian women (50-84 years), there was no correlation between tea consumption and fracture risk [135]. In 703 unrelated elderly older than 90 years and 581 pairs of controls and hip fracture incident patients (71 ± 7 years) in China, there was no relationship between tea consumption and fracture risk [136,137]. ...
... Kreiger, 1992 [135] Model: a case-control study examined the effect of diet on the risk of postmenopausal fracture of the hip and wrist. Treatments: Cases, women aged 50-84 y, were admitted to one of four Metropolitan Toronto hospitals during the period September 1983 through May 1985. ...
Osteoporosis is the second most common disease only secondary to cardiovascular disease, with the risk of fracture increasing with age. Osteoporosis is caused by an imbalance between osteoblastogenesis and osteoclastogenesis processes. Osteoclastogenesis may be enhanced, osteoblastogenesis may be reduced, or both may be evident. Inflammation and high reactive oxygen enhance osteoclastogenesis while reducing osteoblastogenesis by inducing osteoblast apoptosis and suppressing osteoblastic proliferation and differentiation. Catechins, the main polyphenols found in green tea with potent anti-oxidant and anti-inflammatory properties, can counteract the deleterious effects of the imbalance of osteoblastogenesis and osteoclastogenesis caused by osteoporosis. Green tea catechins can attenuate osteoclastogenesis by enhancing apoptosis of osteoclasts, hampering osteoclastogenesis, and prohibiting bone resorption in vitro. Catechin effects can be directly exerted on pre-osteoclasts/osteoclasts or indirectly exerted via the modulation of mesenchymal stem cells (MSCs)/stromal cell regulation of pre-osteoclasts through activation of the nuclear factor kB (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) system. Catechins also can enhance osteoblastogenesis by enhancing osteogenic differentiation of MSCs and increasing osteoblastic survival, proliferation, differentiation, and mineralization. The in vitro effects of catechins on osteogenesis have been confirmed in several animal models, as well as in epidemiological observational studies on human subjects. Even though randomized control trials have not shown that catechins provide anti-fracture efficacy, safety data in the trials are promising. A large-scale, placebo-controlled, long-term randomized trial with a tea regimen intervention of optimal duration is required to determine anti-fracture efficacy.
... Among the 165 articles, 19 full-texts were assessed for eligibility after removing 146 articles (reviews, case reports and overlapped articles). Subsequently 3 articles in which tea extract was studied and 7 ones in which the data not in usable format were excluding from the inclusion and in final, a total of 9 studies were included for the quantitative synthesis [24][25][26][27][28][29][30][31][32][33] (Figure 1). ...
... Case-control *** ** *** 8 Zeng FF [24] Case-control *** ** ** 7 Tomata Y [25] Cohort *** *** ** 8 ...
Fractures are important causes of healthy damage and economic loss nowadays. The conclusions of observational studies on tea consumption and fracture risk are still inconsistent. The objective of this meta-analysis is to determine the effect of tea drinking on the risk of fractures. In this study, a comprehensive literature search was conducted in Pubmed, Embase and reference lists of the relevant articles. Observational studies that reported an estimate of the association between tea drinking and incidence of fractures were included. A meta-analysis was conducted by the STATA software. The results indicated that a total of 9 studies involving 147,950 individuals that examined the association between tea consumption and risk of fractures were included in this meta-analysis. The odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. The pooled OR of 9 observational studies for the tea consumption on risk of fracture was 0.89 (95% CI, 0.78-1.04). In the subgroup analyses, no significant association was detected in neither cohort studies (n = 3; OR, 0.97; 95% CI, 0.89-1.06) nor case-control studies (n = 6; OR, 0.91; 95% CI, 0.70-1.19), respectively. Because of the varied and limited data of the included studies, we are not able to conduct the dose-response meta-analysis. In conclusion, tea consumption might be not associated with the risk of fractures. The following large-sample and well-designed studies are required to confirm the existing conclusions.
... In a case-control study on the effect of diet on the risk of postmenopausal hip and wrist fractures, Kreiger et al. revealed that tea intake was not associated with fracture risk (hip and wrist). These findings are in accord with our MR analysis [27]. However, Myers et al. found that higher black tea and specific classes of flavonoids intake were associated with a lower risk of fractures in older women [12]. ...
Fracture is a global public health disease. Bone health and fracture risk have become the focus of public and scientific attention. Observational studies have reported that tea consumption is associated with fracture risk, but the results are inconsistent. The present study was conducted to evaluate whether tea consumption was causally associated with the risk of bone fracture through two-sample Mendelian Randomization (MR) analysis. We included a large genome-wide association study (GWAS) associated with tea consumption of 447,485 individuals and analyzed the effects of genetic instruments on fractures using fracture cases from the UK Biobank dataset (n=361,194). Inverse variance weighted (IVW) indicated no causal effects of tea consumption on fractures of the skull and face, shoulder and upper arm, hand and wrist, femur, calf, and ankle (odds ratio=1.000, P=0.881; OR=1.000, P=0.857; OR=1.002, P=0.339; OR=0.997, P=0.054; OR=0.998, P=0.569, respectively). Consistent results were also found in MR-Egger, weighted median, and weighted mode. Our research provided evidence that tea consumption is unlikely to affect the incidence of fractures.
... Calcium as the main structural bone element has been the nutritional focus of osteoporosis research over recent decades, although the results have been controversial. Many studies reported salutary effects (125;152-156), some others reported no association (157)(158)(159)(160) and a few studies found adverse relation between bone health and calcium intake (161). ...
p>This study tests the hypothesis that a diet, which complies with current healthy dietary guidelines, is associated with lower plasma alkaline phosphatase (ALP) and stronger handgrip strength as markers of bone health and muscle performance in older people. The study also examines whether men, and those with optimal early nutrition will benefit more from a healthy diet than women and those from a less than optimal early environment. This is the first study to examine the effect of a healthy dietary pattern and to explore its interactions with sex and body size measurements on bone health and muscle performance in the elderly.
The secondary analyses undertaken in this study are based on the data of the National Diet and Nutrition Survey (NDNS) conducted on a UK nationally-representative sample of 1687 men and women aged 65 years and over. Principal component analysis (PCA) was used to summarise dietary patterns, by which seven statistically independent eating patterns were generated.
The healthy dietary pattern identified by PCA characterised by a high intake of vegetables, fruits, cereals, fish and other seafood, showed that strongest negative (beneficial) association with ALP (r = -0.17, p<0.001) and the strongest positive association with hand-grip strength (r = 0.20, p<0.001). Multiple regression analysis controlling for energy intake, a number of confounders and various nutrients, identified the healthy diet as the strongest predictor for serum ALP and handgrip strength in elderly men and women, separately. Subjects in the highest fourth of the healthy diet in comparison to the lowest, were less likely to have high levels of plasma ALP (OR = 0.4, 95% CI, 0.3 - 0.6) after adjustment for known confounders. Healthy diet was of the most benefit for heaviest and tallest men but not heavier and taller women. For those within the shortest and thinnest group, the association between healthy diet and ALP did not reach statistical significance.</p
... These studies were performed between 1990 and 2018 in different locations: eight in USA (Ma et al. 2011, van Lenthe et al. 2011, Hansen et al. 2000, Cummings et al. 1995, Kiel et al. 1990, Hernandez-Avila et al. 1991, Nieves, Grisso, and Kelsey 1992, Kreiger, Gross, and Hunter 1992 (Jokinen et al. 2010, Määttä et al. 2012, two in Southern Europe (Johnell et al. 1995, Kanis et al. 1999) and one each in Singapore (Dai et al. 2018), Netherlands (van Geel et al. 2006, Norway (Meyer et al. 1997), Japan (Suzuki et al. 1997), Australia (Cumming and Klineberg 1994), and Italy (Tavani, Negri, and La Vecchia 1995). These studies totally included 471,939 participants aged ≥18 years (461,094 in cohort-studies and 10,845 in case-control studies) and 41,602 cases of fracture (37,632 in cohort-studies and 3,970 in case-control studies). ...
Background:
Conflicting reports are available about the association of coffee or caffeine intake and risk of fracture. We performed the current updated systematic review and dose-response meta-analysis of coffee consumption and caffeine intake and risk of fracture to quantify this association.
Materials and methods:
PubMed/Medline, ISI Web of Science, and Scopus, Cochrane database were searched up to July 2021. Random-effects model or fixed-effects model was used to pool the study-specific effect sizes (ESs) and 95% confidence intervals (CIs). Dose-response relationship was examined using linear and non-linear dose-response analyses. The certainty of evidence was assessed using NutriGrade tool.
Results:
Out of 22 eligible studies included in the meta-analysis, 15 had cohort and 7 had case-control design. We found no significant association between coffee consumption and risk of fracture, either based on pooling cohort (RR: 0.99; 95% CI: 0.88, 1.12; I2 = 71.4%, Pheterogeneity < 0.01) or case-control studies (OR: 1.13; 95% CI: 0.87, 1.46; I2 = 49.0%, Pheterogeneity=0.08). In the subgroup analysis of cohort studies, we observed that higher coffee intake was inversely associated with risk of fracture in men (RR: 0.85; 95% CI: 0.76 to 0.94). In addition, a positive association was seen between coffee consumption and risk of fracture in studies with less than 12 years of follow-up (RR: 1.14; 95% CI: 1.02 to 1.27). With regard to caffeine intake, a statistically significant positive association was seen with risk of fracture (RR: 1.15; 95% CI, 1.08 to 1.23; I2=26.6%, n = 8). In the dose-response analysis, we found that each additional 100 mg caffeine intake was marginally associated with 2% greater risk of fracture (RR: 1.02; 95% CI: 1 to 1.05; I2= 70.3%, n = 6).
Conclusion:
High coffee consumption was protectively associated with risk of fracture in men, while caffeine intake was positive associated with risk.
... Previous epidemiological studies have yielded inconsistent associations between tea consumption and risk of fracture. Tea consumption was associated with a decreased risk of fracture in some case-control studies [12][13][14], but not in others [15][16][17]. Most of the prospective cohort studies observed null associations between tea consumption and risk of fracture [18][19][20][21][22], while one study reported a positive association [23] and another reported a negative one [24]. ...
Background:
Tea consumption may have favorable effects on risk of fracture. However, little is known about such association in Chinese adults. The aim of this study was to examine the association between tea consumption and risk of hospitalized fracture in Chinese adults.
Methods:
The present study included 453,625 participants from the China Kadoorie Biobank (CKB). Tea consumption was self-reported at baseline. Hospitalized fractures were ascertained through linkage with local health insurance claim databases.
The results:
During a median of 10.1 years of follow-up, we documented 12,130 cases of first-time any fracture hospitalizations, including 1376 cases of hip fracture. Compared with never tea consumers, daily tea consumption was associated with lower risk of any fracture (hazard ratio (HR): 0.88; 95% confidence interval (CI): 0.83, 0.93). Statistically significant reduced risk of hip fracture was shown among daily consumers who most commonly drank green tea (HR: 0.80; 95% CI: 0.65, 0.97) and those who had drunk tea for more than 30 years (HR: 0.68; 95% CI: 0.52, 0.87). Our conclusions: Habitual tea consumption was associated with moderately decreased risk of any fracture hospitalizations. Participants with decades of tea consumption and those who preferred green tea were also associated with lower risk of hip fracture.
... If a permanent reduction in BMD or skeletal strength were to occur from lactation, then lactation should be a strong risk factor for low BMD or fracture in women of all ages. However, over five dozen epidemiologic studies of pre-, peri-, and postmenopausal women have found a neutral effect (16,38,63,158,203,214,215,290,292,299,341,356,368,379,383,397,444,445,448,463,481,506,509,541,547,611,619,625,636,648,683,700,761,828,845,846,861,864,865,869,879,934,935,944,951,969,1020) or a protective effect (25,27,71,83,144,169,212,244,279,327,365,416,421,482,507,700,804,833,879,986,1018) of lactation on peak bone mass, BMD, and fracture risk. This includes a study in which extended duration of breastfeeding per child conferred a progressively greater protection against hip fractures (421). ...
During pregnancy and lactation, female physiology adapts to meet the added nutritional demands of fetuses and neonates. An average full-term fetus contains_30 g calcium, 20 g phosphorus, and 0.8 g magnesium. About 80% of mineral is accreted during the third trimester; calcium transfers at 300-350 mg/day during the final 6 wk. The neonate requires 200 mg calcium daily from milk during the first 6 mo, and 120 mg calcium from milk during the second 6 mo (additional calcium comes from solid foods). Calcium transfers can be more than double and triple these values, respectively, in women who nurse twins and triplets. About 25% of dietary calcium is normally absorbed in healthy adults. Average maternal calcium intakes in American and Canadian women are insufficient to meet the fetal and neonatal calcium requirements if normal efficiency of intestinal calcium absorption is relied upon. However, several adaptations are invoked to meet the fetal and neonatal demands for mineral without requiring increased intakes by the mother. During pregnancy the efficiency of intestinal calcium absorption doubles, whereas during lactation the maternal skeleton is resorbed to provide calcium for milk. This review addresses our current knowledge regarding maternal adaptations in mineral and skeletal homeostasis that occur during pregnancy, lactation, and post-weaning recovery. Also considered are the impacts that these adaptations have on biochemical and hormonal parameters of mineral homeostasis, the consequences for long-term skeletal health, and the presentation and management of disorders of mineral and bone metabolism.
... For the purpose of this study, we ascribed off-label status to all drug uses which met at least one of the following criteria: (1) none of the ICD-9-CM codes in the patient's electronic record during the study period could be matched to any labeled indications of the prescribed drug (Table 1 and Table 6), or (2) the age of the recipient differs from the label specifications (Table 3). An attained age of 50 years was used as an indicator of postmenopausal status as described elsewhere (Lenz et al. 2002;La Vecchia et al. 1997;Kreiger et al. 1992). Off-label -154, 158.0, 159.0, 159.8, 159.9, 171.5-171.9, ...
To determine the level of off-label cancer therapy use in a population of female breast cancer patients and to establish whether this use was evidence-based.
A study was conducted by sampling Cerner's data warehouse for all women diagnosed with breast cancer between January 2000 and June 2009 who received at least one cancer therapy approved by the US-FDA during the study period. Drug encounters were considered off-label if the circumstances of use did not match the age or medical diagnoses specified on the product label at the time of study. The level of evidence for the use of these drugs in a breast cancer setting was evaluated from randomized phase III trials using a tiered approach.
The study included 2,663 women with a median age of 59 years. A total of 1,636 off-label encounters were recorded, representing 13.0% of all encounters. Of the 65 cancer therapies investigated, 55.4% were prescribed off-label. The drugs with the highest off-label use were, in a descending order, vinorelbine, carboplatin, bevacizumab, leuprolide, liposomal doxorubicin and cisplatin. Most off-label encounters were evidence-based and more likely to be associated with private insurance coverage, younger age, ethnicities other than Caucasian, smaller treatment centres and drugs with limited labeled indications that have a longer market history.
Off-label prescribing is common practice in oncology and is an integral component of breast cancer treatment strategies. While this practice tends to be associated with specific socio-demographic factors and disease characteristics, the majority of off-label encounters appear to be evidence-based.
... Most studies of the relationship between caffeine intake and fracture risk have focused on hip fracture as the endpoint. Several studies have failed to demonstrate an association between caffeine or coffee intake and fracture risk at various sites, both those focusing on middle-aged women (Kreiger et al., 1992;Nieves et al., 1992;Johnell et al., 1995;Tavani et al., 1995;Huopio et al., 2000) and those focusing on subjects of both sexes (Holbrook et al., 1988;Johansson et al., 1992;Cumming & Klineberg, 1994;Fujiwara et al., 1997). ...
... Among the 165 articles, 19 full-texts were assessed for eligibility after removing 146 articles (reviews, case reports and overlapped articles). Subsequently 3 articles in which tea extract was studied and 7 ones in which the data not in usable format were excluding from the inclusion and in final, a total of 9 studies were included for the quantitative synthesis [24][25][26][27][28][29][30][31][32][33] ( Figure 1). ...
Fractures are important causes of healthy damage and economic loss nowadays. The conclusions of observational studies on tea consumption and fracture risk are still inconsistent. The objective of this meta-analysis is to determine the effect of tea drinking on the risk of fractures.
A comprehensive literature search was conducted in PubMed, Embase and reference lists of the relevant articles. Observational studies that reported an estimate of the association between tea drinking and incidence of fractures were included. A meta-analysis was conducted by the STATA software.
A total of 9 studies involving 147,950 individuals that examined the association between tea consumption and risk of fractures were included in this meta-analysis. The odds risks (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. The pooled OR of 9 observational studies for the tea consumption on risk of fracture was 0.89 (95% CI, 0.78-1.04). In the subgroup analyses, no significant association was detected in neither cohort studies (n = 3; OR, 0.97; 95% CI, 0.89-1.06) nor case-control studies (n = 6; OR, 0.91; 95% CI, 0.70-1.19), respectively. No significant association was detected in the dose-response meta-analysis.
Tea consumption might not be associated with the risk of fractures. The following large-sample and well-designed studies are required to confirm the existing conclusions.Virtual slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5309904231178427.
... High caffeine intake may involve considerable renal and intestinal calcium losses [13]. Results of previous epidemiological studies have suggested a relationship between high caffeine consumption and low bone mineral density (BMD) and osteoporotic fractures, which however may be offset by a high calcium intake [14,15]. Caffeine intake also reduces inositol levels in the blood. ...
Coffee and tea consumption was hypothesized to interact with variants of vitamin D-receptor polymorphisms, but limited evidence exists. Here we determine for the first time whether increased coffee and tea consumption affects circulating levels of 25-hydroxyvitamin D in a cohort of Saudi adolescents.
A total of 330 randomly selected Saudi adolescents were included. Anthropometrics were recorded and fasting blood samples were analyzed for routine analysis of fasting glucose, lipid levels, calcium, albumin and phosphorous. Frequency of coffee and tea intake was noted. 25-hydroxyvitamin D levels were measured using enzyme-linked immunosorbent assays.
Improved lipid profiles were observed in both boys and girls, as demonstrated by increased levels of HDL-cholesterol, even after controlling for age and BMI, among those consuming 9-12 cups of coffee/week. Vitamin D levels were significantly highest among those consuming 9-12 cups of tea/week in all subjects (p-value 0.009) independent of age, gender, BMI, physical activity and sun exposure.
This study suggests a link between tea consumption and vitamin D levels in a cohort of Saudi adolescents, independent of age, BMI, gender, physical activity and sun exposure. These findings should be confirmed prospectively.
... Other studies report an increased risk of lower bone mineral [15]. However, many studies report an improved bone status [16] or a reduced fracture risk as a result of breast feeding or high parity1718192021. Bone strength is related not only to bone mass but also to bone structural geometry. ...
Human lactation is associated with transient decreases in bone mineral density (BMD). Bone strength is related to both mass and structural geometry. This study investigated longitudinal changes of hip bone strength during lactation using hip structural analysis (HSA), which determines hip structural geometry (including areal BMD, BMDa) from dual-energy X-ray absorptiometry scans (DXA).
Forty-eight lactating women were studied longitudinally at the proximal femur using DXA at approximately 2 weeks postpartum, peak-lactation and post-lactation. Nonpregnant, nonlactating women (NPNL, n = 23) were studied concurrently at baseline and after 1 year. Hip scans were analysed using HSA at the narrow neck, intertrochanter and proximal shaft.
No significant change (> 0.05) was observed in NPNL women for any measurement. In contrast, for lactating women BMDa decreased significantly from 2 weeks postpartum to peak-lactation at narrow neck (−2.8%), intertrochanter (−3.2%) and shaft (−1.4%). Cross-sectional area (CSA) decreased at narrow neck (−3.4%) and intertrochanter (−2.7%). There were no significant changes in bone width. Section modulus decreased at intertrochanter (−2.1%). At shaft, cortical thickness decreased (−1.7%) and buckling ratio increased (2.3%). By post-lactation, measurements were not significantly different from 2 weeks postpartum except for decrements in BMDa (−1.1%) and CSA (− 1.2%) at the shaft. During the study, lactating women lost 5% of their body weight. Adjusting for weight changes decreased the magnitude and significance of HSA changes at peak-lactation and by post-lactation there were no significant differences from 2 weeks postpartum. Calcium intake was not a significant predictor of changes in HSA variables.
In conclusion, lactation is associated with significant but transient changes in hip BMD and structural geometry. Changes in body weight but not calcium intake were associated with these changes. These small changes at the hip during lactation occurred mainly at internal surfaces and had minimal impact on bending or compressive strength.
Current research evaluating the association between tea consumption and bone health still has inconsistent findings.
The electronic databases of Embase, PubMed, Scopus, and Web of Science were systematically searched from inception until December 2022 to identify eligible studies. The calculation of summary relative risks (RRs) and 95% confidence intervals (CIs) was carried out using random-effects models. I2 statistics and Forest plots were used to assess the heterogeneity of RR values across studies.
The pooled relative risks for bone health-related outcomes of interest among tea drinkers, compared to non-drinkers, were 0.910 (95% confidence interval 0.845 to 0.980) for fractures, based on 20 studies, 0.332 (0.207–0.457) for BMD (13 studies), 0.800 (0.674–0.950) for osteoporosis (10 studies), and 1.006 (0.876–1.156) for osteopenia (5 studies). Subgroup analysis of locations showed that the pooled relative risks were 0.903 (0.844–0.966) for the hip, 0.735 (0.586–0.922) for the femur, 0.776 (0.610–0.988) for the lumbar, 0.980 (0.942–1.021) for the forearm and wrist, 0.804 (0.567–1.139) for the phalanges, and 0.612 (0.468–0.800) for Ward’s triangle. One-stage dose–response analysis revealed that individuals who consumed less than 4.5 cups of tea per day had a lower risk of bone health-related outcomes than those who did not consume tea, with statistically significant results.
There is an association between tea consumption and a reduced risk of fractures, osteoporosis, hip, femur, and lumbar, as well as increased BMD.
Fracture is a global public health disease. Bone health and fracture risk have become the focus of public and scientific attention. Observational studies have reported that tea consumption is associated with fracture risk, but the results are inconsistent. The present study used 2-sample Mendelian randomization (MR) analysis. The inverse variance weighted method, employing genetic data from UK Biobank (447,485 cases) of tea intake and UK Biobank (Genome-wide association study Round 2) project (361,194 cases) of fractures, was performed to estimate the causal relationship between tea intake and multiple types of fractures. The inverse variance weighted indicated no causal effects of tea consumption on fractures of the skull and face, shoulder and upper arm, hand and wrist, femur, calf, and ankle (odds ratio = 1.000, 1.000, 1.002, 0.997, 0.998; P = .881, 0.857, 0.339, 0.054, 0.569, respectively). Consistent results were also found in MR-Egger, weighted median, and weighted mode. Our research provided evidence that tea consumption is unlikely to affect the incidence of fractures.
IntroductionAmong the various hip fracture predictors explored to date, modifiable risk factors warrant special consideration, since they present promising targets for preventative measures. This systematic review and meta-analysis aims to assess various modifiable risk factors.Material and methodsWe searched four online databases in September 2017. We included studies that reported on modifiable lifestyle risk factors for sustaining fragility hip fractures. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS).The inclusion criteria consisted of (1) adult patients with osteoporotic hip fracture, (2) original study, (3) availability of full text articles in English, and (4) report of a modifiable lifestyle risk factor.ResultsThirty-five studies, containing 1,508,366 subjects in total, were included in this study. The modifiable risk factors that were significantly associated with an increased risk of hip fracture were the following: weight < 58 kg (128 lbs) (pooled OR 4.01, 95% CI 1.62–9.90), underweight body mass index (BMI) (< 18.5) (pooled OR 2.83, 95% CI 1.82–4.39), consumption of ≥ 3 cups of coffee daily (pooled OR 2.27, 95% CI 1.04–4.97), inactivity (pooled OR 2.14, 95% CI 1.21–3.77), weight loss (pooled OR 1.88, 95% CI 1.32–2.68), consumption of ≥ 27 g (approx. > 2 standard drinks) alcohol per day (pooled OR 1.54, 95% CI 1.12–2.13), and being a current smoker (pooled OR 1.50, 95% CI 1.22–1.85). Conversely, two factors were significantly associated with a decreased risk of hip fracture: obese BMI (> 30) (pooled OR 0.58, 95% CI 0.34–0.99) and habitual tea drinking (pooled OR 0.72, 95% CI 0.66–0.80).Conclusion
Modifiable factors may be utilized clinically to provide more effective lifestyle interventions for at risk populations. We found that low weight and underweight BMI carried the highest risk, followed by high coffee consumption, inactivity, weight loss, and high daily alcohol consumption.
Reproductive hormonal characteristics are a primary influence on the acquisition and maintenance of peak bone mass such that events associated with the reproductive life span and procreation have profound effects on subsequent risk for osteoporosis and fractures. A longer duration of menstruation, either from earlier menarche or later menopause, and the use of estrogen-containing hormonal contraception appear to increase bone mineral density and may reduce fracture risk. Pregnancy and lactation increase bone turnover and decrease bone density, but the effect is subsequently reversed with recovery of density and possible reduction in long-term fracture risk. Conditions that induce amenorrhea or early menopause, and nonestrogen-containing hormonal contraceptives such as depot medroxyprogesterone acetate, are associated with decreased bone density and possibly increased fracture risk. Mechanisms mediating these known or suggested effects are incompletely characterized.
This meta-analysis included 16 studies, involving seven cohort studies and nine case-control studies, and the results indicated that tea consumption may be associated with a reduced the risk of fractures.
Introduction
Regarding relationship of tea consumption with the risk of fractures remains controversial. We performed a meta-analysis to elucidate the association between tea consumption and the risk of fractures.
Methods
Relevant articles were identified up to March 2019 by searching PubMed, Web of Science, and Embase databases. The pooled relative risks (RRs) with 95% confidence intervals (CIs) were computed utilizing fixed or random effects model based on heterogeneity.
Results
Altogether 16 studies (seven cohort and nine case-control studies) were included in this meta-analysis, involving 772,707 participants with 37,166 fracture cases. The RRs (95% CIs) of fracture for the highest versus lowest category of tea consumption were 0.86 (0.78–0.94). Subgroup analysis indicated significant associations in cohort studies (0.90 (0.86–0.94)) and case-control studies (0.77 (0.69–0.85)).
Conclusions
The current meta-analysis indicates that tea consumption may be associated with a reduced the risk of fractures.
The purpose of this review is to examine the correlation between tobacco smoking and hip fractures. The literature that was used for this article was based on studies that investigated not only the direct correlation between smoking and hip fractures but also the effect of smoking on bone mineral density. In general, the incidence of hip fracture was found to be higher in current smokers in both genders. Compared with never smokers, former smokers had a slightly higher risk of hip fracture that was inversely proportional to the cessation span. The relative risk (RR) of hip fracture in current male smokers was higher than the RR for nonsmokers (never and former smokers). In postmenopausal women former and current smoking increased the RR. In premenopausal and postmenopausal women, cessation of smoking decreases the risk of hip fracture. Risk rises with greater cigarette consumption. Risk declines among former smokers, but the benefit is not observed until 10 years after cessation.
Osteoporotic fracture poses a major health problem in an aging population, yet its aetiology is not well established. Much remains to be learned about the role of a number of risk factors. In this paper, the literature is reviewed and suggestions are made for research emphasis.
Osteoporosis is a skeletal disease characterized by a deterioration of bone mass and bone quality that predisposes an individual to a higher risk of fragility fractures. Emerging evidence has shown that the risk for low bone mass and osteoporosis-related fractures can be reduced by nutritional approaches aiming to improve bone microstructure, bone mineral density, and strength. Tea and its flavonoids, especially those of black tea and green tea, have been suggested to protect against bone loss and to reduce risk of fracture, due to tea's antioxidant and anti-inflammatory properties. Based on the results of animal studies, moderate intake of tea has shown to benefit bone health as shown by mitigation of bone loss and microstructural deterioration as well as improvement of bone strength and quality. Epidemiological studies have reported positive, insignificant, and negative impacts on bone mineral density at multiple skeletal sites and risk of fracture in humans with habitual tea consumption. There are limited human clinical trials that objectively and quantitatively assessed tea consumption and bone efficacy using validated outcome measures in a population at high risk for osteoporosis, along with safety monitoring approach. This review summarizes the current state of knowledge of laboratory animal research, epidemiological observational studies, and clinical trials assessing the skeletal effects of tea and its active flavonoids, along with discussion of relevant future directions in translational research.
Prevention of hip fractures involves any or all of three basic measures: fall prevention, prevention and treatment of bone fragility, and the use of external hip protectors. Although none of these approaches is without controversy, as a whole they have substantial potential to conserve health-care resources and maintain the quality of life for many elderly individuals.
The habitual consumption of even moderate quantities of alcohol (1 to 2 drinks/day) is clearly linked with reduced bone mass (osteopenia). Biochemical and histological evaluation of patients with alcoholic bone disease reveal a marked impairment in bone formation in the face of relatively normal bone resorption, Experiments using well-defined osteoblastic model systems indicate that the observed reductions in bone formation result from a direct, antiproliferative effect of ethanol on the osteoblast itself. As bone remodeling and mineralization are dependent on osteoblasts, it follows that the deleterious effect of alcohol on these cells would result in slowed bone formation, aberrant remodeling of skeletal tissue and, ultimately, osteopenia and fractures. The skeletal consequences of alcohol intake during adolescence, when the rapid skeletal growth ultimately responsible for achieving peak bone mass is occurring, may be especially harmful. The specific subcellular mechanisms whereby ethanol inhibits cell proliferation are, as yet, unknown. During the last few years, attention has shifted from nonspecific membrane perturbation effects to actions on certain signaling proteins. Specifically, there is increasing evidence that ethanol may exert significant effects on transmembrane signal transduction processes that constitute major branches of cellular control mechanisms. At present, abstinence is the only effective therapy for alcohol-induced bone disease. An improved understanding of the pathogenesis of alcohol-induced bone disease may eventually result in alternative therapeutic avenues for those who are unable to abstain.
Background:
Decreased ability to absorb calcium with age limits adaptation to low calcium intake and is thought to lead to secondary hyperparathyroidism and increased risk for hip and other fractures. However, the associations between fractional calcium absorption, dietary calcium intake, and risk for fracture have never been studied.
Objective:
To determine whether low fractional calcium absorption in women with low calcium intake increases the risk for subsequent hip and other nonspine fractures.
Design:
Prospective cohort study.
Setting:
Four clinical centers in Baltimore County, Maryland; Portland, Oregon; Minneapolis, Minnesota; and the Monongahela Valley, Pennsylvania.
Participants:
5452 nonblack women 69 years of age or older participating in the fourth examination of the Study of Osteoporotic Fractures.
Measurements:
Fractional calcium absorption was measured by using a 3-hour single isotope (45Ca) technique. Incident fractures were identified prospectively and were confirmed by radiographic report.
Results:
During an average of 4.8 years, 729 women (13%) experienced at least one nonspine fracture; 153 of these women had hip fractures. After adjustment for age, women with lower fractional calcium absorption were at increased risk for hip fracture (relative risk per 1-SD [7.7%] decrease in fractional calcium absorption, 1.24 [95% CI, 1.05 to 1.48]). Women with low fractional calcium absorption and low calcium intake were at greatest risk for subsequent hip fracture; among women whose dietary calcium intake was less than 400 mg/d, those who had fractional calcium absorption at or below the median value of 32.3% had a 2.5-fold (CI, 1.29-fold to 4.69-fold) increase in risk for hip fracture compared with those who had greater absorption efficiency. Fractional calcium absorption was not related to risk for other nonspine fractures (relative risk per 1-SD [7.7%] decrease in fractional calcium absorption, 1.05 [CI, 0.96 to 1.14]).
Conclusions:
In elderly women, low fractional calcium absorption in the setting of low calcium intake increases the risk for hip fracture. Our findings support the hypothesis of type II osteoporosis, which postulates that decreased calcium absorption is an important risk factor for hip fracture in older persons.
Background: Previous studies regarding the impact of cigarette smoking on the risk of hip fracture in post-menopausal women have been inconsistent, suggesting different effects in different groups. The effect of alcohol intake on fracture risk is puzzling: moderate alcohol intake appears to increase bone density, and its association with hip fracture is not clear.
This chapter considers the endogenous and exogenous events that are related directly or indirectly to the capacity to reproduce, for their importance to peak bone mass. In mechanisms of bone loss in lactation, the importance of injectable contraceptive, and the role of hormone variation in association with peak bone mass. Pregnancy and lactation are characterized by significant alterations in the maternal hormone environment, notably estrogen and prolactin concentrations. Pregnancy and lactation provide models that can be examined to learn more of the biology associated with the maintenance of bone mass, particularly apart from calcium regulation by the calciotropic hormones. Lactation, in particular, offers the opportunity to understand the dynamics of bone loss as well as bone recovery. In the adult, bone tissue undergoes a continuous remodeling process consisting of periods of bone resorption and formation with maximal bone accretion, thought to occur in the early third decade, followed by relatively stable bone mineral density until the menopause transition. Stochastic models developed by Horsman and Burkinshaw suggested that two-thirds of the risk for fracture is predicted based on premenopausal bone mineral density (BMD). Therefore, in premenopausal women, the primary goal is to maximize or maintain bone mineral density.
Premenopausal reproductive hormonal characteristics are a primary influence on the acquisition and maintenance of peak bone mass such that events associated with the reproductive lifespan and procreation have profound effects on subsequent risk for osteoporosis and fractures. A longer duration of menstruation, either from earlier menarche or later menopause, and the use of estrogen-containing hormonal contraception appear to increase bone mineral density and may reduce fracture risk. Pregnancy and lactation increase bone turnover and decrease bone density, but the effect is subsequently reversed with recovery of density and possible reduction in long-term fracture risk. Conditions that induce amenorrhea or early menopause, and nonestrogen-containing hormonal contraceptives such as depot medroxyprogesterone acetate, are associated with decreased bone density and possibly increased fracture risk. Mechanisms mediating these known or suggested effects are incompletely characterized.
The population of the developed world is aging. With this aging population, strategies for prevention rather than treatment of chronic disease, such as osteoporosis, are essential for preserving quality of life and reducing health care costs. Tea is the second most consumed beverage in the world and is a rich source of flavonoids that may benefit bone health. There is strong evidence from human studies that habitual tea consumption is positively associated with higher BMD at multiple skeletal sites, while the association with fracture risk is less clear. Fracture studies demonstrate a reduction or no difference in fragility fracture with tea consumption. There are key questions that need to be answered in future studies to clarify if higher consumption of tea not only supports a healthy BMD, but also reduces the risk of fragility fracture. And if the latter relationship is shown to exist, studies to elucidate mechanisms can be designed and executed. This review discusses findings from epidemiological studies as well as potential mechanisms by which flavonoids in tea may mediate an effect, and identifies key knowledge gaps in this research area.
Smoking and alcohol consumption are two lifestyle factors that have important contributions to skeletal health. Deleterious effects of smoking on the skeleton have been recognized for several decades. Smoking adversely affects bone density and increases hip fracture risk in postmenopausal women. In men emerging evidence is suggestive for similar associations but the evidence is not conclusive. Furthermore, the evidence is inadequate to infer a causal relationship between smoking and reduced bone density before menopause in women and in younger men.
Previously, the role of alcohol on skeletal health was not as well studied as that of smoking, and results from those studies suggested both beneficial as well as deleterious effects on the skeleton. However, recent studies on the role of alcohol on the skeleton suggest a “J”-shaped curve. Moderate ingestion of alcohol may offer some degree of benefit to the skeleton. Ongoing research further suggests that both ethanol and non-ethanol components of alcohol affect skeletal heath.
The primary role of vitamin D in pregnancy and lactation is in the regulation of calcium metabolism of the mother and fetus. Significant changes in maternal calcium metabolism occur during pregnancy, lactation, and after weaning, to provide the calcium needed for fetal bone mineral accretion, for the synthesis of breast milk, and for the restoration of the maternal skeleton. Reproductive hormones have important effects on calcium homeostasis and bone metabolism, and during pregnancy and lactation their actions work in concert with the vitamin D endocrine system to ensure the calcium needs are met for fetal bone mineral accretion, for breast milk production, and to maintain circulating maternal calcium concentrations. During pregnancy, the primary strategy to secure additional calcium is by increases in serum concentrations of 1,25-(OH)2D and intestinal calcium absorption. During lactation, maternal bone is demineralized, possibly due to the lactation-induced amenorrhea, in order to secure adequate availability of calcium for breast milk production. After weaning and the return of menses, maternal bone density increases. Recently it has been suggested that low maternal vitamin D status during pregnancy may influence pregnancy outcomes and disease development and growth of the offspring later in childhood or adulthood.
The aims of this study were to determine common international risk factors for hip fracture in women aged 50 years or more. We studied women aged 50 years or more who sustained a hip fracture in 14 centers from Portugal, Spain, France, Italy, Greece, and Turkey over a 1-year period. Women aged 50 years or more selected from the neighborhood or population registers served as controls. Cases and controls were interviewed using a structured questionnaire on work, physical activity, exposure to sunlight, reproductive history and gynecologic status, height, weight, mental score, and consumption of tobacco, alcohol, calcium, coffee, and tea. Significant risk factors identified by univariate analysis included low body mass index (BMI), short fertile period, low physical activity, lack of sunlight exposure, low milk consumption, no consumption of tea, and a poor mental score. No significant adverse effects of coffee or smoking were observed. Moderate intake of spirits was a protective factor in young adulthood, but otherwise no significant effect of alcohol intake was observed. For some risks, a threshold effect was observed. A low BMI and milk consumption were significant risks only in the lowest 50% and 10% of the population, respectively. A late menarche, poor mental score, low BMI and physical activity, low exposure to sunlight, and a low consumption of calcium and tea remained independent risk factors after multivariate analysis, accounting for 70% of hip fractures. Excluding mental score and age at menarche (not potentially reversible), the attributable risk was 56%. Thus, about half of the hip fractures could be explained on the basis of the potentially reversible risk factors sought. In contrast, the use of risk factors to “predict” hip fractures had moderate sensitivity and specificity. We conclude that variations in lifestyle factors are associated with significant differences in the risk of hip fracture, account for a large component of the total risk, and may be of some value in selecting individuals at high risk.
Unlabelled:
The present meta-analysis shows no clear association between coffee consumption and the risk of hip fractures. There was a nonlinear association between tea consumption and the risk of hip fracture. Compared to no tea consumption, drinking 1-4 cups of tea daily was associated with a lower risk of hip fracture.
Introduction:
Prospective cohort and case-control studies have suggested that coffee and tea consumption may be associated with the risk of hip fracture; the results have, however, been inconsistent. We conducted a meta-analysis to assess the association between coffee and tea consumption and the risk of hip fracture.
Methods:
We performed systematic searches using MEDLINE, EMBASE, and OVID until February 20, 2013, without limits of language or publication year. Relative risks (RRs) with 95% confidence intervals (CI) were derived using random-effects models throughout all analyses. We conducted categorical, dose-response, heterogeneity, publication bias, and subgroup analyses.
Results:
Our study was based on 195,992 individuals with 9,958 cases of hip fractures from 14 studies, including six cohort and eight case-control studies. The pooled RRs of hip fractures for the highest vs. the lowest categories of coffee and tea consumption were 0.94 (95% CI 0.71-1.17) and 0.84 (95% CI 0.66-1.02), respectively. For the dose-response analysis, we found evidence of a nonlinear association between tea consumption and the risk of hip fracture (p(nonlinearity) < 0.01). Compared to no tea consumption, 1-4 cups of tea per day may reduce the risk of hip fracture by 28% (0.72; 95% CI 0.56-0.88 for 1-2 cups/day), 37% (0.63; 95% CI 0.32-0.94 for 2-3 cups/day), and 21% (0.79; 95% CI 0.62-0.96 for 3-4 cups/day).
Conclusions:
We found no significant association between coffee consumption and the risk of hip fracture. A nonlinear association emerged between tea consumption and the risk of hip fracture; individuals drinking 1-4 cups of tea per day exhibited a lower risk of hip fractures than those who drank no tea. The association between 5 daily cups of tea, or more, and hip fracture risk should be investigated.
Most women are unaware of the risk factors for osteoporosis (OP). In an effort to prevent the development of OP, women need to have a raised awareness on this issue. The aims of this study were to determine any differences in the level of awareness and knowledge about OP between pre- and postmenopausal women.
Three hundred and six women who presented to the outpatient clinic of the Physical Medicine and Rehabilitation Department were included into the study. Demographic characteristics of the subjects were recorded. The participants were interviewed via an OP awareness questionnaire, which was designed to determine their knowledge of OP and risk factors.
The mean ages of the 126 pre- and 180 postmenopausal women were 41.3 ± 5.9 and 58.9 ± 8.1 years, respectively. Thirty-two percent of premenopausal and 51% of postmenopausal women had heard about OP (p< 0.001), but the mean scores of OP knowledge according to the OP questionnaire were not different between the groups (p> 0.05). Both pre- and postmenopausal women with a higher level of education demonstrated better knowledge of OP based on their awareness questionnaire score (p< 0.001).
Although half of the pre- and postmenopausal women reported having some awareness of OP, their level of knowledge was poor, particularly with regard to the risk factors associated with the condition and its complications. Having information about the risks of OP and a better understanding of the health beliefs of those at risk are important, as both may play a major role in influencing an individual's OP-preventing behaviors.
Injuries are a common cause of morbidity and mortality among elderly people. Falls are the most common type of accident, accounting for around 40% of injuries. There is substantial evidence that heavy alcohol use is an important risk factor for injuries in younger people, but results of the few studies of alcohol and injuries among elderly people have been inconsistent. In this paper, we review the literature on the effects of alcohol on gait and balance and present reasons that a causal relationship between alcohol and injuries is biologically plausible. We review the epidemiological studies of the relationship between alcohol and falls, hip fractures and other injuries in the elderly population and discuss sources of error in these studies. Selection bias, small sample sizes, measurement error and potential confounders such as age, gender, health status and medications may have played a substantial role in negative results from several studies. Further research that will help clarify the relationship between alcohol and injuries in elderly people is sorely needed.
Background
Previous studies regarding the impact of cigarette smoking on the risk of hip fracture in postmenopausal women have been inconsistent, suggesting different effects in different groups. The effect of alcohol intake on fracture risk is puzzling: moderate alcohol intake appears to increase bone density, and its association with hip fracture is not clear.
Methods
To assess the associations of cigarette smoking and alcohol consumption with hip fracture risk among postmenopausal women, we conducted an analysis of a population-based case-control study from Sweden. Cases were postmenopausal women, aged 50 to 81 years, who sustained a hip fracture after minor trauma between October 1, 1993, and February 28, 1995; controls were randomly selected from a population-based register during the same period. A mailed questionnaire requesting information on lifestyle habits and medical history was used 3 months after the hip fracture for cases and simultaneously for controls. Age-adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were computed by means of logistic regression.
Results
Of those eligible, 1328 cases (82.5%) and 3312 controls (81.6%) responded. Compared with never smokers, current smokers had an increased risk of hip fracture (age-adjusted OR, 1.66; 95% CI, 1.41-1.95). Duration of smoking—particularly postmenopausal smoking—was more important than the amount smoked. Former smokers had a small increase in risk (age-adjusted OR, 1.15; 95% CI, 0.97-1.37) that decreased with the duration of cessation. The age-adjusted OR for women consuming alcohol was 0.80 (95% CI, 0.69-0.93).
Conclusions
Cigarette smoking is a risk factor for hip fracture among postmenopausal women; risk decreases after cessation. Alcohol consumption has a weak inverse association with risk.
Osteoporosis is a complex disease, the risk factors of which include a variety of genetic and environmental factors. Among these, the role of diet has been recognized as an important determinant of the risk for osteoporosis, but much of the research thus far has focused on calcium and vitamin D. Results of several recent studies suggest that other nutrients may also contribute to the risk for age-related bone loss and osteoporotic fracture.Curr Opin Orthop 1999, 10:334-338 © Lippincott Williams & Wilkins, Inc.
Pregnancy and lactation are times of additional demand for Ca. Ca is transferred across the placenta for fetal skeletal mineralisation, and supplied to the mammary gland for secretion into breast milk. In theory, these additional maternal requirements could be met through mobilisation of Ca from the skeleton, increased intestinal Ca absorption efficiency, enhanced renal Ca retention or greater dietary Ca intake. The extent to which any or all of these apply, the underpinning biological mechanisms and the possible consequences for maternal and infant bone health in the short and long term are the focus of the present review. The complexities in the methodological aspects of interpreting the literature in this area are highlighted and the inter-individual variation in the response to pregnancy and lactation is reviewed. In summary, human pregnancy and lactation are associated with changes in Ca and bone metabolism that support the transfer of Ca between mother and child. The changes generally appear to be independent of maternal Ca supply in populations where Ca intakes are close to current recommendations. Evidence suggests that the processes are physiological in humans and that they provide sufficient Ca for fetal growth and breast-milk production, without relying on an increase in dietary Ca intake or compromising long-term maternal bone health. Further research is needed to determine the limitations of the maternal response to the Ca demands of pregnancy and lactation, especially among mothers with marginal and low dietary Ca intake, and to define vitamin D adequacy for reproductive women.
The habitual consumption of alcoholic beverages is clearly associated with low bone mass and an increased prevalence of skeletal fractures. Microscopic analysis of skeletal tissue from alcoholic patients reveals reduced osteoblast number and suppressed bone formation activity with a relative sparing of resorptive indices. The decreased number of osteoblasts observed in alcoholic subjects results from either impaired proliferation or accelerated senescence. Polyamines and ornithine decarboxylase (ODC), the rate-limiting enzyme for polyamine synthesis, are essential for cell proliferation in a variety of cell types. To determine if the adverse effect of ethanol on osteoblast number involves modulation of polyamine biosynthesis, we examined the effect of ethanol on parameters of cell growth and ODC activity in a human osteoblast-like osteosarcoma cell line (TE-85). Ethanol markedly impaired DNA synthesis and cell proliferation in a dose-dependent fashion, but alkaline phosphatase activity (a marker of differentiated osteoblast function) remained intact, and accelerated apoptosis was not evident. Thus, the reduced osteoblastic cell number was a result of a direct effect on proliferative processes rather than a nonspecific toxic effect of ethanol to accelerate cell death. Induction of ODC activity was impaired in ethanol-exposed cell cultures in a dose-dependent fashion that paralleled the antiproliferative effects. Finally, supplemental polyamine administration substantially improved DNA synthesis in ethanol-exposed UMR 106-01 cell cultures. These data confirm a direct inhibitory effect of ethanol on osteoblast proliferation without overt cellular toxicity that may, in part, explain the reduced bone mass observed in those who consume excessive amounts of alcohol.
In Fukuoka Prefecture, in south-western Japan, a regional screening program for osteoporosis was conducted from 1994 to 1995. The screening level in the bone mineral density (BMD) at the distal non-dominant radius was equal to or less than two standard deviations below age-specific mean ( –2.0 SD). In 1177 examinees with natural menopause (mean age: 61.4, range: 42–88), 56 of those who were screened were subsequently radiologically confirmed by orthopedic specialists to have osteoporosis (case group). They were then compared with 802 normal BMD ( –1.0 SD) women (reference group) with their lifestyle and reproductive characteristics. The adjusted odds ratio (OR) and its 95% confidence interval (CI) were calculated using a logistic regression model. A significant increase in the ORs for osteoporosis based on the number of years since menopause was observed for 7–13 years since menopause (OR=2.3; 95% CI: 1.0–5.4) compared with
Ageing alters the metabolism of calcium and vitamin D in a number of ways. Intake of calcium and vitamin D, exposure to sunlight, cutaneous production of vitamin D3, renal production of 1,25-dihydroxyvitamin D (1,25(OH)2D3), intestinal absorption of calcium and the ability to adapt to a low calcium diet may all be reduced in elderly subjects. As a consequence, secondary hyperparathyroidism often occurs with ageing and can contribute to accelerated bone loss. In fact, alterations in calcium and vitamin D metabolism may be widespread in the ageing population and play a central role in the pathogenesis of senile (age-related) osteoporosis. From a preventive point of view, recent intervention studies have indicated the need to optimize calcium intake and to maintain serum 25(OH)D3 levels within the normal range in elderly people.
The recent attention given to the concept and role of ‘public nutrition’ serves to underline, firstly, the excellent progress which has been made in lengthening times of survival in both developed and developing populations. At the same time, there must be recognition of the extent of the obstacles to be overcome in order to lengthen disease-free years and years of ‘wellness’. In this review, questions discussed are — is there agreement on nutritional guidelines? How are the nutritional messages being perceived? To what extent are the guidelines being practiced? How demonstrable are the benefits from changes? What are the obstacles to adopting a ‘prudent’ diet, and other aspects of the ‘prudent’ lifestyle? While people, even with advanced understanding, are reluctant to change, evidence indicates that further improvements are certainly feasible.
Osteoporosis is a common, morbid and costly disorder characterized by deterioration in bone strength. Cigarette smoking is associated with reduced bone mineral density (BMD) and increased fracture risk. There are basic, clinical, and observational studies that define several of the underlying pathophysiologic mechanisms that predispose smokers to bone loss. Such mechanisms include alterations in calciotropic hormone metabolism and intestinal calcium absorption, dysregulation in sex hormone production and metabolism, alterations in adrenal cortical hormone metabolism and in the receptor activator of nuclear factor kappa-B (RANK), receptor activator of nuclear factor kappa-B ligand (RANKL), and osteoprotegerin (OPG) system (RANK-RANKL-OPG system), and direct cellular effects of cigarette use on bone cells. In addition, there is evidence of reversibility in the aforementioned mechanisms with smoking cessation. In summary, cigarette smoking is a reversible risk factor for osteoporosis and osteoporotic fractures through diverse pathophysiologic mechanisms.
To assess the effect of postmenopausal use of estrogens on the subsequent risk of hip fracture, we performed a retrospective cohort study of 2873 women in the Framingham Heart Study. Information obtained at routine biennial examinations about the use of estrogens, body weight, age at menopause, smoking, and alcohol consumption was used to evaluate the risk of hip fracture among postmenopausal women who received estrogens. Hip fractures occurred in 179 postmenopausal women, at a rate that increased exponentially after the age of 50. The risk of fracture was inversely related to weight at all ages. The relative risk of hip fracture in subjects who had taken estrogens at any time was 0.65 after adjustment for age and weight (95 percent confidence interval, 0.44 to 0.98). The adjusted relative risk in women who had taken estrogens within the previous two years was further reduced, to 0.34 (95 percent confidence interval, 0.12 to 0.98). Taking estrogens within four years of menopause also protected against fracture. The number of women in each age group who took estrogens was insufficient for a definitive evaluation of risk, but recent use of estrogens appeared to be protective in women under the age of 65 (no fractures among those who took estrogens) and those 65 to 74. We cannot exclude some degree of selection bias among the women who received estrogen-replacement therapy. Nevertheless, this large cohort study supports the hypothesis that postmenopausal use of estrogens protects against subsequent hip fracture in women.
We assessed the rates of vertebral fracture in patients with postmenopausal osteoporosis. Forty-five patients were not treated (91 person-years of observation); 59 were treated conventionally, with calcium (alone or combined with estrogen) or vitamin D or both (218 years); and 61 were treated with sodium fluoride combined with conventional therapy (251 years). The fracture rate (per thousand person-years) was 834 in untreated patients, 419 in those given calcium with or without vitamin D, 304 in those given fluoride and calcium with or without vitamin D, 181 in those given estrogen and calcium with or without vitamin D, and 53 in those given fluoride, estrogen, and calcium with or without vitamin D. It was reduced in all treatment groups (P less than 0.001 for calcium and P less than 1 x 10(-6) for other combinations); fluoride (one years of treatment) and estrogen (but not vitamin D) independently reduced the rate from that observed with calcium alone (P less than 0.001). The combination of calcium fluoride, and estrogen was more effective than any other combination (P less than 0.001). These results provide grounds for optimism about the efficacy of combinations of available agents with sodium fluoride for fracture in postmenopausal osteoporosis.
We interviewed 327 women who had been 50 to 74 years of age when treated for fracture of the hip of lower forearm, to determine their use (or lack of use) of estrogen preparations. Their responses were compared with those in a random sample of 567 women who were of similar age and from the same region. The risk of fracture was 50 to 60 per cent lower in women who had used these drugs for six years or longer than in women who hadnot used them (95 per cent confidence interval of relative risk, 0.3 to 0.6); those using them for shorter periods received less benefit, if any. A decreased risk of fracture was clearly evident only in women still taking estrogens and evident at either common daily dose (0.625 and 1.25 mg). In conjunction with the finding that estrogens can retard the development of osteoporosis in postmenopausal women, our data argue that lowering of the risk of hip and forearm fractures must be weighed as a benefit of long-term estrogen use.