Abstract
In a longitudinal study, we investigated the influence of risk factors on bone mass at menopause and postmenopausal bone loss in 121 healthy postmenopausal women. These women had completed a 2-year prospective study in 1979 and a follow-up examination in 1989. Measurements of the bone mineral content in the distal forearm (single photon absorptiometry) were performed 9 times during the initial study and once at the follow-up examination. Bone mass at menopause (initial measurement), rate of early postmenopausal bone loss, and the subsequent rate of bone loss over 10 years were thus determined. In addition, the bone mineral density of the lumbar spine and proximal femur was measured by dual-energy X-ray absorptiometry (DXA) in 1989. Information about risk factors was assessed by standardized questionnaires and included reproductive history and lifestyle factors (intake of calcium and vitamin D supplements, consumption of alcohol and caffeine, smoking habits, and physical activity). Lactation, oral contraceptive use, and dietary calcium intake above 1500 mg per day was associated with significantly increased bone mass at menopause. The number of pregnancies reduced the rate of early postmenopausal bone loss, whereas moderate alcohol consumption reduced the subsequent rate of bone loss. Smoking significantly reduced femoral bone mineral density. In conclusion, the present prospective study showed that some of the examined putative risk factors positively influenced bone mass at menopause, especially calcium intake, whereas the postmenopausal bone loss was virtually unaffected. Assessment of risk factors in postmenopausal women thus seems to have limited value for reducing future risk of osteoporosis.
Similar content being viewed by others
References
Wasnich RD, Ross PD, Heilbrun LK, Vogel JM. Prediction of postmenopausal fracture risk with use of bone mineral measurements. Am J Obstet Gynecol 1985; 153:745–51.
Hui SL, Slemenda CW, Johnston CC Jr. Age and bone mass as predictors of fracture in a prospective study. J Clin Invest 1988; 81:1804–9.
Riggs BL, Wahner HW, Dunn WL, Mazess RB, Offord KP, Melton LJ III. Differential changes in bone mineral density of the appendicular and axial skeleton with aging. J Clin Invest 1981; 67:328–35.
Genant HK, Cann CE, Ettinger B, Gordan GS. Quantitative computed tomography of vertebral spongiosa: A sensitive method for detecting early bone loss after oophorectomy. Ann Int Med 1982; 97:699–705.
Rickers H, Deding AA, Christiansen C, Rødbro P. Mineral loss in cortical and trabecular bone during high-dose prednisone treatment. Calcif Tissue Int 1984; 36:269–73.
Mazess RB. On aging bone loss. Clin Orthop 1982; 165:239–52.
Lindsay R, Tohme J, Kanders B. The effect of oral contraceptive use on vertebral bone mass in pre- and postmenopausal women. Contraception 1986; 34:333–40.
Aloia JF, Cohn SH, Vaswani A, Yeh JK, Yuen K, Ellis K. Risk factors for postmenopausal osteoporosis. Am J Med 1985; 78:95–100.
Kriska AM, Sandier RB, Cauley JA, LaPorte RE, Horn DL, Pambianco G. The assessment of historical physical activity and its relation to adult bone parameters. Am J Epidemiol 1988; 127:1053–63.
Kleerekoper M, Peterson E, Nelson D, Tilley B, Phillips E, Schork MA, Kuder J. Identification of women at risk for developing postmenopausal osteoporosis with vertebral fractures: role of history and single photon absorptiometry. Bone Miner 1989; 7:171–86.
Stevenson JC, Whitehead MI, Padwick M et al. Dietary intake of calcium and postmenopausal bone loss. Br Med J 1988; 297:15–17.
Riggs BL, Wahner HW, Melton LJ III, Richelson LS, Judd HL, O'Fallon WM. Dietary calcium intake and rates of bone loss in women. J Clin Invest 1987; 80:979–82.
Christiansen C, Riis BJ, Rødbro P. Prediction of rapid bone loss in postmenopausal women. Lancet 1987; i: 1105–8.
Christiansen C, Christensen MS, McNair P, Hagen C, Stocklund K-E, Transbøl I. Prevention of early postmenopausal bone loss: controlled 2-year study in 315 normal females. Eur J Clin Invest 1980; 10:273–9.
Haralddöttir J, Holm L, Jensen JH, Møller A. Danskernes kostvaner 1985, vol. 2. Copenhagen: Danish Food Administration, 1985;325–36.
Diem K, Lentner C. Scientific tables. Documenta Geigy, 1970; 7:509.
Passmore R, Durnin JVGA. Human energy expenditure. Physiol Rev 1955; 35:801–40.
Nilas L, Borg J, Gotfredsen A, Christiansen C. Comparison of single- and dual-photon absorptiometry in postmenopausal bone mineral loss. J Nucl Med 1985; 26: 1257–62.
Hansen MA, Hassager C, Overgaard K, Marslew U, Riis BJ, Christiansen C. Dual-energy X-ray absorptiometry: A precise method of measuring bone mineral density in the lumbar spine. J Nucl Med 1990; 31:1156–62.
Bland JM, Altaian DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; i:307–10.
Stevenson JC, Lees B, Devenport M, Cust MP, Ganger KF. Determinants of bone density in normal women: risk factors for future osteoporosis? Br Med J 1989; 298:924–8.
Riggs BL, Melton LJ III. Involutional osteoporosis. N Engl J Med 1986; 314:1676–86.
Lloyd T, Buchanan JR, Ursino GR, Myers C, Woodward G, Halbert DR. Long-term oral contraceptive use does not affect trabecular bone density. Am J Obstet Gynecol 1989; 160:402–4.
Sandier RB, Slemenda CW, LaPorte RE et al. Postmenopausal bone density and milk consumption in childhood and adolescence. Am J Clin Nutr 1985; 42:270–4.
Matkovic V, Kostial K, Simonovic I, Buzina R, Brodarec A, Nordin BEC. Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutr 1979; 32:540–9.
Nilas L, Christiansen C, Rødbro P. Calcium supplementation and postmenopausal bone loss. Br Med J 1984; 289:1103–6.
Riis B, Thomsen K, Christiansen C. Does calcium supplementation prevent postmenopausal bone loss? A double-blind, controlled clinical study. N Engl J Med 1987; 316:173–7.
Slemenda CW, Hui SL, Longcope C, Wellman H, Johnston Jr. CC. Predictors of bone mass in perimenopausal women: A prospective study of clinical data using photon absorptiometry. Ann Int Med 1990; 112:96–101.
Angus RM, Sambrook PN, Pocock NA, Eisman JA. Dietary intake and bone mineral density. Bone Miner 1988; 4:265–77.
Feitelberg S, Epstein S, Ismail F, D'Amanda C. Deranged bone mineral metabolism in chronic alcoholism. Metabolism 1987; 36:322–6.
Peng TC, Garner SC, Frye GD et al. Evidence of a toxic effect of ethanol on bone in rats. Alcoholism 1982; 6:96–9.
Pocock N, Eisman J, Gwinn T, Sambrook P, Kelly P, Freund J, Yeates M. Muscle strength, physical fitness, and weight but not age predict femoral neck bone mass. J Bone Miner Res 1989; 4:441–8.
Sinaki M, Wahner HW, Offord KP, Hodgson SF. Efficacy of non-loading exercises in prevention of vertebral bone loss in postmenopausal women: A controlled trial. Mayo Clin Proc 1989; 64:762–9.
Daniell HW. Osteoporosis of the slender smoker: vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity. Arch Intern Med 1976; 136:298–304.
Pocock N, Eisman JA, Kelly PJ, Sambrook PN, Yeates MG. Effects of tobacco use on axial and appendicular bone mineral density. Bone 1989; 10:329–31.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hansen, M.A., Overgaard, K., Riis, B.J. et al. Potential risk factors for development of postmenopausal osteoporosis — Examined over a 12-year period. Osteoporosis Int 1, 95–102 (1991). https://doi.org/10.1007/BF01880450
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01880450