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Examining women’s bones during menopause may help head off fractures

Bone fragility has lengthy been a worrisome situation affecting women as they age.

“It’s been considered a silent disease,” says Karl Jepsen, Ph.D., affiliate chair of analysis and professor of orthopaedic surgical procedure at Michigan Medicine, noting, “One of the most important challenges once you’re taking a look at age-related bone fragility is to determine individuals who will fracture.”

Jepsen is the lead writer on a brand new research, revealed within the Journal of Bone and Mineral Research, that examined the bone traits of 198 midlife women transitioning by means of menopause for 14 years. The objective: figuring out women who will expertise bone fragility nicely prematurely of fracture.

“Current identification for bone fragility takes place when the patient is around 65 years of age,” Jepsen explains. “We were hopeful that this study would give us an opportunity to identify those patients as early as 30 years before they fracture based on their bone traits. That means we would have an opportunity to intervene before the fracture happens, instead of after the fact.”

Jepsen provides that understanding how bone construction and bone mass change during ageing just isn’t nicely understood on a person foundation.

“We hypothesized that age-related changes in bone traits also depend on external bone size, which is easily measured,” he says. “This was based mostly on work we had carried out up to now in younger adults with stress fracture dangers the place we discovered people with slender bones have been at a better danger of creating stress fractures.”

Identifying topics

Jepsen and his colleagues from Michigan Medicine Department of Orthopaedic Surgery labored with Sioban Harlow, Ph.D., professor on the University of Michigan School of Public Health and director of the Center for Midlife Science, Carrie Karvonen-Gutierrez, Ph.D., M.P.H., assistant professor on the U-M SPH, and Jane Cauley, DRPH, on the University of Pittsburgh, who had entry to a big cohort of women transitioning by way of menopause referred to as the Study of Women’s Health Across the Nation.

The database had been following the themes since 1996. Women who enrolled at the moment needed to be between 42 and 52 years of age, have an intact uterus and had a minimum of one menstrual interval within the earlier three months. In addition, the themes had roughly 14 annual research visits that included measurements, comparable to bone density scans, of their hip and backbone.

Analyzing X-ray photographs

The analysis workforce analyzed dual-energy X-ray absorptiometry pictures, which measure bone mineral density, of the hip over the 14-year interval to find out if modifications have been occurring in every lady.

They discovered that over that time-frame, women skilled totally different modifications in bone mineral content material and bone space inside the hip, however comparable modifications in areal bone mineral density. In addition, the change in bone mineral content material and bone space correlated negatively with baseline exterior measurement of the neck of the femur slightly below the ball of the hip joint.

“This means women showed similar changes in areal bone mineral density for different structural and biological reasons,” Jepsen says. “Essentially, we found that women with narrow femoral necks showed smaller changes in bone mineral content, but greater increases in bone area compared to women with wide femoral necks who showed greater losses in bone mineral content, but didn’t appear to be experiencing compensatory increases in bone area.”

Jepsen provides that the outcomes are usually not what he anticipated.

“Our results were opposite to all expectations of how we assumed this would work,” Jepsen says. “Based on previous work, we assumed that bone expansion acts to mechanically offset bone loss, but we found some women appeared to have hip bones that were increasing in strength during the menopausal transition while others seemed to be losing strength.”

Moving ahead

“This study demonstrated for the first time that we can track bone changes happening individually in women during menopause,” Jepsen says.

He hopes these outcomes are a stepping level for extra analysis.

“With further research, our goal is to use simple bone traits to identify those women that may benefit from early intervention when it comes to bone fragility, instead of the current strategy, which treats individuals after they have lost appreciable bone mass and strength,” he provides.

In addition, he notes this work additional demonstrates the variability in every individual’s physique.

“Bone is constantly remaking itself, but with age and menopause, considerable declines in bone strength can occur,” Jepsen says. “This study helped us demonstrate how much that process can vary greatly among women.”

Article: Femoral Neck External Size but not aBMD Predicts Structural and Mass Changes for Women Transitioning through Menopause, Karl J. Jepsen, Andrew Kozminski, Erin M.R. Bigelow, Stephen H. Schlecht, Robert W. Goulet,
Sioban D. Harlow, Jane A. Cauley, Carrie Karvonen-Gutierrez, Journal of Bone and Mineral Research, doi: 10.1002/jbmr.3082, revealed on-line 13 January 2017.

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