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BMJ. 1991 October 19; 303(6808): 961–964.
PMCID: PMC1671323

Role of peak bone mass and bone loss in postmenopausal osteoporosis: 12 year study.


OBJECTIVE--To examine the role of peak bone mass and subsequent postmenopausal bone loss in the development of osteoporosis and the reliability of identifying women at risk from one bone mass measurement and one biochemical assessment of the future bone loss. DESIGN--Population based study. SETTING--Outpatient clinic for research into osteoporosis. SUBJECTS--178 healthy early postmenopausal women who had participated in a two year study in 1977. 154 of the women underwent follow up examination in 1989, of whom 33 were excluded because of diseases or taking drugs known to affect calcium metabolism. MAIN OUTCOME MEASURES--Bone mineral content of the forearm and values of biochemical markers of bone turnover. RESULTS--The average reduction in bone mineral content during 1977-89 was 20%, but the fast losers had lost 10.0% more than had the slow loser group (mean loss 26.6% in fast losers and 16.6% in slow losers; p less than 0.001). Prediction of future bone mineral content using baseline bone mineral content and estimated rate of loss gave results almost identical with the actual bone mineral content measured in 1989. Seven women had had a Colles' fracture and 20 a spinal compression fracture. The group with Colles' fracture had low baseline bone mineral content (34.7 (95% confidence interval 31.3 to 38.1) units v 39.4 (38.1 to 40.8) units in women with no fracture) whereas the group with spinal fracture had a normal baseline bone mineral content (38.1 (35.0 to 41.1) units) but an increased rate of loss (-2.4 (-3.5 to -1.3)%/year v -1.8 (-2.1 to -1.5)%/year in women with no fracture). CONCLUSIONS--One baseline measurement of bone mass combined with a single estimation of the rate of bone loss can reliably identify the women at menopause who are at highest risk of developing osteoporosis later in life. The rate of loss may have an independent role in likelihood of vertebral fracture.

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Selected References

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  • Riggs BL, Hodgson SF, O'Fallon WM, Chao EY, Wahner HW, Muhs JM, Cedel SL, Melton LJ., 3rd Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med. 1990 Mar 22;322(12):802–809. [PubMed]
  • Christiansen C, Riis BJ, Rødbro P. Prediction of rapid bone loss in postmenopausal women. Lancet. 1987 May 16;1(8542):1105–1108. [PubMed]
  • Christiansen C, Riis BJ, Rødbro P. Screening procedure for women at risk of developing postmenopausal osteoporosis. Osteoporos Int. 1990 Oct;1(1):35–40. [PubMed]
  • Hansen MA, Overgaard K, Riis BJ, Christiansen C. Potential risk factors for development of postmenopausal osteoporosis--examined over a 12-year period. Osteoporos Int. 1991 Feb;1(2):95–102. [PubMed]
  • Nilas L, Borg J, Gotfredsen A, Christiansen C. Comparison of single- and dual-photon absorptiometry in postmenopausal bone mineral loss. J Nucl Med. 1985 Nov;26(11):1257–1262. [PubMed]
  • Melton LJ, 3rd, Kan SH, Frye MA, Wahner HW, O'Fallon WM, Riggs BL. Epidemiology of vertebral fractures in women. Am J Epidemiol. 1989 May;129(5):1000–1011. [PubMed]
  • Hui SL, Slemenda CW, Johnston CC., Jr Baseline measurement of bone mass predicts fracture in white women. Ann Intern Med. 1989 Sep 1;111(5):355–361. [PubMed]
  • Cummings SR, Black DM, Nevitt MC, Browner WS, Cauley JA, Genant HK, Mascioli SR, Scott JC, Seeley DG, Steiger P, et al. Appendicular bone density and age predict hip fracture in women. The Study of Osteoporotic Fractures Research Group. JAMA. 1990 Feb 2;263(5):665–668. [PubMed]
  • Ross PD, Wasnich RD, Vogel JM. Detection of prefracture spinal osteoporosis using bone mineral absorptiometry. J Bone Miner Res. 1988 Feb;3(1):1–11. [PubMed]
  • Nilas L, Pødenphant J, Riis BJ, Gotfredsen A, Christiansen C. Usefulness of regional bone measurements in patients with osteoporotic fractures of the spine and distal forearm. J Nucl Med. 1987 Jun;28(6):960–965. [PubMed]
  • Ott SM, Kilcoyne RF, Chesnut CH., 3rd Ability of four different techniques of measuring bone mass to diagnose vertebral fractures in postmenopausal women. J Bone Miner Res. 1987 Jun;2(3):201–210. [PubMed]
  • Geusens P, Dequeker J, Verstraeten A, Nijs J. Age-, sex-, and menopause-related changes of vertebral and peripheral bone: population study using dual and single photon absorptiometry and radiogrammetry. J Nucl Med. 1986 Oct;27(10):1540–1549. [PubMed]
  • Brown JP, Delmas PD, Malaval L, Edouard C, Chapuy MC, Meunier PJ. Serum bone Gla-protein: a specific marker for bone formation in postmenopausal osteoporosis. Lancet. 1984 May 19;1(8386):1091–1093. [PubMed]

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