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Epidemiology of osteoporosis

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Abstract

Osteoporosis and related fractures represent a major, and growing, public health concern for the United States and worldwide. The pathogenesis of osteoporosis is complex, requiring attention to the different life phases involved in growth, maintenance, and loss of bone, in addition to non-skeletal factors associated with falls and fractures. While the current clinical definition is based upon bone density measurements, other determinants of skeletal strength, particularly bone quality, are important to identify for future areas of research and prevention efforts. This epidemiologic review describes the definition, pathogenesis, and risk factors, as well as the frequency and impact of osteoporosis, with particular emphasis upon hip fracture.

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References and Recommended Reading

  1. The burden of musculoskeletal conditions at the start of the new millennium. World Health Organ Tech Rep Ser 2003, 919.

  2. Bone Health and Osteoporosis: A Report of the Surgeon General. 2004. Comprehensive summary of current evidence and recommendations for bone health appropriate for clinicians and all health care providers. Key.nding is that certain lifestyle practices and medical interventions known to promote bone health are not being adopted or implemented by the public or in clinical settings.

  3. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy: Osteoporosis prevention, diagnosis, and therapy. JAMA 2001, 285:785–795. NIH panel position paper describes consequences of osteoporosis, risks in different population groups, factors involved in bone health throughout life, treatment recommendations, and directions for future research.

    Article  Google Scholar 

  4. Faulkner KG, Cummings SR, Black D, et al.: Simple measurement of femoral geometry predicts hip fracture: the study of osteoporotic fractures. J Bone Miner Res 1993, 8:1211–1217.

    PubMed  CAS  Google Scholar 

  5. Grisso JA, Kelsey JL, Strom BL, et al.: Risk factors for falls as a cause of hip fracture in women. N Engl J Med 1991, 324:1326–1331.

    Article  PubMed  CAS  Google Scholar 

  6. Grisso JA, Kelsey JL, Strom BL, et al.: Risk factors for hip fracture in black women. The Northeast Hip Fracture Study Group. N Engl J Med 1994, 330:1555–1559.

    Article  PubMed  CAS  Google Scholar 

  7. Nevitt MC, Cummings SR, and the Study of Osteoporotic Fractures Research Group: Type of fall and risk of hip and wrist fractures: the study of osteoporotic fractures. J Am Geriatr Soc 1993, 41:1226–1234.

    PubMed  CAS  Google Scholar 

  8. Ray NF, Chan JK, Thamer M, Melton LJ: Medical expenditures for the treatment of osteoporotic fractures in the United States in 1995: report from the National Osteoporosis Foundation. J Bone Miner Res 1997, 12:24–35.

    Article  PubMed  CAS  Google Scholar 

  9. Praemer SF, Rice DP: Musculoskeletal Conditions in the United States. Park Ridge: American Academy of Orthopaedic Surgeons; 1992.

    Google Scholar 

  10. NHLBI: Data Fact Sheet. Bethesda, MD: National Institutes of Helath; 1996.

    Google Scholar 

  11. Lippuner K, Golder M, Greiner R: Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int 2005, 16(Suppl 2):S8-S17.

    Article  PubMed  Google Scholar 

  12. Gabriel SE, Tosteson AN, Leibson CL, et al.: Direct medical costs attributable to osteoporotic fractures. Osteoporos Int 2002, 13:323–330.

    Article  PubMed  CAS  Google Scholar 

  13. National Osteoporosis Foundation. http://www.nof.org/. Accessed October 26, 2005.

  14. Melton LJ: How many women have osteoporosis now? J Bone Miner Res 1995, 10:175–177.

    PubMed  Google Scholar 

  15. Nevitt MC: Epidemiology of osteoporosis. Rheum Dis Clin North Am 1994, 20:535–59.

    PubMed  CAS  Google Scholar 

  16. Melton LJ, Wahner HW, Richelson LS, et al.: Osteoporosis and the risk of hip fracture. Am J Epidemiol 1986, 124:254–261.

    PubMed  Google Scholar 

  17. Kosecoff J, Kahn KL, Rogers WH, et al.: Prospective payment system and impairment at discharge. The ‘quicker-and-sicker’ story revisited. JAMA 1990, 264:1980–1983.

    Article  PubMed  CAS  Google Scholar 

  18. Leibson CL, Tosteson AN, Gabriel SE, et al.: Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 2002, 50:1644–1650.

    Article  PubMed  Google Scholar 

  19. Jacobsen SJ, Goldberg J, Miles TP, et al.: Race and sex differences in mortality following fracture of the hip. Am J Public Health 1992, 82:1147–1150.

    Article  PubMed  CAS  Google Scholar 

  20. Magaziner J, Hawkes W, Hebel JR, et al.: Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 2000, 55:M498-M507.

    PubMed  CAS  Google Scholar 

  21. Greendale GA, Barrett-Connor E, Ingles S, Haile R: Late physical and functional effects of osteoporotic fracture in women: the Rancho Bernardo Study. J Am Geriatr Soc 1995, 43:955–961.

    PubMed  CAS  Google Scholar 

  22. Salkeld G, Cameron ID, Cumming RG, et al.: Quality of life related to fear of falling and hip fracture in older women: a time trade off study. BMJ 2000, 320:341–346.

    Article  PubMed  CAS  Google Scholar 

  23. Tosteson AN: Economic impact of fractures. In Osteoporosis in Men: The Effects of Gender on Skeletal Health. Edited by Orwoll S. San Diego: Academic Press; 1999:15–27.

    Google Scholar 

  24. Hannan MT, Felson DT, Dawson-Hughes B, et al.: Risk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 2000, 15:710–720.

    Article  PubMed  CAS  Google Scholar 

  25. Zebaze RM, Seeman E: Epidemiology of hip and wrist fractures in Cameroon, Africa. Osteoporos Int 2003, 14:301–305.

    Article  PubMed  Google Scholar 

  26. Lau EM, Lee JK, Suriwongpaisal P, et al.:The incidence of hip fracture in four Asian countries: the Asian Osteoporosis Study (AOS). Osteoporos Int 2001, 12:239–243.

    Article  PubMed  CAS  Google Scholar 

  27. Schwartz AV, Kelsey JL, Maggi S, et al.: International variation in the incidence of hip fractures: cross-national project on osteoporosis for the World Health Organization Program for Research on Aging. Osteoporos Int 1999, 9:242–253.

    Article  PubMed  CAS  Google Scholar 

  28. Gullberg B, Johnell O, Kanis JA: World-wide projections for hip fracture. Osteoporos Int 1997, 7:407–413.

    Article  PubMed  CAS  Google Scholar 

  29. Lauderdale DS, Jacobsen SJ, Furner SE, et al.: Hip fracture incidence among elderly Asian-American populations. Am J Epidemiol 1997, 146:502–509.

    PubMed  CAS  Google Scholar 

  30. Lauderdale DS, Jacobsen SJ, Furner SE, et al.: Hip fracture incidence among elderly Hispanics. Am J Public Health 1998, 88:1245–1247.

    PubMed  CAS  Google Scholar 

  31. Zingmond DS, Melton LJ, 3rd, Silverman SL: Increasing hip fracture incidence in California Hispanics, 1983 to 2000. Osteoporos Int 2004, 15:603–610.

    Article  PubMed  Google Scholar 

  32. Melton LJ, 3rd: The prevalence of osteoporosis: gender and racial comparison. Calcif Tissue Int 2001, 69:179–181.

    Article  PubMed  CAS  Google Scholar 

  33. Riggs BL, Melton LJ, 3rd, Robb RA, et al.: Population-based study of age and sex differences in bone volumetric density, size, geometry, and structure at different skeletal sites. J Bone Miner Res 2004, 19:1945–1954. QCT scans used to describe age and sex distribution of volumetric bone density, geometry, and structure at central and peripheral bone sites in women and men. This study, by using QCT technology, overcomes the limitations of standard DXA densitometry (areal) measures, and furthers our understanding of osteoporosis by using QCT volumetric (three-dimensional) measures of total, cortical, and trabecular bone density and geometry, at different skeletal sites, in a population-based sample of both women and men.

    Article  PubMed  Google Scholar 

  34. Sattin RW, Huber DAL, DeVito CA, et al.: The incidence of fall injury events among the elderly in a defifined population. Am J Epidemiol 1990, 131:1028–1037.

    PubMed  CAS  Google Scholar 

  35. Greenspan SL, Myers ER, Maitland LA, et al.: Fall severity and bone mineral density as risk factors for hip fracture in ambulatory elderly. JAMA 1994, 271:128–133.

    Article  PubMed  CAS  Google Scholar 

  36. Rodan GA: Mechanical loading, estrogen defifciency, and the coupling of bone formation to bone resorption. J Bone Miner Res 1991, 6:527–530.

    PubMed  CAS  Google Scholar 

  37. Reid IR: Relationships among body mass, its components, and bone. Bone 2002, 31:547–555.

    Article  PubMed  CAS  Google Scholar 

  38. Cummings SR, Nevitt MC: Non-skeletal determinants of fractures: the potential importance of the mechanics of falls. Study of Osteoporotic Fractures Research Group. Osteoporos Int 1994, 4(Suppl 1):67–70.

    Article  PubMed  Google Scholar 

  39. Ensrud KE, Fullman RL, Barrett-Connor E, et al.: Voluntary weight reduction in older men increases hip bone loss: the osteoporotic fractures in men study. J Clin Endocrinol Metab 2005, 90:1998–2004.

    Article  PubMed  CAS  Google Scholar 

  40. Ensrud KE, Ewing SK, Stone KL, et al.: Intentional and unintentional weight loss increase bone loss and hip fracture risk in older women. J Am Geriatr Soc 2003, 51:1740–1747.

    Article  PubMed  Google Scholar 

  41. Johnell O, Gullberg B, Kanis JA, et al.: Risk factors for hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis Study. J Bone Miner Res 1995, 10:1802–1815.

    PubMed  CAS  Google Scholar 

  42. Samelson EJ, Zhang Y, Kiel DP, et al.: Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. Am J Public Health 2002, 92:858–862.

    PubMed  Google Scholar 

  43. Reid IR, Chin K, Evans MC, Jones JG: Relation between increase in length of hip axis in older women between 1950s and 1990s and increase in age specific rates of hip fracture [see comments]. BMJ 1994, 309:508–509.

    PubMed  CAS  Google Scholar 

  44. LeBlanc A, Schneider V, Shackelford L, et al.: Bone mineral and lean tissue loss after long duration space.ight. J Musculoskelet Neuronal Interact 2000, 1:157–160.

    PubMed  CAS  Google Scholar 

  45. Maimoun L, Fattal C, Micallef JP, et al.: Bone loss in spinal cord-injured patients: from physiopathology to therapy. Spinal Cord 2005, In press.

  46. Leblanc AD, Schneider VS, Evans HJ, et al.: Bone mineral loss and recovery after 17 weeks of bed rest. J Bone Miner Res 1990, 5:843–850.

    PubMed  CAS  Google Scholar 

  47. Nelson ME, Fiatarone MA, Morganti CM, et al.: Effects of high-intensity strength training on multiple risk factors for osteoporotic fractures. A randomized controlled trial. JAMA 1994, 272:1909–1914.

    Article  PubMed  CAS  Google Scholar 

  48. Hoidrup S, Sorensen TI, Stroger U, et al.: Leisure-time physical activity levels and changes in relation to risk of hip fracture in men and women. Am J Epidemiol 2001, 154:60–68.

    Article  PubMed  CAS  Google Scholar 

  49. Krall EA, Dawson-Hughes B: Walking is related to bone density and rates of bone loss. Am J Med 1994, 96:20–26.

    Article  PubMed  CAS  Google Scholar 

  50. Feskanich D, Willett W, Colditz G: Walking and leisuretime activity and risk of hip fracture in postmenopausal women. JAMA 2002, 288:2300–2306.

    Article  PubMed  Google Scholar 

  51. Englund U, Littbrand H, Sondell A, et al.: A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women. Osteoporos Int 2005, 16:1117–1123.

    Article  PubMed  Google Scholar 

  52. Taaffe DR, Snow-Harter C, Connolly DA, et al.: Differential effects of swimming versus weight-bearing activity on bone mineral status of eumenorrheic athletes. J Bone Miner Res 1995, 10:586–593.

    PubMed  CAS  Google Scholar 

  53. Heaney RP: Weight-bearing activity during youth is a more important factor for peak bone mass than calcium intake. J Bone Miner Res 1995, 10:172–173.

    PubMed  CAS  Google Scholar 

  54. Nieves JW, Grisso JA, Kelsey JL: A case-control study of hip fracture: evaluation of selected dietary variables and teenage physical activity. Osteoporos Int 1992, 2:122–127.

    Article  PubMed  CAS  Google Scholar 

  55. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, et al.: Effect of vitamin D on falls: a meta-analysis. JAMA 2004, 291:1999–2006.

    Article  PubMed  CAS  Google Scholar 

  56. Bischoff-Ferrari HA, Willett WC, Wong JB, et al.: Fracture prevention with vitamin D supplementation: a metaanalysis of randomized controlled trials. JAMA 2005, 293:2257–2264.

    Article  PubMed  CAS  Google Scholar 

  57. Grant AM, Avenell A, Campbell MK, et al.: Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet 2005, 365:1621–1628.

    Article  PubMed  CAS  Google Scholar 

  58. Porthouse J, Cockayne S, King C, et al.: Randomised controlled trial of calcium and supplementation with cholecalciferol (vitamin D3) for prevention of fractures in primary care. BMJ 2005, 330:1003.

    Article  PubMed  CAS  Google Scholar 

  59. Booth SL, Broe KE, Peterson JW, et al.: Associations between vitamin K biochemical measures and bone mineral density in men and women. J Clin Endocrinol Metab 2004, 89:4904–4909.

    Article  PubMed  CAS  Google Scholar 

  60. Vergnaud P, Garnero P, Meunier PJ, et al.: Undercarboxylated osteocalcin measured with a specific immunoassay predicts hip fracture in elderly women: the EPIDOS Study. J Clin Endocrinol Metab 1997, 82:719–724.

    Article  PubMed  CAS  Google Scholar 

  61. McLean RR, Jacques PF, Selhub J, et al.: Homocysteine as a predictive factor for hip fracture in older persons. N Engl J Med 2004, 350:2042–2049.

    Article  PubMed  CAS  Google Scholar 

  62. Simon JA, Hudes ES: Relation of ascorbic acid to bone mineral density and self-reported fractures among US adults. Am J Epidemiol 2001, 154:427–433.

    Article  PubMed  CAS  Google Scholar 

  63. Tucker KT, Hannan MT, Chen H, et al.: Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in older men and women. Am J Clin Nutr 1999,

  64. Whiting SJ, Boyle JL, Thompson A, et al.: Dietary protein, phosphorus and potassium are beneficial to bone mineral density in adult men consuming adequate dietary calcium. J Am Coll Nutr 2002, 21:402–409.

    PubMed  CAS  Google Scholar 

  65. Tucker KL, Hannan MT, Kiel DP: The acid-base hypothesis: diet and bone in the Framingham Osteoporosis Study. Eur J Nutr 2001, 40:231–237.

    Article  PubMed  CAS  Google Scholar 

  66. Hannan MT, Tucker KL, Dawson-Hughes B, et al.: Effect of dietary protein on bone loss in elderly men and women: the Framingham Osteoporosis Study. J Bone Miner Res 2000, 15:2504–2012.

    Article  PubMed  CAS  Google Scholar 

  67. Feskanich D, Singh V, Willett WC, Colditz GA: Vitamin A intake and hip fractures among postmenopausal women. JAMA 2002, 287:47–54.

    Article  PubMed  CAS  Google Scholar 

  68. Michaelsson K, Melhus H, Bellocco R, Wolk A: Dietary calcium and vitamin D intake in relation to osteoporotic fracture risk. Bone 2003, 32:694–703.

    Article  PubMed  CAS  Google Scholar 

  69. Promislow JH, Goodman-Gruen D, Slymen DJ, Barrett- Connor E: Retinol intake and bone mineral density in the elderly: the Rancho Bernardo Study. J Bone Miner Res 2002, 17:1349–1358.

    Article  PubMed  CAS  Google Scholar 

  70. Tucker KL: Dietary intake and bone status with aging. Curr Pharm Des 2003, 9:2687–704.

    Article  PubMed  CAS  Google Scholar 

  71. Kiel D: Smoking and alcohol on bone health. In Nutrition and Bone Health. Edited by Holick MF, Dawson-Hughes B. Totowa, NJ: Humana Press; 2003:481–514.

    Google Scholar 

  72. Hoidrup S, Gronbaek M, Gottschau A, et al.: Alcohol intake, beverage preference, and risk of hip fracture in men and women. Am J Epidemiol 1999, 149:993–1001.

    PubMed  CAS  Google Scholar 

  73. Harris SS, Dawson-Hughes B: Caffeine and bone loss in healthy postmenopausal women. Am J Clin Nutr 1994, 60:573–578.

    PubMed  CAS  Google Scholar 

  74. Cummings SR, Nevitt MC, Browner WS, et al.: Risk factors for hip fracture in white women. N Engl J Med 1995, 332:767–773.

    Article  PubMed  CAS  Google Scholar 

  75. Kiel DP, Felson DT, Hannan MT, et al.: Caffeine and the risk of hip fracture: the Framingham Study. Am J Epidemiol 1990, 132:675–684.

    PubMed  CAS  Google Scholar 

  76. Heaney RP: Effects of caffeine on bone and the calcium economy. Food Chem Toxicol 2002, 40:1263–1270.

    Article  PubMed  CAS  Google Scholar 

  77. Nelson HD, Nevitt MC, Scott JC, et al.: Smoking, alcohol, and neuromuscular and physical function of older women. Study of Osteoporotic Fractures Research Group. JAMA 1994, 272:1825–1831.

    Article  PubMed  CAS  Google Scholar 

  78. Kiel DP, Baron JA, Anderson JJ, et al.: Smoking eliminates the protective effect of oral estrogens on the risk for hip fracture among women. Ann Intern Med 1992, 116:716–721.

    PubMed  CAS  Google Scholar 

  79. Forsen L, Bjorndal A, Bjartveit K, et al.: Interaction between current smoking, leanness, and physical inactivity in the prediction of hip fracture. J Bone Miner Res 1994, 9:1671–1678.

    PubMed  CAS  Google Scholar 

  80. Hoidrup S, Prescott E, Sorensen TI, et al.: Tobacco smoking and risk of hip fracture in men and women. Int J Epidemiol 2000, 29:253–259.

    Article  PubMed  CAS  Google Scholar 

  81. Reid IR: Pathogenesis and treatment of steroid osteoporosis. Clin Endocrinol (Oxf) 1989, 30:83–103.

    CAS  Google Scholar 

  82. Tinetti ME, Speechley M, Ginter SF: Risk factors for falls among elderly persons living in the community. N Engl J Med 1988, 319:1701–1707.

    Article  PubMed  CAS  Google Scholar 

  83. Paganini-Hill CA, Ross RK, Henderson BE: Exercise and other factors in the prevention of hip fracture: the Leisure World study. Epidemiology 1991, 2:16–25.

    Article  PubMed  CAS  Google Scholar 

  84. Cumming RG, Klineberg RJ: Psychotropics, thiazide diuretics and hip fractures in the elderly. Med J Aust 1993, 158:414–417.

    PubMed  CAS  Google Scholar 

  85. Wasnich R, Davis J, Ross P, Vogel J: Effect of thiazide on rates of bone mineral loss: a longitudinal study. BMJ 1990, 301:1303–1305.

    PubMed  CAS  Google Scholar 

  86. Felson DT, Anderson JJ, Hannan MT, et al.: Impaired vision and hip fracture: The Framingham Study. J Am Geriatr Soc 1989, 37:495–500.

    PubMed  CAS  Google Scholar 

  87. LaCroix AZ, Wienpahl J, White LR, et al.: Thiazide diuretic agents and the incidence of hip fracture. N Engl J Med 1990, 322:286–290.

    Article  PubMed  CAS  Google Scholar 

  88. Cauley J, Salamone LM: Postemenopausal endogenous and exogenous hormones, degree of obesity, thiazide diuretics and risk of osteoporosis. In Osteoporosis. Editied by Marcus RF, Kelsey J. San Diego: Academic Press; 2001:741–763.

    Google Scholar 

  89. LaCroix AZ, Cauley JA, Pettinger M, et al.: Statin use, clinical fracture, and bone density in postmenopausal women: results from the Women’s Health Initiative Observational Study. Ann Intern Med 2003, 139:97–104.

    PubMed  CAS  Google Scholar 

  90. Pedersen TR, Kjekshus J: Statin drugs and the risk of fracture. 4S Study Group. JAMA 2000, 284:1921–1922.

    Article  PubMed  CAS  Google Scholar 

  91. Schwartz AV, Sellmeyer DE, Ensrud KE, et al.: Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 2001, 86:32–38.

    Article  PubMed  CAS  Google Scholar 

  92. Strotmeyer ES, Cauley JA, Schwartz AV, et al.: Diabetes is associated independently of body composition with BMD and bone volume in older white and black men and women: the Health, Aging, and Body Composition Study. J Bone Miner Res 2004, 19:1084–1091.

    Article  PubMed  Google Scholar 

  93. Tinetti ME: Clinical practice. Preventing falls in elderly persons. N Engl J Med 2003, 348:42–49.

    Article  PubMed  Google Scholar 

  94. Nicodemus KK, Folsom AR: Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care 2001, 24:1192–1197.

    Article  PubMed  CAS  Google Scholar 

  95. Diamond T, Vine J, Smart R, Butler P: Thyrotoxic bone disease in women: a potentially reversible disorder. Ann Intern Med 1994, 120:8–11.

    PubMed  CAS  Google Scholar 

  96. Marcocci C, Golia F, Vignali E, Pinchera A: Skeletal integrity in men chronically treated with suppressive doses of L-thyroxine. J Bone Miner Res 1997, 12:72–77.

    Article  PubMed  CAS  Google Scholar 

  97. Greenspan SL, Greenspan FS, Resnick NM, et al.: Skeletal integrity in premenopausal and postmenopausal women receiving long-term L-thyroxine therapy. Am J Med 1991, 91:5–14.

    Article  PubMed  CAS  Google Scholar 

  98. Schneider DL, Barrett-Connor EL, Morton DJ: Thyroid hormone use and bone mineral density in elderly men. Arch Intern Med 1995, 155:2005–2007.

    Article  PubMed  CAS  Google Scholar 

  99. Melton LJ, 3rd, Ardila E, Crowson CS, et al.: Fractures following thyroidectomy in women: a population-based cohort study. Bone 2000, 27:695–700.

    Article  PubMed  Google Scholar 

  100. Poor G, Atkinson EJ, O’Fallon WM, Melton LJ, 3rd: Predictors of hip fractures in elderly men. J Bone Miner Res 1995, 10:1900–1907.

    Article  PubMed  CAS  Google Scholar 

  101. Sowers M: Premenopausal reproductive and hormonal characteristics and the risk for osteoporosis. In Osteoporosis. Edited by Marcus RF, Kelsey J. San Diego: Academic Press; 2001:721–739.

    Google Scholar 

  102. Hillier TA, Rizzo JH, Pedula KL, et al.: Nulliparity and fracture risk in older women: the study of osteoporotic fractures. J Bone Miner Res 2003, 18:893–899.

    Article  PubMed  Google Scholar 

  103. Paton LM, Alexander JL, Nowson CA, et al.: Pregnancy and lactation have no long-term deleterious effect on measures of bone mineral in healthy women: a twin study. Am J Clin Nutr 2003, 77:707–714.

    PubMed  CAS  Google Scholar 

  104. Sowers MF, Hollis BW, Shapiro B, et al.: Elevated parathyroid hormone-related peptide associated with lactation and bone density loss. JAMA 1996, 276:549–554.

    Article  PubMed  CAS  Google Scholar 

  105. Hoffman S, Grisso JA, Kelsey JL, et al.: Parity, lactation and hip fracture. Osteoporos Int 1993, 3:171–176.

    Article  PubMed  CAS  Google Scholar 

  106. Ensrud KE, Palermo L, Black DM, et al.: Hip and calcaneal bone loss increase with advancing age: longitudinal results from the study of osteoporotic fractures. J Bone Miner Res 1995, 10:1778–1787.

    PubMed  CAS  Google Scholar 

  107. Rossouw JE, Anderson GL, Prentice RL, et al.: Risks and bene.ts of estrogen plus progestin in healthy postmenopausal women: principal results From the Women’s Health Initiative randomized controlled trial. JAMA 2002, 288:321–333.

    Article  PubMed  CAS  Google Scholar 

  108. Cummings SR, Browner WS, Bauer D, et al.: Endogenous hormones and the risk of hip and vertebral fractures among older women. Study of Osteoporotic Fractures Research Group [see comments]. N Engl J Med 1998, 339:733–738.

    Article  PubMed  CAS  Google Scholar 

  109. Khosla S, Melton LJ, 3rd, Atkinson EJ, et al.: Relationship of serum sex steroid levels and bone turnover markers with bone mineral density in men and women: a key role for bioavailable estrogen. J Clin Endocrinol Metab 1998, 83:2266–2274.

    Article  PubMed  CAS  Google Scholar 

  110. Slemenda CW, Turner CH, Peacock M, et al.: The genetics of proximal femur geometry, distribution of bone mass and bone mineral density. Osteoporos Int 1996, 6:178–182.

    Article  PubMed  CAS  Google Scholar 

  111. Peacock M, Turner CH, Econs MJ, Foroud T: Genetics of osteoporosis. Endocr Rev 2002, 23:303–326.

    Article  PubMed  CAS  Google Scholar 

  112. Recker RR, Deng HW: Role of genetics in osteoporosis. Endocrine 2002, 17:55–66.

    Article  PubMed  CAS  Google Scholar 

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Samelson, E.J., Hannan, M.T. Epidemiology of osteoporosis. Curr Rheumatol Rep 8, 76–83 (2006). https://doi.org/10.1007/s11926-006-0030-6

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