This review summarizes the current knowledge regarding osteoporosis and fracture among older US Asian adults. Asian adults have lower (areal) bone density than non-Hispanic White adults and thus are more likely to be diagnosed and treated for osteoporosis, despite their…
Fracture and osteoporosis are known side effects of aromatase inhibitors (AIs) for postmenopausal hormone receptor positive (HR+) breast cancer (BC) patients. How modifiable lifestyle factors impact fracture risk in these patients is relatively unknown. We conducted a prospective cohort study…
The burden of osteoporosis has increased as the US population over age 65 years has increased. Ethnic diversity in the U.S. has also increased. This is the first large scale US study of fracture outcomes among Asians and ethnic subgroups…
Atypical femur fracture (AFF) is an uncommon complication of long-term bisphosphonate use, but the risk declines substantially after treatment cessation. We report a case of a 70-year-old woman with osteopenia treated with alendronate for 9 years who presented with right…
Bone mineral density (BMD) testing and fracture risk calculation help clinicians assess fracture risk and counsel patients. However, predicted fracture risks and outcomes for US East Asian individuals remain understudied. Retrospective cohort study. Using standardized clinical profiles for East Asian…
Bone mineral density (BMD) reference data exist for U.S. White, Black, and Hispanic (Mexican American) populations but not for U.S. Asians. Few studies have compared BMD findings among different U.S. Asian ethnicities. Retrospective observational study. Large northern California healthcare system.…
Osteoporosis and fragility fracture are major bone toxicities of aromatase inhibitors (AIs) for postmenopausal hormone receptor-positive breast cancer. Except for a few small studies on bone turnover markers and reduced bone mineral density after AI treatment, data on the associations…
Assigning drug exposure is a necessary first step in examining bisphosphonate (BP) treatment in observational studies using pharmacy data. To determine whether the choice of adherence level using the proportion of days covered (PDC) affected BP exposure assignment. 10,381 female…
Sex steroid hormones have been linked to fractures in older women. To test the hypothesis that hormones measured over the menopausal transition predict fractures. Seven US clinical centers. Two thousand nine hundred sixty women (average age, 46.4 ± 2.7 years)…
The menopause transition (MT) is a period of rapid bone loss and has been proposed to be a time-limited window for early intervention to prevent permanent microarchitectural damage and reduce the risk of subsequent fracture. To intervene early, however, we…
We assessed bone mineral density (BMD) change with aromatase inhibitor (AI) treatment in a contemporary cohort of women with breast cancer treated in Kaiser Permanente Northern California. Percent and estimated annual percent changes in BMD at the total hip and…
Estimate the prevalence and identify risk factors for bone loss in women with BRCA mutations. Women, age 40 and older, with BRCA mutations identified from the Breast Cancer Surveillance database at Kaiser Permanente Northern California were invited to participate and…
In the setting of changing temporal trends in the management of osteoporosis, we examined how select characteristics of new oral bisphosphonate (BP) initiators changed over time among 94,073 women within a large, integrated healthcare organization during the period 2004 to…
Examining drug exposure is essential to pharmacovigilance, especially for bisphosphonate (BP) therapy. To examine differences in 4 measures of oral BP exposure: treatment discontinuation, adherence, persistence, and nonpersistence. Among women aged ≥ 50 years who initiated oral BP therapy during…
This cohort study will use DXA scans to: 1) establish the incidence of abnormal DXA scans in women post testing positive for BRCA1 or 2 mutations who have undergone risk-reducing salpingo-oophorectomy (RRSO); and 2) identify risk factors for abnormal DXA…
In clinical practice, bisphosphonate drugs are considered one of the main therapies for osteoporosis, based on strong clinical evidence of significant reduction in risk of hip, vertebral and non-vertebral fractures during the first 3-5 years of therapy. However, concerns have…
This long term surveillance study has three primary goals: 1) to establish algorithms and identify women with postmenopausal osteoporosis; 2) to establish algorithms and identify the occurrence of adverse events of special interest, including osteonecrosis of the jaw, atypical fracture,…
To examine if a comorbid diagnosis of knee or hip osteoarthritis (OA) in older adults with new back pain visits is associated with long-term patient-reported outcomes and back-related health care use. Prospective cohort study. Three integrated health systems forming the…
Caucasian reference data are used to classify bone mineral density in US women of all races. However, use of Chinese American reference data yields lower osteoporosis prevalence in Chinese women. The reduction in osteoporosis labeling may be relevant for younger…
The purpose of this study was to assess the ability of urinary N-telopeptide (U-NTX) to gauge rate of bone loss across and after the menopause transition (MT). U-NTX measurement was measured in early postmenopause in 604 participants from the Study…
Several epidemiologic studies suggest that compared to white women, Asians have a greater propensity to suffer an atypical femur fracture (AFF) while taking bisphosphonate therapy. This study examines the relative risk of AFF following bisphosphonate initiation for Asian compared to…
Low levels of serum 25 Hydroxyvitamin D [25(OH)D] have been linked to greater fracture risk in older women. This study aimed to determine whether higher 25(OH)D is associated with slower loss of bone mineral density (BMD) and lower fracture risk…
To examine contemporary trends in mortality following hip fracture among older postmenopausal women in an integrated healthcare delivery system. Retrospective cohort study of 13,550 women aged ?65 years with hip fracture during 2000 to 2010. Demographic factors, comorbidity index score,…
Contemporary femur fracture rates were examined in northern California women and compared by race/ethnicity. During 2006-2012, hip fracture rates declined, but diaphyseal fracture rates increased, especially in Asians. Women with diaphyseal fracture were younger and more likely to be bisphosphonate-treated.…
Considerable progress has been made toward a more scientific and rational basis for selecting patients for osteoporosis screening and treatment. The monumental efforts of the FRAX development group have yielded a powerful new tool to be used in fracture risk…
PURPOSE: There is limited data pertaining to osteoporotic fractures among North American women of South Asian (SA) descent. This study examines fracture incidence and risk factors among post-menopausal SA, Chinese and White women undergoing mineral density (BMD) testing within a…
OBJECTIVE: Bone turnover markers (BTMs) predict fracture in older women, whereas data on younger women are lacking. To test the hypothesis that BTMs measured before and after menopause predict fracture risk, we performed a cohort study of 2,305 women. METHODS:…
Racial/ethnic origin plays an important role in fracture risk. Racial/ethnic differences in fracture rates cannot be fully explained by bone mineral density (BMD). Studies examining the influence of bone geometry and strength on fracture risk have focused primarily on older…
PURPOSE: Atypical femur fractures represent a potential complication of chronic oral bisphosphonate therapy in women with osteoporosis, but the risk of atypical femur fractures among cancer patients receiving intravenous bisphosphonates at higher cumulative doses remains unclear. We examined femur fractures…
PURPOSE: To characterize the spectrum and outcomes of bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurring with oral bisphosphonate therapy. MATERIALS AND METHODS: We assembled a retrospective cohort of patients who had developed oral BRONJ according to the 2009 American Association…
We evaluated the performance of the Fracture Risk Calculator (FRC) in 5893 men who participated in the baseline visit (March 2000-April 2002) of the Osteoporotic Fractures in Men Study. FRC estimates for 10-yr hip and major osteoporotic (hip, clinical spine,…
BACKGROUND: Reports of atypical femur fracture in bisphosphonate-exposed women have prompted interest in characterizing the clinical profiles of these patients. METHODS: Among women age >/=60 years with hip or femur fracture during 2007-2008, we identified 79 with low-trauma subtrochanteric or…
SUMMARY: Hospital diagnosis codes are useful for assessing hip fracture rates in large populations. However, these codes do not reliably differentiate hip fractures that occur in the subtrochanteric region. Identification of subtrochanteric fractures requires review of radiographic images to distinguish…
Loss of ovarian function has a profound impact on female skeletal health. Bone mineral density findings from the Study of Women's Health Across the Nation demonstrate an accelerated rate of bone loss during the menopausal transition. The greatest reduction occurs…
Recent reports of bisphosphonate-related osteonecrosis of the jaw (BRONJ) have increased awareness of oral health in patients receiving osteoporosis therapy. This study describes the demographic, oral health, and clinical characteristics of a contemporary population of women aged 50 and older…
OBJECTIVE: To evaluate the utility of the Fracture Risk Calculator (FRC, Foundation for Osteoporosis Research and Education) for predicting 10-year hip fracture risk within a 'real world' population. STUDY DESIGN: Retrospective cohort study. METHODS: We identified female members of Kaiser…
PURPOSE: Radiographic features in patients with bisphosphonate-related osteonecrosis of the jaw (BRONJ) are well described, but less is known in bisphosphonate-exposed individuals with stage 0 disease (clinical symptoms without exposed necrotic bone) considered at risk for BRONJ. We sought to…
PURPOSE: Osteonecrosis of the jaw (ONJ) is a serious complication associated with bisphosphonate therapy, but its epidemiology in the setting of oral bisphosphonate therapy is poorly understood. The present study examined the prevalence of ONJ in patients receiving chronic oral…
On the basis of updated fracture and mortality data, we recommend that the base population values used in the US version of FRAX be revised. The impact of suggested changes is likely to be a lowering of 10-year fracture probabilities.…
CONTEXT: Rates of bone loss across the menopause transition and factors associated with variation in menopausal bone loss are poorly understood. OBJECTIVE: Our objective was to assess rates of bone loss at each stage of the transition and examine major…
BACKGROUND: Bone mineral density and mammographic breast density are each associated with markers of lifetime estrogen exposure. The association between mammographic breast density and bone mineral density in early perimenopausal women is unknown. METHODS: We analyzed data from a cohort…
BACKGROUND: High-dose corticosteroid exposure is associated with increased risk of bone loss and osteoporotic fractures. OBJECTIVE: To examine high-dose corticosteroid use and osteoporosis screening and treatment trends in patients receiving high-dose oral or inhaled corticosteroids in a large managed care…
OBJECTIVE AND CONTEXT: Our objective was to examine predictability of reproductive hormone concentrations for bone mineral density (BMD) loss during the menopausal transition. DESIGN: We conducted a longitudinal (five annual examinations), multiple-site (n = 5) cohort study, the Study of…
A case-control study to identify risk factors for fracture of the shafts of the tibia and fibula among persons 45 years of age and older was undertaken in five Northern California Kaiser Permanente Medical Centers during 1996-2001. One hundred seventy-nine…
INTRODUCTION: Although clinical trials indicate that oral bisphosphonates reduce osteoporotic fracture risk, compliance with bisphosphonate therapy in practice is suboptimal, with 1-year discontinuation rates exceeding 50%. METHODS: We conducted a retrospective cohort study among female members of a large integrated…
From 1996 to 2001, the authors undertook a case-control study of 192 pelvis fracture cases (men and women) and 2,402 controls aged > or = 45 years at five Kaiser Permanente medical centers in Northern California. Most information on potential…
A case-control study of 1,150 female and male distal forearm cases and 2,331 controls of age 45 years and older was undertaken from 1996-2001 in five Northern California Kaiser Permanente Medical Centers. Most information on possible risk factors was obtained…
A role for matrix proteins has previously been proposed in the pathogenesis of arterial calcification in the setting of atherosclerosis, and a link has been suggested between osteoporosis and arterial calcification. Our aim has been to investigate whether matrix Gla…
A case-control study undertaken among members of five Northern California Kaiser Permanente medical centers sought to identify risk factors for foot fractures among persons aged 45 years and older. Foot fracture cases (n=920) and frequency matched controls (n=2366) were interviewed…
This case-control study of proximal humerus fracture included 448 incident female and male cases and 2,023 controls aged 45 years or older identified in five Northern California Kaiser Permanente Medical Centers in 1996-2001. Data were collected by using an interviewer-administered…
This case-control study examined the relation of circumstances of falls and characteristics of fallers with risk of fractures at five sites among persons 45 years of age or older from five Kaiser Permanente Medical Centers in Northern California from 1996…
Left-handedness has been associated with increased fracture risk in a small number of previous studies. This study reports risks for fractures at the proximal humerus, distal forearm, pelvis, foot, and shaft of the tibia/fibula according to handedness in a case-control…
The purpose of this study was to prospectively investigate associations of habitual drinking of regular tea with bone mineral density and fracture risk. Study participants were a multiethnic postmenopausal cohort (n = 91,465) from the nationwide Women's Health Initiative Observational…
BACKGROUND: Osteoporosis is a major cause of morbidity. Treatment of osteoporosis reduces the risk of fracture, particularly for postmenopausal women with a history of fracture. METHODS: A retrospective study was conducted using the automated databases of 7 health maintenance organizations…
We tested the hypothesis that higher serum osteocalcin and urinary N-telopeptide of type I collagen (NTx) concentrations would be found in women with increasing cycle irregularity or increased follicle stimulating hormone concentrations. We studied 2,375 pre- and early perimenopausal women…
Bone mineral density (BMD) and fracture rates vary among women of differing ethnicities. Most reports suggest that BMD is highest in African-Americans, lowest in Asians, and intermediate in Caucasians, yet Asians have lower fracture rates than Caucasians. To assess the…
OBJECTIVE: To investigate use of osteoporosis drugs among patients with high exposure to glucocorticoid drugs. STUDY DESIGN: Retrospective review of pharmacy records. METHODS: We identified patients aged > or = 20 years who received prescriptions for > or = 2…
BACKGROUND: Biochemical evidence of hyperthyroidism may be associated with low bone mass, particularly in older postmenopausal women, but no prospective studies of thyroid function and subsequent fracture risk have been done. OBJECTIVE: To examine the association between low levels of…
CONTEXT: Raloxifene hydrochloride, a selective estrogen receptor modulator, prevents bone loss in postmenopausal women, but whether it reduces fracture risk in these women is not known. OBJECTIVE: To determine the effect of raloxifene therapy on risk of vertebral and nonvertebral…
OBJECTIVE: To determine whether the source of preference scores has an impact on the cost-effectiveness of osteoporosis interventions. METHODS: Three groups of subjects aged > or =50 years--199 women without fractures and 183 women with osteoporotic fractures-were studied at two…
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