Association between aortic calcification and total and cardiovascular mortality in older women.

OBJECTIVES: To determine whether older women with abdominal aortic calcification had a greater cardiovascular and all-cause mortality, as such data are limited in older adults. DESIGN: Prospective cohort study with a mean follow-up of 13 years. SETTING: Community-based sample with four US clinical centres. SUBJECTS: A total of 2056 women aged > or =65 years with abdominal aortic calcification assessed on baseline radiographs. MAIN OUTCOME MEASURE: Mortality rate (all, cardiovascular, cancer or other cause) adjudicated from death certificates and hospital records. RESULTS: The prevalence of abdominal aortic calcification increased with age, ranging from 60% at age 65-69 years to 96% at 85 years and older. Participants with aortic calcification were more likely to die during follow-up of any cause (47% vs. 27%) or a cardiovascular-specific cause (18% vs. 11%, both P < 0.001) than those without aortic calcification. In age-adjusted analyses, aortic calcification was associated with a greater rate of all-cause and cause-specific mortality (cardiovascular, cancer, and other, all P < or = 0.01). In analyses adjusted for age and cardiovascular risk factors, aortic calcification was associated with an increased rate of all-cause mortality (HR: 1.37, 95% CI: 1.15-1.64), and noncardiovascular noncancer mortality (HR: 1.57, 95% CI: 1.17-2.11). The associations between aortic calcification and cancer mortality (HR: 1.44, 95% CI: 1.00-2.08) or cardiovascular mortality (HR: 1.18, 95% CI: 0.88-1.57) showed a similar pattern without reaching statistical significance, but was slightly stronger for mortality from coronary heart disease (HR: 1.53, 95% CI: 0.91-2.56). CONCLUSIONS: Abdominal aortic calcification in older women is associated with increased mortality. Future research should examine potential mechanisms for this association.

Assessment of the disturbances in metabolic homeostasis: a hypothesis of synergism.

Based on the hypothesis that a synergistic interaction between triiodothyronine (T(3)) and insulin contributes to abnormalities in glucose and other metabolic pathways, the mechanisms underlying the impairment of metabolic homeostasis (MH) and the development of type-2 diabetes (DM) were investigated via a proposed homeostatic model, [(FG*TG)/T3*FI)]. The MH model characterizes the relationship between T(3) and insulin and the levels of triglycerides (TG), fasting insulin (FI), and fasting glucose (FG) and is introduced as a clinical method to assess insulin sensitivity and the status of metabolic homeostasis in lieu of current screening models advocated by the by American Diabetic Association (ADA). The present study validated the hypothetical model in a sample of 110 African-American women.

A hypothesis of synergism: the interrelationship of T3 and insulin to disturbances in metabolic homeostasis.

While the role of abnormal insulin homeostasis in the pathogenesis of Type-2 diabetes mellitus is well established, the importance of the canonical role of T(3) on Type-2 diabetes or the homeostasis of glucose, lipid, and energy balance has not been addressed. Based on the available evidence from molecular biology, the pivotal regulatory role of T(3) in major metabolic pathways and glycemic control can be delineated by mapping the specific action sites of T(3) and insulin on the metabolic pathways of the glucose-lipid cycle. The current paper presents an integrative hypothesis of the synergistic relationship of T(3) and insulin in metabolic homeostasis and abnormalities.

Back problems among postmenopausal women taking estrogen replacement therapy: the study of osteoporotic fractures.

STUDY DESIGN: Cross-sectional and prospective. OBJECTIVES: To investigate the association between estrogen replacement therapy use, back pain, and back function in a large cohort of elderly women. BACKGROUND: Several studies have suggested that women who use estrogen replacement therapy may be more likely to experience back pain than those who do not. However, the relationships between estrogen replacement therapy, back pain, and impaired back function have not been clearly delineated. METHODS: At baseline information on estrogen replacement therapy use, functional status, back pain and function, and general lifestyle variables was obtained from 7209 elderly white women (mean age 71 years)enrolled in the Study of Osteoporotic Fractures. Lateral radiographs of the lumbar and thoracic spine were taken at baseline and at the third clinic visit, an average of 3.7 years after the baseline visit. Bone mineral density at the hip and spine was measured approximately 2 years after baseline. Follow-up information on back pain and function was also obtained at the third clinic visit. RESULTS: A total of 1039 (14.4%) women were using estrogen replacement therapy at baseline, 2016(28.0%) reported former use, and 4154 (57.6%) had never used estrogen replacement therapy. Compared with never-users, a statistically significant higher percentage of current estrogen users reported clinical back pain (52.7% vs. 43.4%) and back impairment (12.3% vs. 9.2%) at baseline and at the follow-up visit (pain 50.8% vs. 41%; impairment 16.0% vs. 12.1%). This occurred despite a higher prevalence of vertebral fractures in never-users of estrogen at the baseline visit. Current and former estrogen users without vertebral fractures had statistically significant higher likelihoods of having back pain and back dysfunction at both the baseline and third follow-up visit. The increased likelihood of back pain and back impairment in current and former estrogen users remained despite statistical adjustment for age, vertebral fracture, body mass index,smoking history, parity, exercise, arthritis, and diabetes in multivariate models. The relative risk (95%confidence interval) for impaired back function in former and current users at follow-up was 1.1 (0.9, 1.3) and 1.6 (1.3, 2.0), respectively. CONCLUSIONS: Our results indicate that postmenopausal estrogen use is associated with an increased likelihood of back pain and impaired back function in elderly white women.

Carpal tunnel release under intravenous regional or local infiltration anaesthesia.

Fifteen patients with bilateral carpal tunnel syndrome underwent surgery using intravenous regional anaesthesia (IVRA) on one hand and local infiltration anaesthesia (LA) on the other. All 30 carpal tunnel releases were performed without complication. Patient tolerance for IVRA and LA was similar. Six patients preferred the LA, eight preferred IVRA and one had no preference. Tourniquet time averaged 16 minutes when LA was used and 24 minutes with IVRA (P<0.05). Use of local anaesthesia allows more expeditious surgery and limits costs, but intravenous regional anaesthesia is recommended if epineurotomy, internal neurolysis or flexor tenosynovectomy are planned.

Minimal medial epicondylectomy and decompression for cubital tunnel syndrome.

Sixty-four patients (66 elbows) treated for refractory cubital tunnel syndrome had minimal medial epicondylectomy and in situ decompression to minimize the potential disadvantages of classic medial epicondylectomy. After a mean followup of 27 months results were excellent in 27 patients (44%), good in 23 patients (35%), fair in 10 patients (15%), and poor in four patients (6%). No ulnar nerve palsy, ulnar nerve subluxation, or medial elbow instability were seen. The main complaint of patients regarding the procedure was tenderness at the osteotomy site. The results show that minimal medial epicondylectomy and in situ decompression of the ulnar nerve is a safe and effective method to treat patients with cubital tunnel syndrome. This procedure minimizes the disadvantage of medial instability and recurrent symptoms attributable to nerve trauma after a classic medial epicondylectomy.

Peripheral arterial disease in randomized trial of estrogen with progestin in women with coronary heart disease: the Heart and Estrogen/Progestin Replacement Study.

BACKGROUND: Postmenopausal estrogen use has been associated with reduced carotid atherosclerosis in observational studies, but this relationship has not been confirmed in a clinical trial. The impact of estrogen on atherosclerotic disease in other peripheral arteries is unknown. METHODS AND RESULTS: Postmenopausal women with coronary heart disease (CHD) and an intact uterus (n=2763) were randomly assigned to conjugated equine estrogens (0.625 mg) combined with medroxyprogesterone acetate (2.5 mg) daily or to placebo in a secondary CHD prevention trial. This analysis focuses on incident peripheral arterial procedures and deaths in the 2 treatment groups; peripheral vascular disease was a predefined secondary outcome. During a mean of 4.1 years of follow-up, 311 peripheral arterial events were reported in 213 women, an annual incidence of 2.9%. The number of women who had peripheral arterial events was 99 among those assigned to active estrogen/progestin and 114 among those assigned to placebo, a nonsignificant difference (relative hazard 0. 87, 95% CI 0.66 to 1.14). In the placebo group, hypertension and diabetes mellitus were independently associated with higher rates of peripheral arterial events, and plasma HDL cholesterol and body mass index were associated with lower rates of peripheral arterial events. In the estrogen/progestin group, current smoking and diabetes were independent predictors of peripheral arterial events. Incident peripheral arterial disease was not a significant predictor of coronary, cardiovascular, or total mortality. CONCLUSIONS: Treatment with oral conjugated estrogen plus medroxyprogesterone acetate was not associated with a significant reduction in incident peripheral arterial events in postmenopausal women with preexisting CHD.

Modulation of the biologic activity of the rabbit intervertebral disc by gene therapy: an in vivo study of adenovirus-mediated transfer of the human transforming growth factor beta 1 encoding gene.

STUDY DESIGN: In vivo studies using a rabbit model to determine the biologic effects of direct, adenovirus-mediated transfer of a therapeutic gene to the intervertebral disc. OBJECTIVES: 1) To deliver an exogenous therapeutic gene to rabbit lumbar intervertebral discs in vivo, 2) to quantify the resulting amount of gene expression, and 3) to determine the effect on the biologic activity of the discs. SUMMARY OF BACKGROUND DATA: Although growth factors such as transforming growth factor beta 1 appear to have promising therapeutic properties, there currently is no practical method for sustained delivery of exogenous growth factors to the disc for the management of certain chronic types of disease (e.g., disc degeneration). A possible solution is to modify the disc cells genetically through gene transfer such that the cells manufacture the desired growth factors endogenously on a continuous basis. METHODS: Saline, with or without virus, was injected directly into lumbar discs of 22 skeletally mature female New Zealand white rabbits. Group 1 (n = 11) received the adenovirus construct Ad/CMV-hTGF beta 1 containing the therapeutic human transforming growth factor beta 1-encoding gene. Group 2 (n = 6) received adenovirus containing the luciferase marker gene. Group 3 (n = 5) received saline only. The rabbits were killed 1 week after injection. Immunohistochemical staining for human transforming growth factor beta 1 was performed on the disc tissues of one rabbit from Group 1. Nucleus pulposus tissues from the remaining rabbits were cultured in serumless medium. Bioassays were performed to determine human transforming growth factor beta 1 production and proteoglycan synthesis. RESULTS: Discs injected with Ad/CMV-hTGF beta 1 exhibited extensive and intense positive immunostaining for transforming growth factor beta 1. The nucleus pulposus tissues from the discs injected with Ad/CMV-hTGF beta 1 exhibited a 30-fold increase in active transforming growth factor beta 1 production, and a 5-fold increase in total (active + latent) transforming growth factor beta 1 production over that from intact control discs (P < 0.05). Furthermore, these tissues exhibited a 100% increase in proteoglycan synthesis compared with intact control tissue, which was statistically significant (P < 0.05). CONCLUSIONS: The results of this study suggest that the intervertebral disc is an appropriate site for adenovirus-mediated transfer of exogenous genes and subsequent production of therapeutic growth factors. Gene therapy therefore may have useful applications for study of the basic science of the intervertebral disc and for clinical management of degenerative disc disease.

Degenerative lumbar listhesis and bone mineral density in elderly women. The study of osteoporotic fractures.

STUDY DESIGN: A cross-sectional and prospective study. OBJECTIVES: To investigate the association between lumbar listhesis in elderly white women and bone mineral density at the spine, hip, radius, and calcaneus. SUMMARY OF BACKGROUND DATA: Several types of degenerative spinal changes have been found to be associated with high bone mineral density at the spine and other body sites. METHODS: Lateral radiographs of the lumbar spine for 1400 elderly women enrolled in the Study of Osteoporotic Fractures were digitized. Listhesis (antero and retro) was assessed at L3-L4, L4-L5, and L5-S1. Bone mineral density was measured at the spine, hip, calcaneus, and the distal and proximal radius. RESULTS: After adjusting the data for age and body mass index, retrolisthesis at L3-L4, L4-L5, and L5-S1 was associated with mean spinal bone mineral density levels that were 9% to 13% higher compared with those levels in women with no listhesis (P < 0.0001). In addition, bone mineral density at the hip and appendicular sites increased from 4% to 9%. The mean lumbar spinal bone mineral density of women with anterolisthesis at L3-L4 was 12% higher (P < 0.05) than that of women with no listhesis; it was the same for both groups at L4-L5 and was 7% lower (P < 0.005) at L5-S1. At L5-S1 the bone mineral density level at the hip and appendicular sites was also lower among the women with anterolisthesis at that level. CONCLUSIONS: This study suggests that retrolisthesis, like other spinal degenerative diseases, is associated with increased spinal bone mineral density. Anterolisthesis, however, may involve a different etiology, because its association with bone mineral density varies by spinal level.

Lumbar olisthesis and lower back symptoms in elderly white women. The Study of Osteoporotic Fractures.

STUDY DESIGN: A Cross-sectional study. OBJECTIVES: To determine the prevalence of lumbar olisthesis among white women aged 65 years and older and its relation to low back pain and back function. BACKGROUND: Degenerative changes in the lumbar spine of elderly individuals may affect spinal stability, causing olisthesis (subluxation) of the lumbar spine. Neither the prevalence of this condition in the United States nor its relation to back symptoms has been studied previously. METHODS: Lateral radiographs of the lumbar spine for 788 women aged 65 years and older who were enrolled in the Study of Osteoporotic Fractures were digitized. Olisthesis (antero- and retro-) was assessed at L3-L4, L4-L5, and L5-S1. Back pain and function also were assessed. RESULTS: When olisthesis was defined as subluxation of 3 mm or more at any of the three levels studied, the overall prevalence of anterolisthesis was 29% and that of retrolisthesis was 14%. In 90% of women with anterolisthesis and 88% of women with retrolisthesis, subluxation occurred at a single vertebral level. The prevalence of anterolisthesis and retrolisthesis did not vary by smoking status, presence of diabetes, or history of oophorectomy. Anterolisthesis was not associated with the presence of back symptoms. Only retrolisthesis at L3-L4 was associated with a statistically significantly increased likelihood of lower back pain, greater severity of back pain, and impairment of back function. CONCLUSIONS: Anterolisthesis of 3 mm or more in the lower lumbar spine is relatively common among elderly women but is not correlated with back problems. Retrolisthesis at L3-L4 is associated with increased back pain and impaired back function.

Bone mineral density and risk of breast cancer: differences by family history of breast cancer. Study of Osteoporotic Fractures Research Group.

Recent studies have suggested that bone mineral density (BMD) is related to risk of breast cancer in elderly women. This study investigated whether the level of breast cancer risk associated with BMD in women with a positive family history of breast cancer is different from that in women without a family history of breast cancer. Radial and calcaneus BMD were measured at baseline (1986-1988) in 7,250 elderly white women enrolled in the Study of Osteoporotic Fractures, and initial breast cancer status was ascertained at year 1 of follow-up. After a mean of 3.2 years of additional follow-up, 104 incident breast cancer cases, 20 of which appeared in women with a family history of breast cancer, were identified and confirmed by medical record review. Modification of the BMD effect by family history status was assessed by inclusion of interaction terms in proportional hazards regression models. Among women without a family history of breast cancer, those with a proximal radius BMD in the highest tertile were at a 1.48-fold increased risk compared with women in the lowest tertile; among women with a positive family history of breast cancer, those with highest tertile BMD were at a 3.41-fold increased risk compared with women in the lowest tertile. These results suggest that the association between BMD and breast cancer may be different in subgroups of women defined by family history.

Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures.

This retrospective study investigated outcomes of wound healing in a series of 63 consecutive patients with 64 fractures of the calcaneus who underwent open reduction and internal fixation done by two surgeons experienced in this fracture during a 3-year period. Thirty-nine patients were managed preoperatively as outpatient referrals before surgery. Twenty-four patients were admitted directly to the trauma service and were managed as inpatients preoperatively. Minimum patient follow-up was 6 months, with an average follow-up of 18 months. A trend correlating the time between injury and operative intervention with the incidence of complications in wounds was noted; the incidence rose in patients who underwent surgery >5 days after their injury. Two-layered closures had a lower incidence of dehiscence compared to single-layered tension-relieving sutures. Patients with a higher body-mass index (BMI) (kg/ m2) took longer to heal their wounds. Strong trends were noted to link BMI and severity of fractures. In the outpatient group, a history of active smoking preoperatively correlated with increased time to wound healing. In 43 patients, there were no wound-healing complications. In 21 feet, there were varying degrees of wound dehiscence. Average wound healing took 47 days. Risk factors for complications in the wound after calcaneal open reduction and internal fixation include single layered closure, high BMI, extended time between injury and surgery, and smoking. Age, type of immobilization, medical illness (including diabetes), type of bone graft, or use of a Hemovac did not influence wound healing.

Bone mineral density and aortic calcification: the Study of Osteoporotic Fractures.

OBJECTIVE: To investigate the relationship between bone mineral density (in the axial and appendicular skeleton) and calcification of the aorta. DESIGN: Cross-sectional study. SETTING: Community-based study. PARTICIPANTS: A total of 2051 women aged 65 years and older enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS: Bone mineral density (BMD) at the hip, spine, calcaneus, proximal and distal radius; calcification of the aorta (AC); demographic and lifestyle variables; dietary history; functional status; blood pressure; anthropomorphic measures. RESULTS: The prevalence of AC increased with age, ranging from 60% at ages 65 to 69 years to 96% at 85 years and older. BMD in women with calcified arterial plaques was lower (P < .001) when compared with those with no plaques, at all sites measured except the lumbar spine. After adjustment for age, BMD at the hip, spine and calcaneus was not associated with the presence of plaques; only a weak association between BMD and AC remained at the distal and proximal radius. The independent correlates of AC were age, smoking status, systolic blood pressure, coffee drinking, central obesity and a history of diabetes or stroke; current estrogen use was protective. CONCLUSIONS: The results of this study indicate that osteopenia and the deposition of calcific plaques in the wall of the aorta are independent processes that occur as women age. They are probably not causally linked.

Bone mineral density and blood flow to the lower extremities: the study of osteoporotic fractures.

This study tests the hypothesis that reduced blood flow to the lower extremities may affect bone remodeling, resulting in a decrease in bone mineral density (BMD). BMD was measured in the axial and appendicular skeleton of 1292 elderly women (mean age, 71 years) enrolled in the Study of Osteoporotic Fractures. The ratio of the posterior tibial and brachial systolic blood pressures, the ankle/arm index, was used as a measure of blood flow to the legs. In the cross-sectional analysis, this index was positively correlated with BMD at the radius, calcaneus, and hip, but not at the spine. A decrease in the index of 2 standard deviations (SD) (as might occur in patients with moderate arterial disease) was associated with a decrease of 3.7% (95% CI, 1.7%, 5.8%) in hip BMD. The effect size at the hip decreased from 3.7 to 1.8% (and was not statistically significant) when adjustment was made for smoking and/or body mass index (BMI). In the prospective analysis, the rate of bone loss at the hip and calcaneus was greater (p < 0.05) among women whose annual decrease in ankle/arm index was more than 1 SD greater than the mean decrease. This increase was independent of estrogen use, smoking, BMI, pattern of fat distribution, history of diabetes, exercise, and ability to walk. The results from this prospective community-based study provide the first evidence that among relatively healthy older women decreased vascular flow in the lower extremities may be associated with an increased rate of bone loss at the hip and calcaneus.

Calcaneal ultrasound attenuation in older African-American and Caucasian-American women.

The lower fracture rates among African-American women relative to Caucasian women may reflect their higher bone mass. However, bone mass is not the only determinant of bone strength: the quality and microarchitecture of the bone are also important. Quantitative ultrasound is believed to measure properties of bone strength that are independent of bone mass. To test the hypothesis that there are racial differences in quantitative ultrasound measures of bone, we recruited 154 African-American women age > or = 65 years. A random sample of 300 Caucasian women participating in the Study of Osteoporotic Fractures in Pittsburgh, Pennsylvania, was chosen for comparison. The Walker Sonix UBA 575+ was used to measure calcaneal broadband ultrasonic attenuation (BUA). Duplicate BUA measurements were obtained with a reproducibility of 5%. We measured bone mineral density (BMD) of the hip and calcaneus using single (calcaneus) or dual (hip) energy X-ray absorptiometry. The correlation between BUA and calcaneal BMD was similar in Caucasians (r = 0.66, p < 0.001) and African-Americans (r = 0.58, p < 0.001). Age-adjusted BUA (dB/MHz) was higher among the African-American women than Caucasian women (69.1 and 66.2, respectively), but these differences were not statistically significant, (p = 0.12). Adjustment for calcaneal BMD completely attenuated the racial differences in BUA. BMD at the femoral neck and calcaneus was higher among the African-American women, even after adjusting for age, height and weight. In conclusion, our results suggest that racial differences in rates of fracture cannot be explained by differences in bone quality as assessed by ultrasound attenuation.

Apolipoprotein E phenotype, arterial disease, and mortality among older women: the study of osteoporotic fractures.

This study is an investigation of the relationship between apolipoprotein E (apoE) phenotype, arterial disease, and mortality in a group of women (n = 1,751) aged 65 years and older enrolled in the Study of Osteoporotic Fractures. Crude mortality rates were highest among women with the 4-3 and 4-4 phenotypes but age-adjusted mortality showed no statistically significant variations across the phenotype groups. Using multivariate analysis, the mortality experience of women with 4-3 or 4-4 apoE phenotypes was compared to that of women with the 3-3 phenotype: no significant excess total mortality was found [relative risk (RR) = 1.2, 95% confidence interval (CI) 0.8, 1.8] among women with the epsilon 4 allele. Similarly, neither cardiovascular (RR = 0.9. 95% CI 0.5, 1.8) nor cancer (RR = 1.5, 95% CI 0.8, 2.8) mortality rates were significantly different in this group of women. Inclusion of cholesterol levels in the regression models did not change the relative mortality risks. Among women 65-69 year of age epsilon 4 was associated with an approximate doubling of RR for death due to both cardiovascular disease and cancer. No association was found between apoE phenotype and the presence of lower extremity arterial disease (defined as an ankle/arm index of 0.9 or less). These results suggest that women with the epsilon 4 who survive to age 70 years or beyond have a life expectancy that is similar to that for women homozygous for the 3 allele who comprise the majority of the population.

Back problems and atherosclerosis. The Study of Osteoporotic Fractures.

STUDY DESIGN: A cross-sectional and prospective study of osteoporotic fractures. OBJECTIVES: To investigate the correlation between lower extremity arterial disease or history of cardiovascular disease and back pain, back function, osteoporosis, and vertebral fractures. BACKGROUND: It has been postulated that atherosclerosis may compromise blood flow to bone and soft tissues in the back, causing pain and disability. Recent studies have presented conflicting results. METHODS: At baseline, information on back pain and function, general functional status, cardiovascular history, and general lifestyle variables was obtained from 1492 elderly white women (mean age, 71 years) enrolled in the Study of Osteoporotic Fractures. Lateral radiographs of the lumbar and thoracic spine were obtained, and lower extremity arterial disease was assessed. Follow-up information was obtained an average of 3.7 years later. RESULTS: At baseline, 82 women had arterial disease, 443 had a history of cardiovascular disease, and 277 had vertebral fractures; 58 women had one or more additional vertebral fractures during the follow-up period. After adjustment for age, women with cardiovascular disease were more likely to have back pain and disability as a result of the back pain than women free of cardiovascular disease; at the follow-up examination, the back-related disability was more than twice as likely to have worsened in the cardiovascular disease group. No correlation was found between arterial disease and back problems. Neither the prevalence of vertebral fractures at baseline, nor the incidence of vertebral fractures was associated with the presence of arterial disease or cardiovascular disease. CONCLUSIONS: Results indicated that back problems in elderly women are associated with self-reported cardiovascular disease, but not with objectively assessed lower extremity arterial disease.

Bone mineral density and risk of breast cancer in older women: the study of osteoporotic fractures. Study of Osteoporotic Fractures Research Group.

OBJECTIVE: To test the hypothesis that bone mineral density (BMD) is associated with the risk of developing breast cancer in older women. DESIGN: Prospective cohort study with mean (SD) follow-up of 3.2 (1.6) years. SETTING: Four clinical centers, one each located in the following areas: Baltimore, Md; Minneapolis, Minn; Portland, Ore; and the Monongahela Valley in Pennsylvania. PARTICIPANTS: A total of 6854 nonblack women who were 65 years of age or older and enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS: Radius and calcaneus BMD by single photon absorptiometry at baseline; hip and spine BMD by dual-energy x-ray absorptiometry 2 years later. MAIN OUTCOME MEASURE: Breast cancer confirmed by medical record review. RESULTS: A total of 97 women developed breast cancer. In the multivariate model, adjusting for age, the degree of obesity, and other important covariates, the risk of breast cancer was about 30% to 50% higher per 1 SD increase in BMD (relative risk, distal radius BMD=1.50; 95% confidence interval, 1.16-1.95). The age-adjusted incidence rate of breast cancer per 1000 person-years among women in the lowest quartile of distal radius BMD was 2.46, compared with 5.99 among women with the highest BMD. Women with BMD above the 25th percentile were at 2.0 to 2.5 times increased risk of breast cancer compared with women below the 25th percentile. Results were consistent across all BMD sites. CONCLUSIONS: Bone mineral density predicts the risk of breast cancer in older women. The magnitude of the association is similar to that observed between BMD and all fractures. Our findings suggest a link between 2 of the most common conditions affecting a woman's health. Identifying a common denominator for these conditions should substantially improve our understanding of their etiology and prevention.

Smoking and mortality among older women: the study of osteoporotic fractures.

BACKGROUND: Relatively few studies have been focused on the effect of smoking among older individuals. The goal of this study is to investigate the relationship between smoking status and cause-and age-specific mortality among elderly women. METHODS: Women aged 65 years and older and living in four geographical areas (Baltimore, Md, Minneapolis, Minn, Pittsburgh, Pa, and Portland, Ore) were recruited from various population-based listings for participation in the multicenter Study of Osteoporotic Fractures between September 1986 and October 1988 (N=9704). During a mean follow-up of 4.9 years (<99% complete), 751 deaths occurred. The date and cause of death were ascertained, and the relationship between mortality and current and past smoking status was analyzed using Cox proportional hazards modeling techniques. RESULTS: Compared with nonsmokers, women smokers aged 65 to 74 years have a more than twofold increase in mortality attributable to increases in both cardiovascular and cancer mortality; death from smoking-related cancers increased eight- to 10-fold. Women 75 years and older who smoke have a small overall increased relative risk (RR) of mortality (RR=1.4; 95% confidence interval [CI], 0.9 to 2.3), but more than five-fold increased risk of dying from a smoking-related cancer (RR=5.2; 95% CI, 1.6 to 16.8). All-cause and cardiovascular death rates approach those of nonsmokers within 10 years after a woman quits smoking; morality from smoking-related cancers remains elevated for at least 23 years. CONCLUSIONS: The harmful effects of continuing to smoke are apparent even among women aged 75 years and older.

Functional status and mobility among elderly women with lower extremity arterial disease: the Study of Osteoporotic Fractures.

OBJECTIVE: To investigate the relationship between lower extremity arterial disease, functional status, and mobility among elderly women. DESIGN: Cross-sectional study. SETTING: Community. PARTICIPANTS: 1492 healthy white women, 65 years of age or older, residing in a rural community, able to walk without the assistance of another person, and enrolled in the Pittsburgh clinic of the multicenter Study of Osteoporotic Fractures. Those with bilateral hip replacement were excluded. MEASUREMENTS: Ankle/arm index (AAI); instrumental activities of daily living (IADLs); measures of recent physical activity, muscle strength, gait and balance; general demographic, lifestyle, and physical variables. RESULTS: Women with lower extremity arterial disease (defined as an AAI of 0.9 or less) were more likely to report difficulty with one or more IADLs than were women free of this disease. After adjusting for age and other potential confounders, only difficulty with walking 2-3 blocks remained highly correlated with disease (relative risk (RR) 2.8, 95% confidence interval (CI) 1.6, 4.8). Several measures of physical activity were inversely and independently related to a low AAI. Muscle strength in the hip, arm, knee, and hand and measures of static and dynamic balance were correlated with low AAI in the univariate analysis, but most of these trends were not statistically significant after adjustment for age and other confounders. Exclusion of women with symptomatic arterial disease did not substantially affect the results obtained. CONCLUSION: Women with mild, predominantly subclinical, lower extremity arterial disease living in the community have decreased functional status and mobility.