In vitro effects of Epstein-Barr virus on peripheral blood mononuclear cells from patients with rheumatoid arthritis and normal subjects.

Peripheral blood mononuclear cells from 10 patients with rheumatoid arthritis and 9 control subjects were cultured in vitro for 30 days with and without infection by Epstein-Barr virus. All cultures showed polyclonal stimulation of B cells as indicated by rising levels of IgM in the culture supernates, reaching maximal at 18-24 days, and with no quantitative or kinetic difference between the RA and control cells. IgM anti-IgG was also produced in both groups and maximally at 18-24 days, but in greater quantity by the RA lymphocytes. The anti-IgG made by the RA lymphocytes was more easily absorbed by solid phase IgG than was the anti-IgG made by the normal lymphocytes and thus was judged to be of higher affinity. RA lymphocytes uninfected with EBV had higher transformation scores than did the normal controls and developed spontaneously into permanent cell lines in six instances.

Calcium intake: covariates and confounders.

One common nutrient postulated to be protective against osteoporosis, hypertension, and colon cancer is dietary calcium. We report here nutrient patterns by calcium intake in older adult residents of a geographically defined community in Southern California. The analysis included all 426 men and 531 women aged 50-79 y with complete 24-h diet data. Nutrient-density-adjusted calcium intake was divided into tertiles: low intake (less than 284 mg/1000 kcal), mid intake (284-440 mg/1000 kcal), and high intake (greater than 440 mg/1000 kcal). The distribution of the reported 24-h nutrient density of protein, fat, fiber, caffeine, trace minerals, vitamin D, and vitamin C was examined in relation to the calcium-intake tertiles. In both men and women, the adjusted intakes of protein, saturated fatty acids, vitamin D, magnesium, and phosphorus were significantly higher in the high-calcium-intake group than in the low- and mid-calcium-intake groups. In both men and women, alcohol intake was significantly lower in the high-calcium-intake group. Studies postulating a protective role for calcium will need to consider the multicolinearity in the Western diet.

Quality of life in patients with multiple injuries--basic issues, assessment, and recommendations.

BACKGROUND: While the primary goal of trauma care continues to be the preservation of life, interest has begun to focus on disability and quality of life of those who survive. Numerous instruments have been developed to measure personal well-being, impairment, or subjective life-satisfaction. But there is no consensus regarding which instruments are most appropriate to use in multiply injured patients, and comparison of results are difficult. OBJECTIVE: The objective of this multinational conference was to arrive at a consensus regarding the measurement of quality of life in survivors of multiple trauma. Specifically we sought to identify the best time intervals for measurement and a minimum set of instruments. METHOD: The group reviewed instruments currently in use for quality of life measurement in multiply injured patients. A structured discussion covered the following topics: definition of the population, the concept of quality of life, the importance of different domains of quality of life at different time points, the type of measures and their validity, consistency, and practicability, the mode of administration, subject burden, and availability of population norms. RESULTS: The group suggested three time points, after 3, 12 and 24 months, for the assessment of quality of life after multiple injury. The Glasgow Outcome Scale (GOS) was suggested as an overall global outcome measure including death and vegetative state. The EuroQol was proposed to permit economic analysis, and the SF-36 as a validated global quality of life measure. CONCLUSION: While most selected measures are psychometrically sound, many have had limited use in the setting of multiple injuries. Researchers and clinicians may use these suggestions as a source of information when developing a measurement strategy.

The epidemiology of traumatic death. A population-based analysis.

Despite the proliferation of trauma systems, there are no population-based data describing the epidemiology of traumatic death. To provide these data, we reviewed all trauma deaths occurring in San Diego (California) County during 1 year. There were 625 traumatic deaths during the study (27.3 deaths per 100,000 population per year). Motor vehicle trauma was the most common cause of injury leading to death (N = 344 [55.2%]; 15.0 annual deaths per 100,000 population). Central nervous system injuries were the most common cause of death (48.5%, or 13.2 deaths per 100,000 population per year). Sepsis was responsible for only 2.5% of the overall mortality. Based on life-table data, traumatic death resulted in an annual loss of 1091 years of life per 100,000 and an annual loss of 492 years of productivity per 100,000. Injury continues to account for an enormous loss of life despite improvements in survival wrought by trauma systems.

A prospective study of alcohol consumption and bone mineral density.

OBJECTIVES: To study the effects of alcohol consumption on bone mineral density in a defined population. DESIGN: Prospective study of bone mineral density, measured during 1988-91, in a cohort who had given baseline data on alcohol intake in the previous week and in the previous 24 hours and other factors affecting bone mineral density during 1973-5. SETTING: Rancho Bernardo, California. SUBJECTS: 182 men and 267 women aged 45 and over at baseline, half having been randomly selected and half having been chosen for hyperlipidaemia, who gave baseline information on alcohol intake in one week. Of these subjects, 142 men and 220 women gave information on alcohol intake in 24 hours. MAIN OUTCOME MEASURES: Bone mineral density of the radial shaft, ultradistal wrist, femoral neck, and lumbar spine. RESULTS: Men and women were considered separately, and the tertiles of alcohol consumption were used to delineate low, medium, and high values of alcohol intake. With increasing alcohol intake in one week, bone mineral density (adjusted for age, body mass index, smoking, taking exercise, and oestrogen replacement therapy in women) increased significantly in the femoral neck of men (p < 0.01) and the spine of women (p < 0.01). With increasing alcohol intake in 24 hours, adjusted bone mineral density increased significantly in the radial shaft (p < 0.05) and spine (p < 0.001) of women. Similar, but not significant, patterns were seen at the other bone sites. CONCLUSIONS: Social drinking is associated with higher bone mineral density in men and women.

Sex differences in osteoporosis in older adults with non-insulin-dependent diabetes mellitus.

OBJECTIVE: To describe the association of non-insulin-dependent diabetes mellitus (NIDDM) with bone mineral density (BMD). DESIGN: A survey of men and women from an established epidemiologic cohort who were separately screened for diabetes by oral glucose tolerance test between 1984 and 1987 and for osteopenia by BMD measured in 1988-1989. SETTING: A community-based population of older adults, Rancho Bernardo, Calif. PARTICIPANTS: The first 627 consecutively seen white men and women aged 55 to 88 years. MAIN OUTCOME MEASURES: Bone density measured by single photon absorptiometry at the ultradistal wrist and midradius and by dual x-ray absorptiometry at the femoral neck and lumbar spine. MAIN RESULTS: Among the 236 men and 391 women, whose average age was 72 years, 41 men and 39 women had NIDDM, 56 men and 110 women had impaired glucose tolerance, and 139 men and 242 women had normal glucose tolerance. Men with diabetes had BMD levels similar to those men with normal glucose tolerance, whereas women with diabetes had significantly higher BMD levels at all sites than women with normal glucose tolerance. The increased bone density in diabetic women was unexplained by age, obesity, cigarette smoking, alcohol intake, regular physical activity, and the use of diuretics and estrogen. The multiply adjusted mean BMD in women with NIDDM compared with normoglycemic women was 0.600 g/cm2 vs 0.548 g/cm2 at the midradius; 0.265 g/cm2 vs 0.230 g/cm2 at the ultradistal wrist; 0.654 g/cm2 vs 0.610 g/cm2 at the femoral neck; and 0.962 g/cm2 vs 0.859 g/cm2 at the spine. The sex differences were unexplained by survivor bias, prior obesity, or duration of diabetes. Differences were seen in women (but not men) whose diabetes was first detected at the screening evaluation, ie, before drug or dietary treatment. Similarly, in women (but not men) without diabetes increasing BMD levels at all four sites were associated with increasing postchallenge glucose levels independent of age and body mass index. CONCLUSIONS: Older women with NIDDM or hyperglycemia had better BMD than women with normal glucose tolerance, independent of differences in obesity and many other risk factors. No differences in bone density by diabetic status were observed in men. We hypothesize that the sex differences may be explained by the greater androgenicity reported in women with hyperglycemic and hyperinsulinemic conditions.

An 18-year prospective study of dietary calcium and bone mineral density in the hip.

The object of this study was to determine whether a single 24-hour diet recall of calcium intake obtained an average of 18 years previously would predict bone mineral density (BMD) in the hip in older men and women. A prospective population-based cohort study was done in Rancho Bernardo, California. Between 1973 and 1975, a 24-hour diet recall was obtained in 140 men and 220 women aged 45 and older by a trained interviewer using food models and containers. Responses were coded by the Nutrition Coordinating Center, University of Minnesota. Between 1988 and 1991, BMD in the femoral neck, trochanter, and intertrochanter was measured using dual-energy x-ray absorptiometry. Results showed that age-adjusted mean BMD levels increased significantly with increasing tertile of calcium intake at all hip sites in women, with the most striking difference at the femoral neck. These associations persisted after adjustment for body mass index, smoking, exercise, alcohol intake, use of estrogen replacement therapy, and number of years postmenopausal. No significant trends were seen for men at any hip site. It is concluded that low dietary calcium predicts low BMD in older women independent of other major determinants of BMD.

The association of lifetime weight and weight control patterns with bone mineral density in an adult community.

We examined the association of lifetime weight and weight change to bone mineral density (BMD) at four skeletal sites, the radial shaft, the ultradistal wrist, the total hip and lumbar spine, in a community-based population of 1043 older white men and women. In those currently overweight (body mass indices (BMI) > 26), the age-adjusted mean BMD at all sites was significantly higher than in those with BMI less than 26. Lifetime maximum BMI was also positively and significantly associated with a higher age-adjusted BMD at all sites except the ultradistal wrist in men. Weight gain or fluctuation of 10 lbs or more between the ages of 40 and 60 was associated with significantly higher age-adjusted mean BMD at all sites compared to weight loss or no weight change in both men and women. Weight at age 18 was unassociated with BMD but weight gain after age 18 was associated with significantly higher age-adjusted mean BMD at all sites. Conversely, dieting, weight loss or a lifetime maximum BMI of less than 24 were all associated with markedly lower BMD at all sites in both sexes. Weight patterns were closely correlated with current BMI; most of these trends persisted but were no longer statistically significant after controlling for current weight.

Sex-specific vs. unisex body mass indices as predictors of non-insulin dependent diabetes mellitus in older adults.

In order to examine sex differences in the association of obesity with the risk of non-insulin dependent diabetes mellitus (NIDDM) when using the body mass index (BMI), we compared unisex body mass index classifications with sex-specific categories, as defined by the Metropolitan Life Tables, based on their utility in predicting the 12-year incidence of NIDDM in men and women. The present analysis included all 747 men and 969 women from a defined older caucasian population in Rancho Bernardo, California, who were 40 years of age or older at the baseline examination in 1972-1974 and who had complete diabetes-related data available then and between 1984-1987. The 12-year age-adjusted incidence rates for NIDDM increased with increasing BMI among women (all steps significant), but was significantly increased only in the most obese category of men (relative risk (RR) = 2.3, P less than 0.05 for men; RR = 3.8, P less than 0.001 for women). Men and women had nearly identical rates of NIDDM in this obese category. When identical (unisex) BMI cutpoints were used, results were the same; (RR = 2.4, P less than 0.05 for men; RR = 3.1, P less than 0.01 for women). These data indicate that unisex and sex-specific cutpoints for BMI identify the same sex-specific patterns of association between obesity and risk of NIDDM.

A prospective population-based study of alcohol use and non-insulin-dependent diabetes mellitus.

The effect of alcohol use on risk of non-insulin-dependent diabetes mellitus was assessed in a defined population. A 24-hour recall of alcohol intake and past-week alcohol intake were obtained by separate interviewers between 1973 and 1975, and responses were coded by the Nutrition Coordinating Center, University of Minnesota. Of the 524 adults aged 30-79 years without diabetes at baseline, 31 men and 44 women were identified as diabetic by means of a glucose tolerance test (World Health Organization criteria) between 1984 and 1987. Men, but not women, who developed diabetes reported significantly more alcohol intake in the past week and in the past 24 hours. The highest rate of diabetes among alcohol users was in heavy drinkers--statistically significant only in men. Alcohol use remained a significant predictor of diabetes in men after adjustment for baseline age, body mass index (weight (kg)/height (m)2), cigarette smoking, family history of diabetes, and systolic blood pressure with a logistic regression model. The relative risk associated with past-week alcohol intake was 1.5 per 137.8 g; for past-24-hour alcohol intake, it was 1.5 per 24.5 g. Adjustment for baseline fasting plasma glucose and triglycerides did not change the results. Alcohol intake appears to be associated with risk of non-insulin-dependent diabetes mellitus in men.

Dietary calcium and risk of hip fracture: 14-year prospective population study.

To assess the effect of dietary calcium intake on risk of hip fracture, a geographically defined caucasian population in southern California was studied prospectively. Between 1973 and 1975, a quantified 24 hour diet recall was obtained by a dietician from 957 men and women aged 50 to 79 years at baseline. Follow-up to 1987 with mortality records and interviews showed 15 men and 18 women with hip fractures. The age-adjusted risk of hip fracture was inversely associated with dietary calcium whether considered as mg per day or as nutrient density (mg per 1000 kcal). No other nutrient was consistently associated with hip fracture in any Cox proportional hazards model that included calcium. The association between calcium and fracture persisted after adjustment for cigarette smoking, alcohol intake, exercise, and obesity. The significant independent inverse association of dietary calcium with subsequent risk of hip fracture (relative risk = 0.6 per 198 mg/1000 kcal) strongly supports the hypothesis that increased dietary calcium intake protects against hip fracture.

Determining the market for nurse practitioner services: the New Haven experience.

This study examined factors associated with the intent to use nurse practitioner (NP) services among 331 residents of the New Haven, Connecticut, urban area. Using a stratified random sample, a telephone survey was conducted to investigate the significance of selected socio-economic, attitudinal, cognitive, and health care use characteristics known to influence consumers' choices about health care providers and services. Applying marketing concepts, these findings indicated that 62% of the respondents would use NP services. Chi-square analysis and stepwise logistic regression indicated that dissatisfaction with present health care, family size, and age were the best predictors of intent to use NP services. Respondents believed that NP services were not different from physician services; they were concerned about issues of availability and cost of care. Consumers would seek NP care if it were covered by health insurance and if it cost less than physician care. Implications for designing effective marketing strategies and policy development are discussed.

Self-reported arthritis among men and women in an adult community.

In the Rancho Bernardo, California population of older adults, the age-adjusted prevalence rate of self-reported arthritis was higher in women than men for all types combined (38.6 vs. 22.3%, p less than 0.05), and for osteoarthritis (18.1 vs 12.9%). Men and women with osteoarthritis and disabling arthritis were significantly more likely to report co-morbid conditions. Women with osteoarthritis were significantly less likely to drink alcohol and more likely to be taking estrogen replacement therapy. At 15 years of follow up, mortality rates were not significantly increased in men or women with arthritis or osteoarthritis compared to those without arthritis.

The impact of major in-hospital complications on functional outcome and quality of life after trauma.

BACKGROUND: Little is known about the impact of major in-hospital complications on functional outcome in the short- and long-term period after serious injury. The Trauma Recovery Project (TRP) is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life and functional limitation. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. The specific objectives of the present report are to examine the effect of postinjury complications on functional outcomes at discharge and at 6-, 12-, and 18-month follow-up time points in the TRP population. METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years or older; admission Glasgow Coma Scale score of 12 or greater; and length of stay greater than 24 hours. Quality of life was measured after injury using the Quality of Well-being (QWB) scale, a sensitive index to the well end of the functioning continuum (range, 0 [death] to 1.000 [optimum functioning]). Major in-hospital complications were assessed for 820 patients and were coded as pulmonary, cardiovascular, gastrointestinal, hepatic, hematologic, infections, renal, musculoskeletal, neurologic, and vascular, on the basis of standardized codes used in the Trauma Registry. RESULTS: Major in-hospital complications were present in 83 (10.1%) patients. Discharge QWB scores were significantly lower in patients with major complications (0.394 vs. 0.402, p < 0.05). QWB scores were also significantly lower at 6-month follow-up in patients with major complications (0.575 vs. 0.637, p < 0.0001). Types of major complications with significantly lower 6-month follow-up QWB scores were pulmonary, gastrointestinal, infections, and musculoskeletal. Patients with major complications also had significantly lower 12-month (0.626 vs. 0.674, p < 0.01) and 18-month (0.646 vs. 0.681, p < 0.05) follow-up QWB scores. Pulmonary major complications and infections were associated with significantly lower QWB scores at 12-month follow-up. CONCLUSION: These results provide new evidence that major in-hospital complications may have an important impact on functional outcomes after major trauma.

The association of lifetime weight and weight control patterns with diabetes among men and women in an adult community.

We examined the association of degree and duration overweight, dietary habits and exercise with non-insulin dependent diabetes mellitus risk in a defined population of 886 men and 1114 women who were aged 50 years and older when examined in 1984-1987. After an oral glucose tolerance test, 142 men and 142 women were classified as diabetic using WHO criteria. Compared to those with appropriate childhood weight, reported underweight as a child significantly increased the rate of diabetes as an adult (RR = 1.3, P less than 0.05). Underweight as a teenager was also associated with an increased rate (RR = 1.3, P less than 0.05). Underweight as a teenager was also associated with an increased rate (RR = 1.4, P less than 0.01). In adults with current body mass indices (weight/height2) greater than 26, the diabetes rate was significantly higher for those underweight as children (RR = 1.7, P less than 0.01). A multivariate logistic regression analysis of adult diet and weight behaviors, adjusting for age and current smoking, found that a weight gain or fluctuation between the ages of 40 and 60 of 10 lbs or more significantly increased the diabetes rate (RR = 1.4, P less than 0.05; RR = 1.7, P less than 0.01). Weight gain between age 18 and the 1984-1987 visit also significantly increased the rate (RR = 1.4 per 17.3 percent, P less than 0.001). Exercise as the only means to control weight was associated with a significantly reduced diabetes rate (RR = 0.05, P less than 0.05).

Base deficit as a sensitive indicator of compensated shock and tissue oxygen utilization.

To determine the relationship of the arterial base deficit (BD) to physiologic indicators of shock and resuscitation--heart rate, mean arterial pressure (MAP), cardiac output (CO), arteriovenous oxygen difference (AVO2), mixed venous oxygen saturation (VSAT) and oxygen delivery to consumption ratio (RATIO)--16 swine were monitored invasively, bled 40 per cent of their calculated blood volume and resuscitated with crystalloid and blood. During hemorrhage, the MAP, CO, VSAT and RATIO decreased and the BD and AVO2 increased. One hour after hemorrhage, but before crystalloid infusion, the MAP, VSAT and RATIO had increased significantly from previous levels and the AVO2 had narrowed significantly, while the BD showed no significant change. All parameters returned to baseline with resuscitation. BD accurately reflected the hemodynamic and tissue perfusion changes associated with hemorrhagic shock and resuscitation in this model. BD can be used as an indicator of the severity of the shock state and the efficacy of resuscitation when invasive monitoring is impractical or not available. BD was more reflective of the true volume deficit during compensated shock than other physiologic variables in this study.

The importance of gender on outcome after major trauma: functional and psychologic outcomes in women versus men.

BACKGROUND: Outcome after major trauma is an increasingly important focus of injury research. The effect of gender on functional and psychological outcomes has not been examined. The Trauma Recovery Project is a large, prospective, epidemiologic study designed to examine multiple outcomes after major trauma, including quality of life, functional outcome, and psychological sequelae such as depression and early symptoms of acute stress reaction. The specific objectives of the present report are to examine gender differences in short- and long-term functional and psychological outcomes in the Trauma Recovery Project population. METHODS: Between December 1, 1993, and September 1, 1996, 1,048 eligible trauma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enrollment criteria for the study included age 18 years and older, admission Glasgow Coma Scale score of 12 or greater, and length of stay greater than 24 hours. Quality of life was measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1.000 = optimum functioning). Depression was assessed using the Center for Epidemiologic Studies Depression scale and early symptoms of acute stress reaction were assessed using the Impact of Events scale. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after discharge. RESULTS: Functional outcome was significantly worse at each follow-up time point in women (n = 313) versus men (n = 735). Quality of Well-being scale scores were markedly and significantly lower at 6-month follow-up in women compared with those in men (0.606 vs. 0.646, p < 0.0001). This association persisted at 12-month (0.637 vs. 0.6685, p < 0.0001) and 18-month (0.646 vs. 0.6696, p < 0.0001) follow-up. Women were also significantly more likely to be depressed at all follow-up time points (discharge odds ratio [OR] = 1.4, p < 0.05; 6-month follow-up OR = 2.2, p < 0.01; 12-month follow-up OR = 2.0, p < 0.01; 18-month follow-up OR = 2.2, p < 0.01) and to have early symptoms of acute stress reaction at discharge (OR = 1.4, p < 0.05). These differences remained significant and independent after adjusting for injury severity, mechanism, age, and sociodemographic factors. CONCLUSION: Women are at risk for markedly worse functional and psychological outcomes after major trauma than men, independent of injury severity and mechanism. Gender differences in short- and long-term trauma outcomes have important implications for future studies of recovery from trauma.

A population-based comparison of quantitative dual-energy X-ray absorptiometry with dual-photon absorptiometry of the spine and hip.

Dual photon absorptiometry (DPA) is currently the most widely used method for noninvasive bone mineral density (BMD) measurement of the axial skeleton. Dual energy X-ray absorptiometry (DEXA) is a recently developed technique that uses an X-ray tube as a photon source; it has demonstrated several significant advantages over DPA in preliminary studies. We report here a quantitative comparison of the DEXA and DPA technologies using a Hologic DEXA (Hologic QDR model 1000, Waltham, MA) scanner and a Lunar DPA (Lunar Radiation DP3, gandolineum-153 source) scanner at both the proximal femur and lumbar spine sites using bone density measurements from a population-based sample of older white men and women who had complete DEXA and DPA measurements of the hip (n = 217) or the spine (n = 176). To examine the relationship of BMD measured by the DPA scanner to BMD measured on the DEXA scanner, normal least squares linear regression was used to regress the DPA BMD on the DEXA BMD for each site. DEXA values were consistently lower than DPA values, with an average difference of 16%. The squared multiple correlation (R2) values were at or above 0.95 for almost all sites, with Ward's triangle having the lowest value (0.89). The slope for all sites was similar, ranging from 0.94 to 1.1. Research and clinical centers that wish to change to DEXA technology because of its shorter examination time and greater precision can therefore compare DEXA with DPA values using representative conversion factors.

Risk factors for mortality after failed coronary angioplasty: an anesthesia perspective.

Monitored anesthesia care (MAC) for percutaneous transluminal coronary angioplasty (PTCA), and anesthesia for emergent coronary artery bypass graft (CABG) surgery due to failed PTCA, have added relatively new challenges to the cardiac anesthesiologist in community practice. This study attempted to define easily identifiable preangioplasty and periangioplasty risk factors for mortality after failed PTCA. A total of 1,380 angioplasties performed in a single community hospital were retrospectively reviewed; 120 (8.7%) were attempted PTCAs requiring subsequent CABG during the same hospital stay. The 120 failures included 10 surgical mortalities (8.3%); multivariate analysis revealed several significant differences between the mortality and survivor groups. Mortality tended to be higher in insulin-dependent diabetics (P = 0.003), females (P = 0.005), and patients 70 years or over (P = 0.043). Previous CABG, decreased left ventricular ejection fraction, and number of vessels with significant disease did not differ between the groups. Patients who died required more vasopressor agents (P = 0.011) during PTCA and experienced cardiac arrests (P = 0.011) at significantly higher rates than survivors. Left system (left anterior descending or circumflex coronary artery) angioplasty, inability to pass the angioplasty guidewire, and antiarrhythmic drug use did not differ between groups. Data concerning endotracheal intubation in the catheterization laboratory and time from laboratory exit to initiation of cardiopulmonary bypass, while bivariately significant, were too sparse for multivariate analysis. The authors believe that several risk factors for postangioplasty surgical mortality are easily determined without access to diagnostic angiographic studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Lifetime milk consumption and bone mineral density in older women.

This study examined the relationship between lifetime milk consumption both axial and appendicular bone mineral density in 581 postmenopausal White women. Positive significant, graded associations between milk consumption in adulthood and bone mineral density at the spine, total hip, trochanter, intertrochanter, and midradius, but not the ultradistal wrist or femoral neck, were observed. Adolescent milk consumption showed similar, statistically significant associations (spine and midradius). Associations were independent of age, body mass index, years postmenopausal, thiazide, estrogen and alcohol use, smoking, and exercise. Regular milk consumption in youth and adulthood is associated with better bone mineral density at cortical and trabecular sites in elderly women.