Women with hip fracture have a greater rate of decline in bone mineral density than expected: another significant consequence of a common geriatric problem.

INTRODUCTION: Hip fracture is a major public health problem, annually affecting over 350,000 persons in the United States and 1.6 million worldwide. Consequences include decreased survival, loss of independence, and increased risk of subsequent fractures. A substantial decline in bone mineral density (BMD) also occurs, yet the magnitude of the decline specifically attributable to hip fracture has not been documented. METHODS: To determine the amount of BMD decline attributable to hip fracture, the rate of decline in BMD in a cohort of hip fracture patients was compared with that in a cohort of women of similar age and BMD but without hip fracture. All subjects were community dwelling when enrolled. Hip fracture patients in the Baltimore Hip Studies (BHS) came from two hospitals in Baltimore, Maryland, from 1992 through 1995; comparison subjects came from the Study of Osteoporotic Fracture (SOF) enrolled in four areas of the United States during the same period. Eighty-four white, female hip fracture patients 65 years and older from the BHS were compared with 168 SOF participants matched on age, race, and BMD at baseline. BMD of the femoral neck and total hip was measured by dual-energy x-ray absorptiometry. RESULTS: Hip fracture patients had a greater decline in BMD during the 12-month postfracture follow-up than that expected on the basis of the nonfracture cohort: 4.9% vs. 0.4% at the femoral neck and 3.5% vs. 0.7% for the total hip. The decline in BMD in hip fracture patients was 11.8 times the amount expected at the femoral neck (matched on age and baseline BMD and adjusted for between-cohort differences in smoking prevalence) and 4.9 times that expected for the total hip at the end of 1 year after the hip fracture. CONCLUSION: In this sample of older women, bone loss over the year following hip fracture far exceeded that expected and is an important clinical management concern.

Weight, weight change, mortality in a random sample of older community-dwelling women.

OBJECTIVE: To evaluate the relationship between measured weight, weight change, and 6-year mortality risk in a random sample of 648 community-dwelling women aged 65 and older from Baltimore, Maryland. MEASUREMENTS: Data were collected using a standardized questionnaire and administered in person by trained interviewers. Questionnaires were completed annually from 1984 to 1986, and body weight was measured at each interview. Weight was defined as body mass index (BMI) of low (< 23 kg/m2), average (> or = 23 kg/m2 to < or = 28 kg/m2), and high (> 28 kg/m2). Four mutually exclusive categories of weight change of at least 4.5% in BMI over the three annual interviews were developed to describe all possible weight change patterns: weight gain, weight loss, no change, and weight cycling. RESULTS: During the follow-up period, 106 women (16%) died. Women with low baseline BMI, regardless of weight change, and those who lost weight, regardless of baseline BMI had increased mortality risk. Women with average baseline BMI and weight loss had a very high mortality risk (hazard ratio (HR) 3.84, 95% Confidence interval (CI) 2.14-6.89). Women who weight cycled had increased mortality risk at low and high baseline weights, and a nonsignificant increased risk at average baseline weight (P = .069). Analyses were adjusted for age, education, smoking, alcohol usage, and pre-existing illness and included an interaction between weight change and baseline BMI. CONCLUSIONS: These results suggest that white, older, community-dwelling women are at an increased risk of mortality if they are underweight, lose weight, or weight cycle.

Cigarette smoking, alcohol consumption, and screening mammography among women ages 50 and older.

BACKGROUND: The associations among cigarette smoking and alcohol consumption with recent screening mammograms were evaluated among women ages 50 years and older. METHODS: The sample included 946 white and African-American women ages 50 years and older from the 1995 Maryland Behavioral Risk Factor Survey. Bivariate and logistic regression analyses were performed to evaluate the associations between current cigarette smoking and alcohol consumption in the past month (none, 1-7 drinks, >7 drinks) with obtaining a screening mammogram in the past 2 years (recent mammogram), controlling for sociodemographic and health variables. RESULTS: Seventy-eight percent of respondents had recent mammograms, 15% smoked cigarettes, 18% reported 1-7 drinks, and 12% reported >7 drinks in the past month. Smokers had lower mammography rates than nonsmokers (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.30-0.75). Women who drank alcoholic beverages had higher mammography rates than nondrinkers (OR = 1.37, 95% CI = 1.03-1.83). Smokers had the lowest mammography rates, regardless of their consumption of alcohol. An interaction was observed among white but not African-American women: nonsmokers who consumed moderate amounts of alcohol (1-7 drinks) had the highest mammography rates in this subgroup. CONCLUSIONS: To reduce breast cancer mortality, it is important to increase screening mammography among all women over age 50 and especially among smokers and the oldest women.

Tuberculosis in the homeless.

The prevalence of tuberculosis in the homeless is on the rise. The presence of human immunodeficiency virus and multidrug-resistant tuberculosis in the homeless has contributed to this high prevalence. Several factors, including alcoholism, substance abuse, and psychiatric illness, combine to make it difficult to diagnose and treat tuberculosis in the homeless. Medical providers are likely to encounter homeless individuals in a number of settings, including emergency departments, community and free clinics, public hospitals, and health maintenance organizations. Appropriate screening, prevention, and treatment should be undertaken in collaboration with local health departments. The use of directly observed therapy and of the treatment regimens published by the Centers for Disease Control and Prevention improves treatment outcomes among the homeless.

Screening for sexually transmitted diseases by primary care physicians.

The acquired immunodeficiency syndrome epidemic has drawn attention to screening for sexually transmitted diseases by primary care physicians. A telephone survey of primary care physicians in an area with a high incidence of STDs (Washington, DC) to ascertain the determinants and the extent of screening and counseling for STDs was completed in 1987. Ninety-nine physicians (33 internists, 38 obstetrician/gynecologists, and 28 family/general practitioners), representing 61% of those eligible, completed the interview. One third (39.4%) were screening for gonorrhea, more than one half (57.5%) for syphilis, and almost all (94%) had tested at least one individual for human immunodeficiency virus infection. Analysis suggested that concomitant screening for hepatitis B was significantly and positively associated with screening for gonorrhea and syphilis. Less than half (45.9%) of the physicians asked new patients about their sexual practices. Physicians should take histories of sexual practices and do more preventive counseling.

Social ties and mortality in Evans County, Georgia.

In an attempt to replicate Berkman and Syme's study of social networks and mortality in Alameda County, California, the authors investigated the relationship between a social network index and survivorship from 1967 to 1980 in the Evans County, Georgia, cohort. They constructed an index modeled after the Berkman Social Network Index and tested it in race- and sex-specific proportional hazards models for 2,059 subjects who were examined in 1967-1969 during the Evans County Cardiovascular Epidemiologic Study. The present study emphasized a priori specification of the social network index and statistical hypothesis test. Descriptive analyses were consistent with a modest social networks effect (e.g., hazard ratio (95 per cent confidence interval) of 1.6 (1.2-2.2) ). Among white males, the age-adjusted hazard ratio comparing the lowest to the highest value of our six-level index was 2.0 (1.2-3.4), but control for potential confounders (principally cardiovascular disease risk factors) reduced this value to 1.5 (0.8-2.6). The social networks effect among white females, black males, and black females was weaker and clearly nonsignificant. Exploratory analyses suggested that marital status, church activities, and an alternate social network index predicted survivorship, but not in a dose-response fashion. Reduced survivorship among older subjects with few social ties was the most important feature of the data.