Physical activity reduces bone loss in the distal forearm in post-menopausal women--a 25-year prospective study.

Intervention studies have shown that high-intensity training programs with duration of 1-3 years can influence bone mass in post-menopausal women. We wanted to investigate whether moderate physical activity could be associated with reduced post-menopausal bone loss also in the long-term perspective. We evaluated changes in bone mass and bone structure by repeated single-photon absorptiometry measurements of the distal forearm in 91 moderately physically active and 21 inactive women, categorized according to information from questionnaires, from menopause and on average 25 years onwards. Data were calculated with analysis of variance and analysis of covariance tests and presented as means with 95% confidence interval. There were no group differences in bone mass or bone structure at menopause. The mean annual loss in bone mineral content was 1.2% (1.1, 1.3) in the physically active and 1.6% (1.3, 1.8) in the inactive women (after adjustment for menopausal age P = 0.02) and the mean decline in a strength index based on bone mass and bone structure was 0.7% (0.6, 0.8) in the physically active and 1.2% (0.8, 1.5) in the inactive women (P = 0.004). There were no group differences in the changes in bone structure. Physical activity is also in a long-term perspective associated with reduced post-menopausal bone loss.

Early menopause and risk of osteoporosis, fracture and mortality: a 34-year prospective observational study in 390 women.

OBJECTIVE: A prospective evaluation of the long-term effects of early menopause on mortality, risk of fragility fracture and osteoporosis. DESIGN: Prospective population-based observational study. SETTING: Malmö, Sweden. POPULATION: A total of 390 white north European women aged 48 years at the start of the study. METHODS: At baseline, bone mineral density (BMD) was measured by single-photon absorptiometry (SPA) in the distal forearm and menopausal status was noted. Menopause was determined according to the World Health Organization criterion of a minimum of 12 months of continuous amenorrhoea. Women were divided into early menopause (occurring before age 47 years) and late menopause (occurring at age 47 years or later). At age 77, forearm BMD was re-measured by SPA and proximal femur and lumbar spine BMD were measured by dual-energy X-ray absorptiometry (DXA). The prevalence of osteoporosis was determined using the DXA data. Mortality rate and the incidence of fractures were registered up until age 82. Data are presented as means with 95% confidence intervals (95% CI). MAIN OUTCOME MEASURES: Incidence of fragility fractures, mortality, prevalence of osteoporosis at age 77. RESULTS: Women with early menopause had a risk ratio of 1.83 (95% CI 1.22-2.74) for osteoporosis at age 77, a risk ratio of 1.68 (95% CI 1.05-2.57) for fragility fracture and a mortality risk of 1.59 (95% CI 1.04-2.36). CONCLUSIONS: Menopause before age 47 is associated with increased mortality risk and increased risk of sustaining fragility fractures and of osteoporosis at age 77.

Changes in forearm bone mass and bone size after menopause--a mean 24-year prospective study.

OBJECTIVE: Bone loss and periosteal expansion is found after menopause. The accelerated early postmenopausal bone loss is not permanent but if the same accounts for the periosteal expansion is unknown. METHODS: Bone mineral density (BMD) and skeletal structure of the distal forearm were followed from menopause and on average 24 years (range 18-28) by single-photon absorptiometry at 12 occasions in a population-based sample of 81 Caucasian women with no medication or disease affecting bone metabolism. A Strength Index based on areal BMD and bone structure was calculated. Postmenopausal serum-estradiol levels and incident distal radius fractures were registered. Data are presented as means with 95% confidence interval (95% CI). RESULTS: The annual BMD loss in three periods, 0-8, 8-16 and 16-28 years after menopause, was 2.0% (1.6, 2.4), 1.0% (0.6, 1.4) and 1.0% (0.7, 1.3), respectively. The annual periosteal expansion was 1.0% (0.8, 1.3), 0.0% (-0.3, 0.3) and 0.0% (-0.2, 0.2), respectively. Mean post-menopausal oestrogen levels correlated moderately with annual loss in aBMD (r=0.51, p<0.001) but less with the annual changes in bone width (r= -0.22, p=0.06). CONCLUSION: Postmenopausal periosteal expansion in the distal forearm seems to occur only in the first postmenopausal decade.