The Impact of Endogenous Estrogen Exposure Duration on Fracture Incidence: a Longitudinal Cohort Study.

CONTEXT: Although it is well documented that estrogen hormone is positively associated with bone mineral density and lower risk of fracture, there are limited studies on the association between duration of endogenous estrogen exposure (EEE) and fracture, especially by longitudinal design. OBJECTIVE: This study aimed to investigate the relationship between EEE with fracture incidence by longitudinal design in a community-based study. METHODS: A total of 5269 eligible postmenarcheal women, including 2411 premenopausal and 2858 menopausal women, were recruited from among the Tehran Lipid and Glucose Study. Cox proportional hazards regression model with adjustment of potential confounders was performed to assess the relationship between duration of EEE and incident of any hospitalized fractures. RESULTS: A total of 26.7% (1409/5269) women were menopausal at the baseline, and 2858 of the remaining participants reached menopause at the end of follow-up. Results of the unadjusted model demonstrated that the EEE z-score was negatively associated with fracture incidence [unadjusted hazard ratio (HR) 0.81, 95% CI 0.68-0.96] in postmenarchal women, indicating that per 1-SD increase of EEE z-score, the hazard of fracture reduced by 19%. Results remained statistically unchanged after adjustment for potential confounders (adjusted HR 0.70, 95% CI 0.58-0.86). CONCLUSION: The findings of this cohort study suggest that a longer duration of EEE has a protective effect on fracture incidence; a point that needs to be considered in fracture risk assessment.

Comparison of the Efficacy Between Two Micro-Operative Therapies of Old Patients With Osteoporotic Vertebral Compression Fracture: A Network Meta-Analysis.

Osteoporotic vertebral compression fracture (OVCF) afflicts most aged people. Except for conservative therapy (CT), percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are another two the common choices, but current evaluation of their efficacy is not performed. All the trial data were originated from electronic database including PubMed, Embase, and Cochrane Library. Four indicators with mean difference (MD) or odd ratio (OR) with their 95% credible interval (95% CrI) were analyzed to evaluate the efficacy, including the value of visual analog scale (VAS), Oswestry disability index (ODI), relieving kyphotic angle (KA), and rate of fracture. Besides, the results were demonstrated in the forest plots and slash tables. Furthermore, the surface under the cumulative ranking curve (SUCRA) was calculated. A total of 32 trials among 2,852 patients are included. Using network comparison, we found that PKP and PVP both have good performance as OVCF treatments. However, in different aspects, PKP seemed to be the best to eliminate pain with high value of SUCRA on ODI and VAS (0.624 and 0.588, respectively), and PVP had better performance in KA and decreasing incidence of fracture. The micro-operative therapy, both PKP and PVP, had better efficacy than CT in four aspects. And PKP was better in pain alleviating, according to VAS and ODI results, while PVP had the superiority in KA and reducing the incidence of fracture. J. Cell. Biochem. 118: 3205-3212, 2017. © 2017 Wiley Periodicals, Inc.