Bone health in immigrant Hispanic women living in Texas.

Osteoporosis is a serious national public health problem, and is expected to increase significantly over the next few decades, especially in women. A limitation of bone health research exists since few studies have involved Hispanic women, and even fewer, Hispanic immigrant women. For this study we examined the effects of anthropometric, behavioral, and health history variables on bone mineral density (BMD) in 84 immigrant Hispanic women, age 40 and above. BMD was assessed at the spine, femur, and forearm using dual energy x-ray absorptiometry (DXA). Demographic information, health histories, and behavioral risk factors were obtained from a questionnaire. In the younger group (mean age = 44.1 years) 61% had spinal osteopenia, and in the postmenopausal group (mean age = 53.0 years) 59% had osteopenia and 13% had osteoporosis. Femur sites were free of osteoporosis. Mean body mass index (BMI) was 31.8 ± 6.1 and mean waist girth was 95.6 ± 12.5 cm, indicating overall and abdominal obesity. Partial correlations indicated a significant positive relationship between body fat variables and total femur BMD values. ANOVAs revealed no differences in BMD values at any bone site across tertile levels for calcium intake or for physical activity. However, supplemental and dietary calcium intakes were very low and few participants engaged in regular physical activity outside of work and activities of daily living (ADL). In light of the expected increase in osteoporosis in this population and the prevalence of spinal osteopenia in the younger participants, education about the health risks of osteoporosis should be made available to this group.

Impact of Tai Chi on Peripheral Neuropathy Revisited: A Mixed-Methods Study.

Exercise may be beneficial to older persons living with peripheral neuropathy (PN), but maintaining an exercise program is challenging. After participating in a 12-week tai chi (TC) study, 12 participants requested classes continue. A mixed-methods design was used to explore long-term engagement of older persons with bilateral PN enrolled in a TC class for 18 months beyond the original 3-month study. Pre- and posttest measures of functional status and quality of life (QOL) were conducted. Focus groups were held after 18 months of twice-weekly classes. Psychosocial support was critical to participants' long-term commitment to exercise. Participants reported, and objective assessments confirmed, increased strength, balance, and stamina beyond that experienced in the original 12-week study. Changes in QOL scores were nonsignificant; however, qualitative data supported clinical significance across QOL domains. Results from this study support psychosocial and physical benefits of TC to older persons.

Evaluation of web-based osteoporosis educational materials.

BACKGROUND: Many women are unaware of risk factors for and consequences of osteoporosis. Hence, patient education is an essential step in preventing and managing osteoporosis. Unfortunately, numerous studies have demonstrated a mismatch between the reading difficulty of typical patient education materials and the reading ability of many American adults. METHODS: We examined the readability and quality of web-based information on osteoporosis using the Suitability Assessment of Materials (SAM) and DISCERN instruments. The three most widely used Internet search engines, Google, Yahoo, and MSN, were selected based on popularity according to Nielsen/Net Ratings. The search term osteoporosis was entered to generate the first 30 websites listed by each of the three search engines. Several websites appeared on all three search engines; we identified 27 unique websites. RESULTS: Overall, 51.9% of materials were rated by the SAM as not suitable. Most materials scored poorly for their reading level (82.6% were rated not suitable), with an average reading level at grade 11.5 +/- 2.8. The mean DISCERN score for overall description of treatment options was 35.7 +/- 18.0, indicating inadequate quality. Most materials had low quality in a number of indicators, including accuracy and biased presentation of information. CONCLUSIONS: Web-based osteoporosis information is written above the reading ability of most American adults, and much of it lacks adequate quality.

Comparison between 60 matched pairs of postmenopausal black and white women: analysis of risk factors related to bone mineral density.

PURPOSE: Osteoporosis is a systemic disease in which bone density is reduced, leading to weakness of the skeleton and increased vulnerability to fractures. The purpose of this study was to compare known or suspected risk factors (medical, gynecological, and lifestyle characteristics) related to bone loss between 60 matched pairs of black and white postmenopausal women. METHODS: The two racial groups were matched one for one on selective anthropometric variables [age (years), standing height (cm), and body weight (kg)] in order to equate age and body size between groups. Information on risk factors was obtained from an orally administered questionnaire and body composition variables (in addition to those used for matching) assessed by anthropometry and total body dual energy X-ray absorptiometry (DXA). Four skinfold sites (chest, triceps, mid-axillary, and abdomen) were measured with Harpendon calipers and four body circumferences (chest, forearm contracted, waist, and gluteal) were assessed with a Gulick tape. DXA radius, spine, femur, and whole body measurements were obtained on a Hologic QDR-2000 with software version 7.20. RESULTS: White women reported significantly higher proportions of alcohol use, family history of broken bones, and a greater utilization of hormones, calcium and vitamins than did black women. Black women reported a greater numbers who had other diseases (i.e., overactive thyroid, diabetes, rheumatoid arthritis, or kidney stones). Although age and body weight were similar in both groups, black women had greater lean tissue and less body fat than white women. Blacks had significantly higher bone mineral density across all body sites with the exception of the mid- and ultra-distal radius. CONCLUSION: On the basis of these data, it was concluded that part of the difference often observed in bone density between black and white postmenopausal women might be due to lifestyle factors.

Random field assessment of inhomogeneous bone mineral density from DXA scans can enhance the differentiation between postmenopausal women with and without hip fractures.

Bone mineral density (BMD) measurements from Dual-energy X-ray Absorptiometry (DXA) alone cannot account for all factors associated with the risk of hip fractures. For example, the inhomogeneity of bone mineral density in the hip region also contributes to bone strength. In the stochastic assessment of bone inhomogeneity, the BMD map in the hip region is considered as a random field and stochastic predictors can be calculated by fitting a theoretical model onto the experimental variogram of the BMD map. The objective of this study was to compare the ability of bone mineral density and stochastic assessment of inhomogeneous distribution of bone mineral density in predicting hip fractures for postmenopausal women. DXA scans in the hip region were obtained from postmenopausal women with hip fractures (N=47, Age: 71.3±11.4 years) and without hip fractures (N=45, Age: 66.7±11.4 years). Comparison of BMD measurements and stochastic predictors in assessing bone fragility was based on the area under the receiver operating characteristic curves (AUC) from logistic regression analyses. Although stochastic predictors offered higher accuracy (AUC=0.675) in predicting the risk of hip fractures than BMD measurements (AUC=0.625), this difference was not statistically significant (p=0.548). Nevertheless, the combination of stochastic predictors and BMD measurements had significantly (p=0.039) higher prediction accuracy (AUC=0.748) than BMD measurements alone. This study demonstrates that stochastic assessment of bone mineral distribution from DXA scans can serve as a valuable tool in enhancing the prediction of hip fractures for postmenopausal women in addition to BMD measurements.

The effect of 15 weeks of exercise on balance, leg strength, and reduction in falls in 40 women aged 65 to 89 years.

OBJECTIVE: Risk of falling increases as people age, and decreased leg strength and poor balance have been implicated as contributors. Our aims were to:1) assess the efficacy of a fall-prevention exercise program on balance and leg strength in women aged 65 to 89 years and 2) conduct a 1-year follow-up to determine the effect of exercise on fall rates. METHODS: Forty women were classified by falling history and fear of falling and assigned to exercise and control groups using stratified randomization. We used the Berg Balance Scale, Get-up and Go, Functional Reach, and Wall-Sit Tests to evaluate changes in balance and leg strength before and after a supervised 15-week exercise program (31-hr sessions/week). We conducted 1-year follow-up telephone interviews and compared the number of falls reported by exercise and control groups.The study used a 2 x 2 (exercise/control by pretest/post-test) factorial design with the testing times being a repeated factor, so we used analysis of variance (ANOVA) to evaluate differences between the 2 groups across testing times. Power analysis computed a priori with STPLAN software (Version 4.2) showed that a sample size of 40 was necessary to determine statistical differences in balance and leg strength. RESULTS: Exercise subjects showed significant improvement on 5 of 14 items (5.2%, p < or = 05 to 34.4%, p < or = .01) in the Berg Balance Scale and on the total score (6.8%, p < or = .05). Leg strength increased significantly (p < or = .05) on post-test as measured by the Wall-Sit Test. Control subjects reported 6 falls and exercise subjects no falls during the follow-up year, but this difference was not significant using Fischer's exact test (p=.106). CONCLUSION: The exercise program resulted in increased balance and leg strength, but did not result in a significant difference in falls during the follow-up period. Further research with a larger and possibly older sample is needed to more adequately investigate this question. Health care providers who work with older women should provide exercise programs in which balance and leg strength are emphasized.

Evaluation of decision rules for identifying low bone density in postmenopausal African-American women.

OBJECTIVE: While African-American women tend to have greater bone mineral density (BMD) than caucasian women, they are still at risk of developing osteoporosis later in life. Clinical decision rules (i.e., algorithms) have been developed to assist clinicians identify women at greatest risk of low BMD. However, such tools have only been validated in caucasian and Asian populations. Accordingly, the objective of this study was to compare the performance of five clinical decision rules in identifying postmenopausal African-American women at greatest risk for low femoral BMD. METHODOLOGY: One hundred-seventy-four (n=174) postmenopausal African-American women completed a valid and reliable oral questionnaire to assess lifestyle characteristics, and completed height and weight measures. BMD at the femoral neck was measured via dual energy x-ray absorptiometry (DXA). We calculated sensitivity, specificity, positive predictive value, and negative predictive value for identifying African-American women with low BMD (T-Score < or = -2.0 SD) using five clinical decision rules: Age, Body Size, No Estrogen (ABONE), Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Self-Assessment Tool (OST), Simple Calculated Osteoporosis Risk Estimation (SCORE), and body weight less than 70 kg. RESULTS: Approximately 30% of African-American women had low BMD, half of whom had osteoporosis (BMD T-Score < or = -2.5 SD). Sensitivity for identifying women with a low BMD (T-Score < or = -2.0 SD) ranged from 65.57-83.61%, while specificity ranged from 53.85-78.85%. Positive predictive values ranged from 80.95-87.91%, while negative predictive values ranged from 48.44-58.33%. CONCLUSION: Our data suggest that the clinical decision rules analyzed in this study have some usefulness for identifying postmenopausal African-American women with low BMD. However, there is a need to establish cut-points for these clinical decision rules in a larger, more diverse sample of African-American women.

Osteoporosis coverage in selected women's magazines and newspapers, 1998-2001.

OBJECTIVE: To evaluate the accountability of osteoporosis information available in selected mass-circulating women's magazines (n=8) and a sample of newspapers (n=2). METHODS: Osteoporosis articles (n=132) were assessed for sources of information used, incidence/prevalence statistics, risks factors, and prevention measures. RESULTS: Expert sources were highlighted in the majority of articles, whereas incidence/ prevalence statistics were described in less than half of the articles. Risk factors and prevention measures were outlined in most articles; however, much of the information presented was ambiguous and incomplete. CONCLUSIONS: It appears that the reporting of osteoporosis in women's magazines and newspapers is not entirely balanced; thus, future coverage should provide greater detail when reporting risks and preventive measures.

Bone mineral density in Hispanic women: a review of the literature with implications for promoting culturally relevant osteoporosis education.

Osteoporosis is a disease that primarily affects postmenopausal women of all ethnicities. Demographic projections indicate that the number of Hispanics over age 65 in the U.S. will increase from 2.9 million currently, to 17.5 million in 2050. A majority will be women. Recent research has increased understanding about biocultural correlates of osteoporosis in Hispanic women, and indicates that their risk for the disease is about equal to that of non-Hispanic White (NHW) women. Although Hispanics living in the U.S. share many biological and cultural characteristics with the general population, there are important differences in disease pre-disposition and associated morbidity that present challenges to osteoporosis prevention efforts. The purpose of this article is to provide a review of selected bone density studies that have included Hispanic women, to summarize the findings, and to discuss implications of these findings for osteoporosis prevention education for this population.

Lifetime physical activity and calcium intake related to bone density in young women.

OBJECTIVE: Osteoporosis is a significant public health problem associated with increased mortality and morbidity. Our aim in this cross-sectional study was to investigate the relationship between lifetime physical activity and calcium intake and bone mineral density (BMD) and BMC (bone mineral content) in 42 regularly menstruating Caucasian women (age 21.26+/-1.91 years, BMI 23.83+/-5.85). METHODS: BMD and BMC at the lumbar spine (L2-L4), hip (femoral neck, trochanter, total), and total body were assessed by dual energy x-ray absorptiometry (DXA). Lifetime history of physical activity and calcium intake was obtained by a structured interview using valid and reliable instruments. RESULTS: Measures of both lifetime physical activity and calcium intake were highly correlated. In stepwise multiple regression analyses, lean mass was the most important and consistent factor for predicting BMD and BMC at all skeletal sites (attributable r2 = 28.8%-78.7%). Lifetime physical activity contributed to 3.0% of the variation in total body BMD, and life-time weight-bearing physical activity explained 15.1% of variance in lumbar spine BMC. Current calcium intake predicted 6% of the variance in BMD at the femoral neck and trochanter. CONCLUSIONS: We found lean mass to be a powerful predictor of BMD and BMC in young women. Because lean mass can be modified to some extent by physical activity, public health efforts must be directed at increasing physical activity throughout the lifespan. Furthermore, our results suggest that adequate calcium intake may help to enhance bone mass, thus decreasing the risk of osteoporotic fracture later in life.