Beruflich Dokumente
Kultur Dokumente
DOI 10.1007/s00198-011-1623-0
ORIGINAL ARTICLE
Received: 24 November 2010 / Accepted: 24 February 2011 / Published online: 6 April 2011
# International Osteoporosis Foundation and National Osteoporosis Foundation 2011
Abstract
Summary This analysis compares femur neck bone mineral
density (FNBMD) and bone determinants in adults between
National Health and Nutrition Examination Survey
(NHANES) III (19881994) and NHANES 20052008.
FNBMD was higher in NHANES 20052008 than in
NHANES III, but between-survey differences varied by
age, sex, and race/ethnicity. The likelihood that FNBMD
has improved appears strongest for older white women.
Introduction Recent data on hip fracture incidence and
femur neck osteoporosis suggest that the skeletal status of
older US adults has improved since the 1990s, but the
explanation for these changes remains uncertain.
The findings and conclusions in this report are those of the authors
and do not necessarily represent the views of the Centers for Disease
Control and Prevention or the Department of Health and Human
Services.
A. C. Looker (*)
National Center for Health Statistics,
Centers for Disease Control and Prevention,
Room 4310, 3311 Toledo Road,
Hyattsville, MD 20782, USA
e-mail: ALooker@cdc.gov
L. J. Melton III
Division of Epidemiology, College of Medicine, Mayo Clinic,
Rochester, MN, USA
e-mail: melton.j@mayo.edu
L. G. Borrud
National Center for Health Statistics,
Centers for Disease Control and Prevention,
Room 4327, 3311 Toledo Road,
Hyattsville, MD 20782, USA
e-mail: LBorrud@cdc.gov
J. A. Shepherd
Department of Radiology, University of California San Francisco,
San Francisco, CA, USA
e-mail: john.shepherd@radiology.ucsf.edu
Introduction
772
Methods
Sample
The NHANES are conducted by the National Center for
Health Statistics (NCHS), Centers for Disease Control and
773
774
Results
Mean FNBMD by age decade, sex, race/ethnicity, and
survey period is shown in Fig. 1ac. In general, FNBMD
was higher in NHANES 20052008 than NHANES III:
when standardized to the 2000 US Census population, the
age-adjusted mean for the total population age 20+years
was 0.839 gm/cm 2 in NHANES 20052008 versus
0.816 gm/cm2 in NHANES III (p<0.05). As noted earlier,
however, significant age, sex, and race/ethnic interactions
with survey period were found, indicating that betweensurvey FNBMD differences varied depending on these
characteristics. For example, among nonwhites, means were
higher in NHANES III than in NHANES 20052008 in
some age decades. However, between-survey FNBMD
differences were generally more consistently positive in
direction and larger in magnitude for adults age 50 years
and older than in younger adults when compared within sex
and race/ethnicity.
Table 1 compares means (or percents) of selected
comparably measured bone determinants by survey period
among older adults after adjusting for age, sex, and race/
ethnicity. Factors which differed significantly between
surveys in a direction consistent with improved FNBMD
were as follows: age, BMI, height, weight at age 25, ever
smoked, positive health status, use of bisphosphonates,
selective estrogen receptor modulators (SERMS) and other
non-estrogen medications that increase BMD, total calcium
intake, and caffeine intake. All other bone determinants
either changed in a direction that was inconsistent with
improved FNBMD (medications that decrease BMD, sex
hormone use, personal history of previous hip/wrist/spine
fracture, milk intake) or did not change significantly
between surveys (three or more drinks when consuming
alcohol, mother had a hip fracture, and sodium intake).
Table 2 summarizes results of the analyses performed to
assess the impact of the selected bone determinants that
changed in a manner consistent with improved BMD and
for possible differences in DXA methodology on the
FNBMD differences observed between surveys. The effect
775
Non-Hispanic whites
1
Women
Men
gm/cm2
0.9
0.8
0.7
0.6
0
2029
3039
4049
5059
6069
7079
80+
2029
3039
4049
5059
6069
7079
80+
7079
80+
7079
80+
Age (y)
Non-Hispanic blacks
1.1
Women
Men
gm/cm2
1
0.9
0.8
0.7
0
2029
3039
4049
5059
6069
7079
80+
2029
3039
4049
5059
6069
Age (y)
Mexican Americans
1
Women
Men
gm/cm2
0.9
0.8
0.7
0.6
0
2029
3039
4049
5059
6069
7079
80+
2029
3039
4049
5059
6069
Age (y)
Discussion
The present study examined FNBMD changes over time
across the entire adult age range, and thus extends our
776
Table 1 Selected bone determinants by NHANES survey period among adults age 50+years
Bone determinant
%a
Mean or percent
NHANES III 19881994
Age (years)
Body weight (kg)
Height (cm)
BMI
Weight at age 25 (lbs)
Ever smoked (%)
Positive health status (%)
Drink 3+ units alcohol (%)
Use medications that decrease BMD (%)c
Use medications that increase BMD (%)
Sex hormones
Bisphosphonates, SERMS, other non-estrogen drugs
Mother had a hip fracture (%)
Self-reported previous hip, wrist or spine fracture (%)
Drink milk 1+ times/week (%)
Calcium from food and supplements (mg/day)
Sodium from food (mg/day)
Caffeine (mg/day)
NHANES 20052008
64.5b
76.2
166.6
27.4
142.3
62.9b*
79.3*
167.6*
28.1*
145.5*
2
4
1
3
2
57.9
75.8
12.2
5.2
53.4*
80.2*
14.6
7.2*
8
6
16
28
8.0
0.4
8.7
8.8
77.2
872.4.
3,108.4
271.3
5.0*
7.3*
8.6
10.8*
71.7*
1,204.6*
3,136.5
206.2*
60
95
1
19
7
28
1
32
All bone determinants have been adjusted for age, sex and race/ethnicity except where noted
a
Glucocorticoids, antineoplastic drugs, anticonvulsants, barbiturates, heparin, IV nutrition products, lithium, cyclosporine, tacrolimus
*p<0.05
Table 2 Mean femur neck BMD by NHANES survey period among adults age 50+years
Race/ethnicity, sex
Non-Hispanic white
Women
Men
Non-Hispanic black
Women
Men
Mexican American
Women
Men
NHANES III
19881994
NHANES
20052008
%c
NHANES III
19881994
NHANES
20052008
%c
NHANES III
19881994
NHANES
20052008
0.672
0.787
0.717*
0.805*
6
2
0.675
0.799
0.716*
0.797
6
0.3
0.692
0.811
0.717*
0.805
4
0.7
0.796
0.872
0.806
0.893
1
2
0.796
0.885
0.810
0.888
2
0.3
0.820
0.898
0.806
0.893
2
0.6
0.726
0.839
0.756*
0.819
4
2
0.734
0.844
0.755*
0.818*
3
3
0.748
0.864
0.756
0.819*
1
6
%c
a
BMI, height, weight at age 25 years, smoking, health status, use of bisphosphonates, SERM, and other nonestrogen drugs, total calcium intake, and
caffeine intake
b
*p<0.05
777
5
-5
-15
-25
-35
-45
-55
BMI
Age 25
weight
Smoking
Calcium
778
Appendix 1
Specific drugs composing medication groups
I. Medications that increase BMD
(A) Sex hormones (NHANES III and NHANES
20052008)
1. Estrogens: estradiol, estradiol valerate, estrogenic
substances, conjugated estrogens, esterified estrogens (alone and with methyltestosterone), estropipate, ethinyl estradiol (alone or with ethynodiol
diacetate, levonorgestrel, norethindrone, norethindrone acetate, or desogestrel), diethylstilbesterol
(alone or with disphosphate), fluoxymesterone, or
quinestrol.
2. Testosterones: testosterone, testosterone cypionate, stanozolol and nandrolone decanoate.
(B) Non-estrogen drugs
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