Premenopausal women with idiopathic low-trauma fractures and/or low bone mineral density

A. Cohen, Robert R. Recker, Joan M. Lappe, D. W. Dempster, S. Cremers, D. J. McMahon, E. M. Stein, J. Fleischer, C. J. Rosen, H. Rogers, R. B. Staron, J. LeMaster, E. Shane

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Abstract

Introduction In men, idiopathic osteoporosis (IOP) is often associated with low serum insulin-like growth factor (IGF-1) and reduced bone formation. The characteristics of premenopausal women with IOP are not well defined. We aimed to define the clinical, reproductive, and biochemical characteristics of premenopausal women with unexplained osteoporosis. Methods This is a cross-sectional study of 64 women with unexplained osteoporosis, 45 with fragility fractures, 19 with low bone mineral density (BMD; Z-score less than or equal to -2.0) and 40 normal controls. The following are the main outcome measures: clinical and anthropometric characteristics, reproductive history, BMD, gonadal and calciotropic hormones, IGF-1, and bone turnover markers (BTMs). Results Subjects had lower BMI and BMD than controls, but serum and urinary calcium, serum estradiol, vitamin D metabolites, IGF-1, and most BTMs were similar. Serum parathyroid hormone (PTH) and the resorption marker, tartrate-resistant acid phosphatase (TRAP5b), were significantly higher in both groups of subjects than controls and directly associated in all groups. Serum IGF-1 and all BTMs were directly associated in controls, but the association was not significant after controlling for age. There was no relationship between serum IGF-1 and BTMs in subjects. There were few differences between women with fractures and low BMD. Conclusions Higher serum TRAP5b and PTH suggest that increased bone turnover, possibly related to subclinical secondary hyperparathyroidism could contribute to the pathogenesis of IOP. The absence of differences between women with fractures and those with very low BMD indicates that this distinction may not be clinically useful to categorize young women with osteoporosis.

Original languageEnglish
Pages (from-to)171-182
Number of pages12
JournalOsteoporosis International
Volume23
Issue number1
DOIs
StatePublished - Jan 2012

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Bone Density
Bone Remodeling
Osteoporosis
Insulin-Like Growth Factor I
Wounds and Injuries
Serum
Parathyroid Hormone
Gonadal Hormones
Reproductive History
Secondary Hyperparathyroidism
Somatomedins
Osteogenesis
Vitamin D
Estradiol
Cross-Sectional Studies
Outcome Assessment (Health Care)
Calcium
Control Groups

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism

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Premenopausal women with idiopathic low-trauma fractures and/or low bone mineral density. / Cohen, A.; Recker, Robert R.; Lappe, Joan M.; Dempster, D. W.; Cremers, S.; McMahon, D. J.; Stein, E. M.; Fleischer, J.; Rosen, C. J.; Rogers, H.; Staron, R. B.; LeMaster, J.; Shane, E.

In: Osteoporosis International, Vol. 23, No. 1, 01.2012, p. 171-182.

Research output: Contribution to journalArticle

Cohen, A, Recker, RR, Lappe, JM, Dempster, DW, Cremers, S, McMahon, DJ, Stein, EM, Fleischer, J, Rosen, CJ, Rogers, H, Staron, RB, LeMaster, J & Shane, E 2012, 'Premenopausal women with idiopathic low-trauma fractures and/or low bone mineral density', Osteoporosis International, vol. 23, no. 1, pp. 171-182. https://doi.org/10.1007/s00198-011-1560-y
Cohen, A. ; Recker, Robert R. ; Lappe, Joan M. ; Dempster, D. W. ; Cremers, S. ; McMahon, D. J. ; Stein, E. M. ; Fleischer, J. ; Rosen, C. J. ; Rogers, H. ; Staron, R. B. ; LeMaster, J. ; Shane, E. / Premenopausal women with idiopathic low-trauma fractures and/or low bone mineral density. In: Osteoporosis International. 2012 ; Vol. 23, No. 1. pp. 171-182.
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abstract = "Introduction In men, idiopathic osteoporosis (IOP) is often associated with low serum insulin-like growth factor (IGF-1) and reduced bone formation. The characteristics of premenopausal women with IOP are not well defined. We aimed to define the clinical, reproductive, and biochemical characteristics of premenopausal women with unexplained osteoporosis. Methods This is a cross-sectional study of 64 women with unexplained osteoporosis, 45 with fragility fractures, 19 with low bone mineral density (BMD; Z-score less than or equal to -2.0) and 40 normal controls. The following are the main outcome measures: clinical and anthropometric characteristics, reproductive history, BMD, gonadal and calciotropic hormones, IGF-1, and bone turnover markers (BTMs). Results Subjects had lower BMI and BMD than controls, but serum and urinary calcium, serum estradiol, vitamin D metabolites, IGF-1, and most BTMs were similar. Serum parathyroid hormone (PTH) and the resorption marker, tartrate-resistant acid phosphatase (TRAP5b), were significantly higher in both groups of subjects than controls and directly associated in all groups. Serum IGF-1 and all BTMs were directly associated in controls, but the association was not significant after controlling for age. There was no relationship between serum IGF-1 and BTMs in subjects. There were few differences between women with fractures and low BMD. Conclusions Higher serum TRAP5b and PTH suggest that increased bone turnover, possibly related to subclinical secondary hyperparathyroidism could contribute to the pathogenesis of IOP. The absence of differences between women with fractures and those with very low BMD indicates that this distinction may not be clinically useful to categorize young women with osteoporosis.",
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AU - Lappe, Joan M.

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AU - Cremers, S.

AU - McMahon, D. J.

AU - Stein, E. M.

AU - Fleischer, J.

AU - Rosen, C. J.

AU - Rogers, H.

AU - Staron, R. B.

AU - LeMaster, J.

AU - Shane, E.

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N2 - Introduction In men, idiopathic osteoporosis (IOP) is often associated with low serum insulin-like growth factor (IGF-1) and reduced bone formation. The characteristics of premenopausal women with IOP are not well defined. We aimed to define the clinical, reproductive, and biochemical characteristics of premenopausal women with unexplained osteoporosis. Methods This is a cross-sectional study of 64 women with unexplained osteoporosis, 45 with fragility fractures, 19 with low bone mineral density (BMD; Z-score less than or equal to -2.0) and 40 normal controls. The following are the main outcome measures: clinical and anthropometric characteristics, reproductive history, BMD, gonadal and calciotropic hormones, IGF-1, and bone turnover markers (BTMs). Results Subjects had lower BMI and BMD than controls, but serum and urinary calcium, serum estradiol, vitamin D metabolites, IGF-1, and most BTMs were similar. Serum parathyroid hormone (PTH) and the resorption marker, tartrate-resistant acid phosphatase (TRAP5b), were significantly higher in both groups of subjects than controls and directly associated in all groups. Serum IGF-1 and all BTMs were directly associated in controls, but the association was not significant after controlling for age. There was no relationship between serum IGF-1 and BTMs in subjects. There were few differences between women with fractures and low BMD. Conclusions Higher serum TRAP5b and PTH suggest that increased bone turnover, possibly related to subclinical secondary hyperparathyroidism could contribute to the pathogenesis of IOP. The absence of differences between women with fractures and those with very low BMD indicates that this distinction may not be clinically useful to categorize young women with osteoporosis.

AB - Introduction In men, idiopathic osteoporosis (IOP) is often associated with low serum insulin-like growth factor (IGF-1) and reduced bone formation. The characteristics of premenopausal women with IOP are not well defined. We aimed to define the clinical, reproductive, and biochemical characteristics of premenopausal women with unexplained osteoporosis. Methods This is a cross-sectional study of 64 women with unexplained osteoporosis, 45 with fragility fractures, 19 with low bone mineral density (BMD; Z-score less than or equal to -2.0) and 40 normal controls. The following are the main outcome measures: clinical and anthropometric characteristics, reproductive history, BMD, gonadal and calciotropic hormones, IGF-1, and bone turnover markers (BTMs). Results Subjects had lower BMI and BMD than controls, but serum and urinary calcium, serum estradiol, vitamin D metabolites, IGF-1, and most BTMs were similar. Serum parathyroid hormone (PTH) and the resorption marker, tartrate-resistant acid phosphatase (TRAP5b), were significantly higher in both groups of subjects than controls and directly associated in all groups. Serum IGF-1 and all BTMs were directly associated in controls, but the association was not significant after controlling for age. There was no relationship between serum IGF-1 and BTMs in subjects. There were few differences between women with fractures and low BMD. Conclusions Higher serum TRAP5b and PTH suggest that increased bone turnover, possibly related to subclinical secondary hyperparathyroidism could contribute to the pathogenesis of IOP. The absence of differences between women with fractures and those with very low BMD indicates that this distinction may not be clinically useful to categorize young women with osteoporosis.

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