No abstract

A retrospective study was carried out to determine the relationship between parity and bone mineral density (BMD) in middle-aged women. Eight hundred and twenty-five woman aged 41-76 years were recruited from four general practice registers in Cambridge. Subjects were unselected as to their health status. Each subject completed a detailed health questionnaire. Participation rate was 50%. The main outcome measure was BMD measured at the spine (L2-4, n = 825) and hip (neck, intertrochanter and Ward's triangle; n = 817) by dual-energy X-ray absorptiometry (DXA) using the Hologic QDR-1000 densitometer. It was found that the unadjusted mean BMD was significantly higher at all sites among the parous women (p = 0.031 to < 0.00001), and remained significantly higher at the femoral neck (p = 0.025), intertrochanter (p = 0.001) and Ward's triangle (p = 0.045) after adjusting for age and body mass index (BMI). Similar findings were seen after stratifying for potential confounding variables. There was a consistent upward trend of BMD with increasing parity at all sites. Parity remained a significant independent predictor of BMD at all sites after controlling for age, BMI, menopausal status, oral contraceptive and hormone replacement therapy use, smoking status and breast-feeding status in multiple linear regression analyses. There was, on average, a 1.0% increase in BMD per live birth. Our findings therefore suggest a positive relationship between parity and bone mass.

SUMMARY Osteoporosis is a serious complication of inflammatory bowel disease which has not received adequate recognition despite its high prevalence and potentially devastating clinical effects. Its pathogenesis remains poorly defined although corticosteroid therapy and sex hormone deficiency are likely to play a major role. Recent advances in the diagnosis and management of osteoporosis have facilitated early detection of bone loss and identified means by which this may be prevented. Bone density measurements to predict fracture risk and define thresholds for prevention and treatment should be performed routinely in patients with inflammatory disease. Hormone replacement therapy is effective in prevention of bone loss in peri‐ and post‐menopausal patients, but the treatment of younger women and men of all ages requires further study.

Alendronate increased bone mineral density but did not reduce new fractures in glucocorticoid induced osteoporosis Saag KG, Emkey R, Schnitzer TJ, et al, for the Glucocorticoid-Induced Osteoporosis Intervention Study Group. Alendronate for the prevention and treatment of glucocorticoid-induced osteoporosis. N Engl J Med 1998;339:292-9. QuestionIn patients who have osteoporosis that is induced by long term glucocorticoid treatment, is alendronate eVective for increasing bone mineral density (BMD) and reducing new fractures? Design 2 parallel randomised, placebo controlled trials with 48 weeks follow up. Setting centres in the US and 22 centres in other countries.Patients 560 patients who were 17-83 years of age and had rheumatological, pulmonary, dermatological, gastrointestinal, or other diseases that required >1 year of glucocorticoid treatment (daily dose >7.5 mg of prednisone or its equivalent). Exclusion criteria were evidence of metabolic bone disease (other than glucocorticoid induced or postmenopausal osteoporosis), low serum 25-hydroxyvitamin D concentrations, concomitant drug treatments that might aVect bone turnover, pregnancy, lactation, renal insuYciency, severe cardiac disease, or major upper gastrointestinal disease. A 2.5 mg dose of alendronate was used in the multinational study only, and patients allocated to this group (n=83) were not analysed. Patients (n=477, 30% men, 22% premenopausal women, 49% postmenopausal women) were stratified according to duration of glucocorticoid treatment: <4 months (34%), 4-12 months (21%), and >12 months (45%).