No abstract

Changes in incidence and lifetime risk of fractures are of major importance in the epidemiology of osteoporosis. We focused on hip fractures in women and men and on radial and humeral fractures in women. The study subjects comprised 4500 women and men 20 years old or more with fractures. In women 1735 fractures of the distal radius, 747 fractures of the proximal humerus, 878 cervical and 635 trochanteric hip fractures were included. In men 273 cervical and 232 trochanteric hip fractures were included. The fractures were registered during the period 1976 to 1984 and changes in age-specific incidence were calculated (chi-squared test for linear trend; p-values less than 0.05 were considered significant). On the basis of life tables and population background data, the lifetime risk was estimated. The incidence of cervical hip fractures in women aged 60-89 years decreased significantly (p < 0.05) during the observation period, while no significant decrease was found in the incidence of trochanteric fractures. No significant changes in incidence were observed in women with radial or humeral fractures, or in men with hip fractures. A women 60 years old with a life expectancy of 81 years had an estimated residual lifetime risk of radial, humeral or hip fracture of 17%, 8% and 14% respectively. A man 60 years of age with a life expectancy of 77 years had an estimated risk of hip fracture of 6%.(ABSTRACT TRUNCATED AT 250 WORDS)

With the aim of preventing postmenopausal bone loss, a placebo-controlled double-blind trial of 2 years duration was performed. We randomized 315 healthy volunteers in their early natural menopause to seven treatment and three placebo groups: 17 beta-oestradiol, oestriol and sequential norethisteron (hormones); bendroflumethiazide 5 mg/day (thiazide); hormones and thiazide; sodium fluoride 20 mg/day; vitamin D3 2000 IU/day (D3); fluoride and D3; and 1 alpha (OH) vitamin D3 0.25 microgram/day (1 alpha D3). All participants were given daily calcium supplement of 500 mg. Every 3 months we measured the bone mineral content (BMC) of both forearms by photon absorptiometry and chemical quantities in blood and 48 h urinary collections. The study was completed by 264 (84%). The combined placebo groups showed a linear fall in BMC reaching 3.3% after 2 years (P < 0.001). Hormones and hormones and thiazide led to a 2.5% gain in BMC (P < 0.01). Thiazide alone postponed the BMC fall for 6 months. After 2 years the thiazide group showed a BMC fall of 1.5% (P < 0.05), less than that of the placebo group (P < 0.05). BMC declined by 3.6%, 4.5%, 3.7% and 3.7% during the respective use of fluoride, D3, fluoride and D3 and 1 alpha D3. Nevertheless, the urinary calcium excretion during 1 alpha D3 and D3 treatment was 1--1.5 mmol/day higher than in the placebo groups. Apparently, there is no real alternative to oestrogen/gestagen in the prevention of postmenopausal osteoporosis.