Bone loss accelerates substantially in the late perimenopause and continues at a similar pace in the first postmenopausal years. Body weight is a major determinant of the rate of menopausal BMD loss, whereas ethnicity, per se, is not. Healthcare providers should consider this information when deciding when to screen women for osteoporosis.

The inflammation of aging hypothesis purports that aging is the accumulation of damage, which results, in part, from chronic activation of inflammation process. We tested this hypothesis in relationship to fractures in 2985 men and women enrolled in the Health ABC study. Results showed that subjects with the greatest number of inflammatory markers have the highest risk of fracture.Introduction: Cytokines play major roles in regulating bone remodeling in the bone microenvironment, but their relationship to fractures is uncertain. Materials and Methods: The study population includes 2985 well-functioning white and black women and men (42%, black; 51%, women) 70-79 yr of age enrolled in the Health Aging and Body Composition Study. Inflammatory markers were measured in frozen serum using standardized assays. We measured interleukin (IL-6), TNF␣, C-reactive protein (CRP), and soluble receptors (IL-2 sR, IL-6 sR, TNF sR1and TNF sR2).Cytokine-soluble receptors were measured in a subset (n ‫ס‬ 1430). Total hip BMD was measured by DXA. During 5.8 ± 1.6 yr of 95% complete follow-up, incident fractures were confirmed in 268 subjects. The risk of fracture was compared among subjects with the highest inflammatory markers (quartile 4) versus lower levels (quartiles 1, 2, and 3) using proportional hazard models. Results and Conclusions: Subjects who fractured were more likely to be white and female. Baseline markers of inflammation were higher among subjects who subsequently experienced an incident fracture. In multivariate models, the relative risk of fracture (95% CIs) for subjects with the highest inflammatory markers (quartile 4) compared with those with lower inflammatory markers (quartiles 1, 2, and 3) was 1.34 (0.99, 1.82) for CRP; 1.28 (0.95-1.74) for IL-6; 1.28 (0.97-1.70) for TNF␣; 1.52 (1.04-2.21) for IL-2 sR; 1.33 (0.90-1.96) for IL-6 sR; 1.73 (1.18-2.55) for TNF sR1 and 1.48 (1.01-2.20) for TNF sR2. In subjects with three or more (out of seven) high inflammatory markers, the relative risk of fracture was 2.65 (1.44-4.89) in comparison with subjects with no elevated markers. (p trend ‫ס‬ 0.001). We conclude that elevated inflammatory markers are prognostic for fractures, extending the inflammation hypothesis of aging to osteoporotic fractures.

Background The association between and vitamin D levels and fractures is uncertain. Objective To test the hypothesis that serum 25-hydroxyVitamin D (25(OH) vitamin D) levels are associated with the risk of hip fracture in community dwelling women. Design Nested case-control study. Setting 40 US clinical centers. Participants We studied 400 cases of incident hip fractures and 400 controls matched on age, race/ethnicity and date of blood draw (average follow-up time, 7.1 years). Subjects were selected from 39,795 postmenopausal women without previous hip fractures, not using estrogens or other bone-active therapies. Measurements Serum 25(OH) vitamin D was measured on baseline serum using radioimmunoassay with DiaSorin reagents and divided into quartiles. Conditional logistic regression was used to estimate the odds ratio with 95% confidence intervals (CI). Multivariable models included age, body mass index, parental and personal history of fractures, smoking, alcohol and calcium intake, geographic location and corticosteroid use. Results The mean (standard deviation, SD) 25(OH) vitamin D (nM) was lower in cases, 56.2(20.3) compared to controls, 59.7(18), p=0.007. A 25 nM (10ng/ml) decrease in 25(OH) vitamin D was associated with a 33% increased risk of hip fracture (odds ratio=1.33; 95%CI,1.06, 1.68) in multivariable models. Compared to women with 25(OH) vitamin D ≥70.7 nM (Quartile 4), the odds ratio of hip fracture was 1.71 (1.05, 2.79), 1.09 (0.70, 1.71) and 0.82 (0.51, 1.31) in women with 25(OH) vitamin D <47.5 nM, 47.5 to 60 nM, 60 to <70 nM, respectively, p trend =0.015. This association was in part mediated by a marker of bone resorption but remained statistically significant. Adjustment for falls, physical function, frailty, renal function, or sex steroid hormones had no effect on this association. Limitations No measure of bone density. Conclusion Low serum 25(OH) vitamin D concentrations are associated with a higher risk of hip fracture. Measurement of 25(OH) vitamin D may be useful in identifying women at high risk of hip fracture.

Two factors generally reported to influence bone density are body composition and muscle strength. However, it is unclear if these relationships are consistent across race and sex, especially in older persons. If differences do exist by race and/or sex, then strategies to maintain bone mass or minimize bone loss in older adults may need to be modified accordingly. Therefore, we examined the independent effects of bone mineral-free lean mass (LM), fat mass (FM), and muscle strength on regional and whole body bone mineral density (

The search for cost-effective alternatives to hysterectomy in treating uterine fibroids has extended to magnetic resonance-guided focused ultrasound surgery (MRgFUS), in which a noninvasive thermal ablation device is integrated with MR imaging to ablate soft tissue. A small bean-shaped volume of focused ultrasound energy is directed into the target for about 15 seconds to heat the tissue to 60-90°and induce thermal coagulation.Cost utility analysis was based on a Markov model, the parameters of which were drawn from a series of clinical studies of MRgFUS and from literature dealing with clinical efficacy. Costs were estimated from the perspective of the National Health Service Trusts in England and Wales. The major outcome measure was incremental cost-effectiveness, estimated by cost per quality-adjusted life-year (QALY) gained.The base-case results imply a cost saving and a small QALY gain per woman resulting from MRgFUS treatment. The cost per QALY gained was sensitive to the cost of MRgFUS relative to other treatments such as hysterectomy, myomectomy, and uterine artery embolization. It also was sensitive to patient age and to the nonperfused volume relative to the total volume of fibroids. The investigators conclude that MRgFUS is likely to be a cost-effective initial strategy for treating symptomatic uterine fibroids. ABSTRACTUnlike total hysterectomy (TH), supracervical hysterectomy (SCH), also known as subtotal hysterectomy, removes only the body of the uterus, preserving the cervix. In theory, SCH does not damage nerves innervating the bladder and pelvic floor, nor does it disrupt the superior pelvic supports. For these reasons, SCH is thought not to predispose to urinary incontinence. The goal of this meta-analysis was to determine whether the type of hysterectomy performed does, in fact, influence the risk of incontinence. Numerous databases including MEDLINE and the Cochrane Library were searched for abstracts presented at major meetings and bibliographies of retrieved articles. A fixed effect model served to calculate summary relative risk estimates and 95% confidence intervals (CIs).Three studies, all published in the years 2002-2005, were eligible for analysis. All were randomized trials that followed patients for at least 12 months postoperatively. No statistically significant difference in the risk of developing stress urinary incontinence was found between women undergoing SCH and those having total abdominal hysterectomy. The relative risk (RR) was 1.3, with a 95% CI of 0.94-1.78. The RR for urge urinary incontinence was 1.37 (95% CI, 0.77-2.46). Longer follow-up intervals may be needed to accept the conclusion that the extent of hysterectomy does not influence the risk, because observational studies suggest that urinary incontinence may take years to develop following hysterectomy. Operative Gynecology 429ABSTRACT Glandular neoplasms of the uterine cervix have become increasingly prevalent in the past 2 decades and tend to develop in women of childbearing age, raising the question of whether co...