Dr Jerilynn C Prior - Vancouver Coastal Health Research Institute

WHAT’S NEW IN OSTEOPOROSIS RISKS &
PREVENTION
Dr Jerilynn C Prior
WHAT’S NEW IN OSTEOPOROSIS RISKS &
PREVENTION
Dr Jerilynn C Prior
Centre for Menstrual Cycle and Ovulation Research,
Vancouver Coastal Health Research Institute,
Vancouver Hospital, University of British Columbia
September 28, 2005
www.cemcor.ubc.ca
What’s New in Osteoporosis
• What we will cover:
™The healthy renovation of bone
™Periods and bone
™Young women’s risks for fracture
™Bone loss just before menopause
™Simple strategies to prevent fractures
Bone Remodeling BALANCE
Bone Formation
Osteoblast receptors
+Parathyroid hormone
+Progesterone -Cortisol
CaMOS—10-year Follow-Up Study
• Cohort Follow-Up
• 9423 men and women at baseline (mean age
62)
• 85% follow-up for five years
• Not enough hip fractures to be sure what
causes them!
• Beginning the 10-yr follow-up this fall!
Women’s Bone Life Cycle
L
i
Young Osteoporosis Women
™Skipping more than 3 menstrual cycles
(when not pregnant or breast feeding)
™Worrying that what we eat will make us
gain weight
Normal Menstrual Cycle
Normal BMD n = 34
Lowest 10th percentile BMD n = 31
9
8
p=
0.002
7
6
Urinary
Pregnanediol
(ng/mg Cr)
5
4
Mean PDG difference--p = 0.006
Area under PDG curve difference--p =
0.002
3
95% CI
(corrected for
BMI) from
B spline plot
2
1
0
1
5
10
15
Re-drawn from MF Sower, J Bone Min Res 1998;13:1191
20
25
30
Bone Loss with Ovulation
Disturbances-- Premenopausal Adulthood
Cancellous bone density--QCT
change/year (mg/cm3)
6
4
2
0
-2
-4
-6
-8
-10
Normal 1 SLP >1 SLP Anov
n=13 n=12
n=28 n=13
Prior et al. 1990 NEJM
The Pill and Bone—CaMOS
OC use
no OC use
(adjusted for age, BMI, height, and cigarette and alcohol use)
1.4
1.2
*
1
Mean
BMD
g/cm2
*
0.8
0.6
0.4
427
64
Spine
* P < 0.05
427
64
Neck
Prior Canad. Med Assoc. J,
2001;165:1023-9
335
52
Trochanter
335
52
Ward's
Women’s Bone Life Cycle
L
i
Perimenopause & Early Menopause
Regular
Irregular < 12 mo 1-3 years 4-6 years
after menopause
Okano J Bone Min Res 1998:13:309
ABC’s of Healthy Bones
A
B
C
D
E
Normal Menstrual Cycle
F
Bone Remodeling BALANCE
↓ with Estrogen
↑ with Progesterone
GH
What’s New in Osteoporosis
• In Summary:
™The healthy renovation of bone
™We need regular cycles and to ovulate most cycles
™Worry about weight may relate to risks for
fracture
™Bone loss begins during the chaos of
perimenopause
™Preventing osteoporosis is as simple as ABCs!
Centre for
Menstrual
Cycle &
Ovulation
Research
www.cemcor.ubc.ca