A cohort study of the effect of endogenous estrogen on spine fracture risk and bone structure in elderly women and an assessment of its diagnostic usefulness

Richard Prince, Ian Dick, J. Beilby, S.S. Dhaliwal, A. Devine

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Abstract

The decline in endogenous estrogen concentration after menopause is associated with accelerated bone loss. However, effects in older women remain controversial and the usefulness of estrogen status as a predictor of spine fracture has not been assessed. Therefore, we undertook a prospective cohort Study of 1350 women mean age 75 years in order to Study the role of endogenous estrogen concentration on the risk of morphometric X-ray absorptiometry (MXA)-defined vertebral deformity and atraumatic clinical spine fracture and the association of endogenous estrogen with bone structure. At 5 years 70 patients (5.2%) had sustained >= 1 incident spine fracture. The fracture group had significantly lower concentrations of baseline free estradiol index (FEI) median (IQ range) (0.38 (0.22-0.60) vs. 0.49 (0.29-0.84) pmol/nmol, p=0.009). The patients in the lowest tertile of FEI (FEI < 0.35) had twice the risk of sustaining a clinical vertebral fracture compared to those subjects in the highest tertile (FEI > 0.68) (HR 2.18: 95% CI 1.11-4.28). A low FEI was associated with an increased risk of a vertebral deformity over the 5-year study (OR 1.77: 95% Cl 1.02-3.07) for the lowest compared to highest tertile. A low baseline FEI was associated with lower baseline QUS. heel bone structure and DXA hip bone structure at 12 months and with deterioration in QUS heel bone structure 5 years later. The effect size of the FEI in predicting spine fracture was similar to the effect size for DXA BMD and heel QUS, probably because of the beneficial effect of the FEI on bone structure.The data suggest that the estrogen effect on reducing spine fracture is at least in part due to an effect on bone structure and its measurement does not significantly improve fracture prediction. (c) 2007 Published by Elsevier Inc.
Original languageEnglish
Pages (from-to)33-38
JournalBone
Volume41
Issue number1
DOIs
Publication statusPublished - 2007

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Cohort Effect
Bone Fractures
Estradiol
Estrogens
Spine
Cohort Studies
Bone and Bones
Calcaneus
Pelvic Bones
Heel
Photon Absorptiometry
Menopause
Prospective Studies

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title = "A cohort study of the effect of endogenous estrogen on spine fracture risk and bone structure in elderly women and an assessment of its diagnostic usefulness",
abstract = "The decline in endogenous estrogen concentration after menopause is associated with accelerated bone loss. However, effects in older women remain controversial and the usefulness of estrogen status as a predictor of spine fracture has not been assessed. Therefore, we undertook a prospective cohort Study of 1350 women mean age 75 years in order to Study the role of endogenous estrogen concentration on the risk of morphometric X-ray absorptiometry (MXA)-defined vertebral deformity and atraumatic clinical spine fracture and the association of endogenous estrogen with bone structure. At 5 years 70 patients (5.2{\%}) had sustained >= 1 incident spine fracture. The fracture group had significantly lower concentrations of baseline free estradiol index (FEI) median (IQ range) (0.38 (0.22-0.60) vs. 0.49 (0.29-0.84) pmol/nmol, p=0.009). The patients in the lowest tertile of FEI (FEI < 0.35) had twice the risk of sustaining a clinical vertebral fracture compared to those subjects in the highest tertile (FEI > 0.68) (HR 2.18: 95{\%} CI 1.11-4.28). A low FEI was associated with an increased risk of a vertebral deformity over the 5-year study (OR 1.77: 95{\%} Cl 1.02-3.07) for the lowest compared to highest tertile. A low baseline FEI was associated with lower baseline QUS. heel bone structure and DXA hip bone structure at 12 months and with deterioration in QUS heel bone structure 5 years later. The effect size of the FEI in predicting spine fracture was similar to the effect size for DXA BMD and heel QUS, probably because of the beneficial effect of the FEI on bone structure.The data suggest that the estrogen effect on reducing spine fracture is at least in part due to an effect on bone structure and its measurement does not significantly improve fracture prediction. (c) 2007 Published by Elsevier Inc.",
author = "Richard Prince and Ian Dick and J. Beilby and S.S. Dhaliwal and A. Devine",
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A cohort study of the effect of endogenous estrogen on spine fracture risk and bone structure in elderly women and an assessment of its diagnostic usefulness. / Prince, Richard; Dick, Ian; Beilby, J.; Dhaliwal, S.S.; Devine, A.

In: Bone, Vol. 41, No. 1, 2007, p. 33-38.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A cohort study of the effect of endogenous estrogen on spine fracture risk and bone structure in elderly women and an assessment of its diagnostic usefulness

AU - Prince, Richard

AU - Dick, Ian

AU - Beilby, J.

AU - Dhaliwal, S.S.

AU - Devine, A.

PY - 2007

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N2 - The decline in endogenous estrogen concentration after menopause is associated with accelerated bone loss. However, effects in older women remain controversial and the usefulness of estrogen status as a predictor of spine fracture has not been assessed. Therefore, we undertook a prospective cohort Study of 1350 women mean age 75 years in order to Study the role of endogenous estrogen concentration on the risk of morphometric X-ray absorptiometry (MXA)-defined vertebral deformity and atraumatic clinical spine fracture and the association of endogenous estrogen with bone structure. At 5 years 70 patients (5.2%) had sustained >= 1 incident spine fracture. The fracture group had significantly lower concentrations of baseline free estradiol index (FEI) median (IQ range) (0.38 (0.22-0.60) vs. 0.49 (0.29-0.84) pmol/nmol, p=0.009). The patients in the lowest tertile of FEI (FEI < 0.35) had twice the risk of sustaining a clinical vertebral fracture compared to those subjects in the highest tertile (FEI > 0.68) (HR 2.18: 95% CI 1.11-4.28). A low FEI was associated with an increased risk of a vertebral deformity over the 5-year study (OR 1.77: 95% Cl 1.02-3.07) for the lowest compared to highest tertile. A low baseline FEI was associated with lower baseline QUS. heel bone structure and DXA hip bone structure at 12 months and with deterioration in QUS heel bone structure 5 years later. The effect size of the FEI in predicting spine fracture was similar to the effect size for DXA BMD and heel QUS, probably because of the beneficial effect of the FEI on bone structure.The data suggest that the estrogen effect on reducing spine fracture is at least in part due to an effect on bone structure and its measurement does not significantly improve fracture prediction. (c) 2007 Published by Elsevier Inc.

AB - The decline in endogenous estrogen concentration after menopause is associated with accelerated bone loss. However, effects in older women remain controversial and the usefulness of estrogen status as a predictor of spine fracture has not been assessed. Therefore, we undertook a prospective cohort Study of 1350 women mean age 75 years in order to Study the role of endogenous estrogen concentration on the risk of morphometric X-ray absorptiometry (MXA)-defined vertebral deformity and atraumatic clinical spine fracture and the association of endogenous estrogen with bone structure. At 5 years 70 patients (5.2%) had sustained >= 1 incident spine fracture. The fracture group had significantly lower concentrations of baseline free estradiol index (FEI) median (IQ range) (0.38 (0.22-0.60) vs. 0.49 (0.29-0.84) pmol/nmol, p=0.009). The patients in the lowest tertile of FEI (FEI < 0.35) had twice the risk of sustaining a clinical vertebral fracture compared to those subjects in the highest tertile (FEI > 0.68) (HR 2.18: 95% CI 1.11-4.28). A low FEI was associated with an increased risk of a vertebral deformity over the 5-year study (OR 1.77: 95% Cl 1.02-3.07) for the lowest compared to highest tertile. A low baseline FEI was associated with lower baseline QUS. heel bone structure and DXA hip bone structure at 12 months and with deterioration in QUS heel bone structure 5 years later. The effect size of the FEI in predicting spine fracture was similar to the effect size for DXA BMD and heel QUS, probably because of the beneficial effect of the FEI on bone structure.The data suggest that the estrogen effect on reducing spine fracture is at least in part due to an effect on bone structure and its measurement does not significantly improve fracture prediction. (c) 2007 Published by Elsevier Inc.

U2 - 10.1016/j.bone.2007.03.014

DO - 10.1016/j.bone.2007.03.014

M3 - Article

VL - 41

SP - 33

EP - 38

JO - Bone

JF - Bone

SN - 8756-3282

IS - 1

ER -