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New Concepts in Women’s Bone Health

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (15 March 2018) | Viewed by 61522

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Special Issue Editor

Professor Jerilynn C. Prior

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Guest Editor

Division of Endocrinology, Department of Medicine, The University of British Columbia, Vancouver, Canada

Special Issue Information

Dear Colleagues,

We are organizing a Special Issue on “New Concepts in Women’s Bone Health” in the International Journal of Environmental Research and Public Health. The venue is a peer-reviewed scientific journal that publishes articles and communications in the interdisciplinary area of environmental health sciences and public health. For detailed information on the journal we refer you to https://0-www-mdpi-com.brum.beds.ac.uk/journal/ijerph.

Our current concepts about women and bone health go back to the 1930s and 1940s, shortly after estradiol was first characterized and became used as a therapy. In that era, estrogen was “the” women’s hormone, menopause was “estrogen-deficiency”, all women’s osteoporosis was considered “postmenopausal” and the anti-resorptive actions of estrogen were the gold standard for osteoporosis treatment. Both basic and clinical sciences as well as public health have advanced since then. Now we must consider many other variables related to women’s bone health—in utero and childhood environments, peak bone mass, the development and maintenance of ovulatory menstrual cycles, insulin resistance and obesity, emotional/social/nutritional stressors, exercise and energy sufficiency, inflammation and oxidation, urban versus rural environments and air pollution, anti-depressants, combined hormonal contraceptives and other common medications and even hot flushes and night sweats. We are only starting to understand sex/gender differences in bone metabolism and fracture risk since, until recently, osteoporosis has been considered an “old woman’s disease.”

To improve public health, we must understand how to prevent the fragility fractures that are the negative outcome of areal bone mineral density (BMD) (and other characteristics) that are inadequate for the time in a woman’s life cycle and for her environmental challenges. We also now know that fracture prevention relates to bone strength and micro-architecture as well as to BMD and its rate of change, genetic, reproductive, environmental and developmental characteristics.

Our current method for assessing areal BMD only became widely available in the late 1990s. Thus, although we have prospective “snap shots” of BMD changes over short timeframes, very few long, prospective studies have had fragility fracture as the outcome. Clearly estradiol suppresses bone resorption but bone remodeling has two main phases; it is not clear (once growth is complete) what promotes women’s bone formation. In addition, new understandings of women’s bone health must include understanding dietary patterns, macronutrients and vitamin D, as well as inflammation.

This Special Issue is open to any subject area related to the physiology of bone health across woman’s lifecycle, to social/emotional/environmental challenges that are unique to women and to therapies that ensure resorption/formation bone balance to prevent fragility fractures. Our goal is to gather and present the newest data about women’s bone health and fracture prevention, to revise outmoded concepts, and ultimately to improve public health for women of all ages.

The listed keywords below suggest just a few of the many possibilities.

Prof. Dr. Jerilynn C. Prior
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Areal Bone Mineral Density (BMD)
Volumetric Bone Mineral Density/micro-architecture/strength
Incident fragility fracture risk including morphometric vertebral fractures
Prospective
Peak bone mass
Adolescent bone health
Premenopausal bone health
Perimenopausal bone health
Reproductive changes related to bone health
Common medications related to women’s bone health—e.g. combined hormonal contraceptives, antidepressants, agents for treatment of diabetes and obesity, chemotherapy
Common diseases related to women’s bone health—polycystic ovary syndrome, celiac disease, liver diseases, kidney diseases, cystic fibrosis, living with HIV
Physical activity related to women’s bone health
Dietary patterns, macro and micronutrients and women’s bone health
Environmental issues and women’s bone health
Obesity, insulin resistance, sarcopenia and frailty related to women’s bone health
Emotional/psychological and mental health issues related to women’s bone health

Published Papers (10 papers)

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Editorial

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4 pages, 249 KiB

Open AccessEditorial

Innovations in Women’s Bone Health—Appreciating Important “Bone Variables” Besides Estrogen

by Jerilynn C. Prior

Int. J. Environ. Res. Public Health 2018, 15(9), 1929; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15091929 - 05 Sep 2018

Viewed by 2302

Abstract

n/a Full article

(This article belongs to the Special Issue New Concepts in Women’s Bone Health)

Research

Jump to: Editorial, Review

11 pages, 1052 KiB

Open AccessArticle

The Use of Antidepressive Agents and Bone Mineral Density in Women: A Meta-Analysis

by Julietta Ursula Schweiger, Ulrich Schweiger, Michael Hüppe, Kai G. Kahl, Wiebke Greggersen, Kamila Jauch-Chara and Eva Fassbinder

Int. J. Environ. Res. Public Health 2018, 15(7), 1373; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15071373 - 30 Jun 2018

Cited by 34 | Viewed by 6846

Abstract

Antidepressive agents are one of the fastest-growing classes of prescribed drugs. However, the effects of antidepressive agents on bone density are controversial. The aim of this meta-analysis is to evaluate the state of research on the relationship between the use of tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) and bone mineral density (BMD) in women. The database searched was Pubmed. The meta-analysis included human studies in women fulfilling the following criteria: (i) an assessment of bone mineral density in the lumbar spine, the femoral neck or the total hip; (ii) a comparison of the BMD of depressed individuals using antidepressive agents (SSRIs or TCAs), and a control group that did not use antidepressive agents; (iii) measurement of BMD using dual-energy X-ray absorptiometry (DXA); and (iv) calculations of the mean BMD and standard deviation or standard error. Four studies were identified, which, in total, included 934 women using antidepressive agents and 5767 non-using individuals. The results showed that no significant negative composite weighted mean effect sizes were identified for the comparisons between SSRI users and non-users. Similarly, no significant negative composite weighted mean effect sizes were identified for the comparisons between TCA users and non-users, indicating similar BMD in SSRI or TCA users and non-users. The meta-analysis shows that the association between antidepressant medication and bone mineral density has not been extensively researched. Only four studies fulfilled the inclusion criteria. The global result of the literature review and meta-analysis was that the use of antidepressive agents was not associated with lower or higher BMD. This result applies to both SSRIs and TCAs and to all measurement locations (lumbar spine, femoral neck and total hip). Full article

(This article belongs to the Special Issue New Concepts in Women’s Bone Health)

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13 pages, 2169 KiB

Open AccessArticle

Women’s Mid-Life Night Sweats and 2-Year Bone Mineral Density Changes: A Prospective, Observational Population-Based Investigation from the Canadian Multicentre Osteoporosis Study (CaMos)

by Evelyn M. M. Wong, George Tomlinson, Marsha M. Pinto, Claudie Berger, Angela M. Cheung and Jerilynn C. Prior

Int. J. Environ. Res. Public Health 2018, 15(6), 1079; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15061079 - 26 May 2018

Cited by 6 | Viewed by 4455

Abstract

Women’s hot flushes and night sweats, collectively called vasomotor symptoms (VMS), are maximal (79%) in late perimenopause. The evidence describing whether VMS are associated with loss of areal bone mineral density (BMD) is mixed. We examined baseline and 2-year data for 1570 randomly selected women aged 43–63 in the Canadian Multicentre Osteoporosis Study (CaMos), a prospective Canada-wide study; we used linear regression to assess the relationship of night sweats (VMSn) with BMD and its changes. Clinically important VMSn occurred for 12.2%. Women with VMSn were slightly younger (54.5 vs. 55.3 years, p = 0.02) and less likely to use sex steroid therapies (39.8% vs. 51.4%, p < 0.05). BMD at the lumbar spine (L1-4), femoral neck (FN) and total hip (TH) were similar between those with/without VMSn. In adjusted models, we did not find a significant association between VMSn and 2-year change in L1-4, FN and TH BMD. Age, reproductive status, weight, sex steroid therapy and smoking status were associated with 2-year change in BMD. Incident fractures over 2 years also did not differ by VMSn. Our analyses were restricted to VMSn and may not truly capture the relationship between VMS and BMD. Additional research involving VMS, bone loss and fracture incidence is needed. Full article

(This article belongs to the Special Issue New Concepts in Women’s Bone Health)

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18 pages, 956 KiB

Open AccessArticle

Association of Plasma Lipids and Polar Metabolites with Low Bone Mineral Density in Singaporean-Chinese Menopausal Women: A Pilot Study

by Diana Cabrera, Marlena Kruger, Frances M. Wolber, Nicole C. Roy, John J. Totman, Christiani Jeyakumar Henry, David Cameron-Smith and Karl Fraser

Int. J. Environ. Res. Public Health 2018, 15(5), 1045; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15051045 - 22 May 2018

Cited by 31 | Viewed by 4353

Abstract

The diagnosis of osteoporosis is mainly based on clinical examination and bone mineral density assessments. The present pilot study compares the plasma lipid and polar metabolite profiles in blood plasma of 95 Singaporean-Chinese (SC) menopausal women with normal and low bone mineral density (BMD) using an untargeted metabolomic approach. The primary finding of this study was the association between lipids and femoral neck BMD in SC menopausal women. Twelve lipids were identified to be associated with low BMD by the orthogonal partial least squares (OPLS) model. Plasma concentrations of eight glycerophospholipid, glycerolipid, and sphingolipid species were significantly lower in menopausal women with low BMD but higher in two glycerophospholipid species (phosphatidylinositol and phosphatidic acid). Further, this study found no significant differences in plasma amino acid metabolites. However, trends for lower 4-aminobutyric acid, turanose, proline, aminopropionitrile, threonine, and methionine were found in women with low BMD. This pilot study identified associations between lipid metabolism and femoral neck BMD in SC women. Further studies are required on larger populations for evaluating the bone health effect of these compounds and their usefulness as clinical biomarkers for osteoporosis prediction in women. Full article

(This article belongs to the Special Issue New Concepts in Women’s Bone Health)

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14 pages, 874 KiB

Open AccessArticle

Adult Premenopausal Bone Health Related to Reproductive Characteristics—Population-Based Data from the Canadian Multicentre Osteoporosis Study (CaMos)

by Azita Goshtasebi, Claudie Berger, Susan I. Barr, Christopher S. Kovacs, Tanveer Towheed, K. Shawn Davison and Jerilynn C. Prior

Int. J. Environ. Res. Public Health 2018, 15(5), 1023; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15051023 - 18 May 2018

Cited by 16 | Viewed by 3986

Abstract

Amenorrhea is important for women’s bone health. However, few have reported reproductive, anthropometric (body mass index [BMI], height) and bone health (areal bone mineral density [BMD], prevalent fractures) in a population-based study. The purposes of this cross-sectional study of women in the randomly-selected Canadian Multicentre Osteoporosis Study (CaMos) population were: (1) to describe reproductive, demographic, anthropometric and lifestyle variables; and (2) in menstruating women, to relate reproductive and other variables to BMD at the lumbar spine (L1-4, LS), femoral neck (FN) and total hip (TH) sites and to prevalent fragility fractures. This study describes the reproductive characteristics of 1532 women aged 30–60 years. BMD relationships with reproductive and other variables were described in the 499 menstruating women. Mean menarche age was 12.8 years, 96% of women were parous and 95% had used combined hormonal contraceptives (CHC). Infertility was reported by 9%, androgen excess by 13%, amenorrhea by 8% and nulliparity by 4%. LS BMD was negatively associated with amenorrhea and androgen excess and positively related to current BMI and height. A later age at menarche negatively related to FN BMD. BMI and height were strongly related to BMD at all sites. Prevalent fragility fractures were significantly associated with quartiles of both LS and TH BMD. Full article

(This article belongs to the Special Issue New Concepts in Women’s Bone Health)

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12 pages, 806 KiB

Open AccessArticle

Premature Spinal Bone Loss in Women Living with HIV is Associated with Shorter Leukocyte Telomere Length

by Shirin Kalyan, Neora Pick, Alice Mai, Melanie C. M. Murray, Kristen Kidson, Jackson Chu, Arianne Y. K. Albert, Hélène C. F. Côté, Evelyn J. Maan, Azita Goshtasebi, Deborah M. Money and Jerilynn C. Prior

Int. J. Environ. Res. Public Health 2018, 15(5), 1018; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15051018 - 18 May 2018

Cited by 8 | Viewed by 3630

Abstract

With advances in combination antiretroviral therapy (cART), people living with HIV are now surviving to experience aging. Evidence suggests that individuals living with HIV are at greater risk for low bone mineral density (BMD), osteoporosis, and fractures. Better understanding of the pathophysiology of bone health in women living with HIV (WLWH) is important for treatment strategies. The goal of this study was to explore new biological factors linked to low BMD in WLWH. Standardized BMD measures of WLWH were compared to reference values from an unselected population of women from the same geographical region of the same age range. Linear regression analysis was used to assess relationships among health-related characteristics, cellular aging (measured by leukocyte telomere length; LTL), cART, and BMD of WLWH. WLWH (n = 73; mean age 43 ± 9 years) had lower BMD Z-scores at the lumbar spine (LS) (mean difference = −0.39, p < 0.001) and total hip (TH) (−0.29, p = 0.012) relative to controls (n = 290). WLWH between 50 and 60 years (n = 17) had lower Z-scores at the LS (p = 0.008) and TH (p = 0.027) compared to controls (n = 167). Among WLWH, LS BMD was significantly associated with LTL (R² = 0.09, p = 0.009) and BMI (R² = 0.06, p = 0.042). Spinal BMD was adversely affected in WLWH. Reduction of LTL was strongly associated with lower BMD and may relate to its pathophysiology and premature aging in WLWH. Full article

(This article belongs to the Special Issue New Concepts in Women’s Bone Health)

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10 pages, 738 KiB

Open AccessArticle

Does Molimina Indicate Ovulation? Prospective Data in a Hormonally Documented Single-Cycle in Spontaneously Menstruating Women

by Jerilynn C. Prior, Chiaki Konishi, Christine L. Hitchcock, Elaine Kingwell, Patti Janssen, Anthony P. Cheung, Nichole Fairbrother and Azita Goshtasebi

Int. J. Environ. Res. Public Health 2018, 15(5), 1016; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15051016 - 18 May 2018

Cited by 9 | Viewed by 4897

Abstract

Approximately 33% of normal-length (21–35 days) cycles have subclinical ovulatory disturbances and lack sufficient progesterone, although their normal length ensures enough estrogen. Subclinical ovulatory disturbances are related to significant premenopausal spine bone loss (−0.86%/year). Molimina, non-distressing premenstrual experiences, may detect ovulation within normal-length cycles. This prospective study assessed the relationship between molimina and ovulation. After 1-cycle of daily diary and first morning urine collections, women answered the Molimina Question (MQ): “Can you tell by the way you feel that your period is coming?” and were invited to share (a) predictive premenstrual experience(s). A 3-fold increase in follicular-luteal pregnanediol levels confirmed ovulation. In 610 spontaneously menstruating women (not on hormonal contraception, mean age 31.5 ± 5.3, menarche age 12.7 ± 1.5, cycle length [CL] 29 days, MQ positive in 89%), reported premenstrual experiences which included negative moods (62%), cramps (48%), bloating (39%), and front (26%) or axillary (25%) breast tenderness. Of 432 women with pregnanediol-documented cycles, 398 (92%) were ovulatory (CL: 29 ± 5) and 34 (8%) had ovulatory disturbances (CL: 32 ± 14). Women with/without ovulatory cycles were similar in parity, body mass index, smoking, dietary restraint and the MQ; ovulatory-disturbed cycles were longer. Molimina did not confirm ovulation. A non-invasive, inexpensive ovulation indicator is needed to prevent osteoporosis. Full article

(This article belongs to the Special Issue New Concepts in Women’s Bone Health)

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12 pages, 371 KiB

Open AccessFeature PaperArticle

by Mireille Luc, Hélène Corriveau, Gilles Boire, Johanne Filiatrault, Marie-Claude Beaulieu and Isabelle Gaboury

Int. J. Environ. Res. Public Health 2018, 15(5), 944; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15050944 - 09 May 2018

Cited by 17 | Viewed by 3509

Abstract

A Fracture Liaison Service (FLS) has been calculated to be a cost-effective model of care for patients with fragility fracture (FF). Cost-effectiveness can be achieved when adherence to bone health recommendations from FLS staff is high. This prospective study combined participants’ telephone longitudinal survey data (intervention group, n = 354) and interviews with 16 individuals from FLS in three health regions of the province of Quebec (Canada). Participants were recruited between January 2013 and April 2015. Regression models were fit to examine the relationship between participant-related factors and adherence at 12 months to osteoporosis medication, vitamin D supplementation, and participation in physical activity. Participants acknowledging FF as a consequence of osteoporosis were more likely to adhere to medication (odds ratio (OR) 2.5; p = 0.001) and vitamin D supplementation (OR 2.3; p = 0.01). Paradoxically, the same participants were less prone to engage in physical activity (OR 0.5, p = 0.01). Qualitative interviews suggested that feedback from FLS coordinators helped participants understand the underlying cause of their FF. This study highlighted the key roles of FLS staff in helping patients to recognize FF as a sign of underlying bone disease and encouraging adherence to care recommendations. Full article

(This article belongs to the Special Issue New Concepts in Women’s Bone Health)

11 pages, 348 KiB

Open AccessArticle

Association of Insulin Resistance with Bone Strength and Bone Turnover in Menopausal Chinese-Singaporean Women without Diabetes

by Maria Kalimeri, Francesca Leek, Nan Xin Wang, Huann Rong Koh, Nicole C. Roy, David Cameron-Smith, Marlena C. Kruger, Christiani Jeyakumar Henry and John J. Totman

Int. J. Environ. Res. Public Health 2018, 15(5), 889; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15050889 - 30 Apr 2018

Cited by 14 | Viewed by 4066

Abstract

Insulin resistance (IR) is accompanied by increased areal or volumetric bone mineral density (aBMD or vBMD), but also higher fracture risk. Meanwhile, imbalances in bone health biomarkers affect insulin production. This study investigates the effect of IR on proximal femur and lumbar spine BMD, femoral neck bending, compressive and impact strength indices (Composite Strength Indices) and circulating levels of parathyroid hormone (PTH), C-telopeptide of Type I collagen (CTx-1) and 25(OH) Vitamin D₃, in a cohort of 97 healthy, non-obese, menopausal Chinese-Singaporean women. Lumbar spine aBMD was inversely associated with IR and dependent on lean body mass (LBM) and age. No such associations were found for vBMD of the third lumbar vertebra, aBMD and vBMD of the proximal femur, or circulating levels of PTH, CTx-1 and 25(OH) Vitamin D₃. Composite Strength Indices were inversely associated with IR and independent of LBM, but after adjusting for fat mass and age, this association remained valid only for the impact strength index. Composite Strength Indices were significantly lower in participants with a high degree of IR. Our findings on IR and Composite Strength Indices relationships were in agreement with previous studies on different cohorts, but those on IR and BMD associations were not. Full article

(This article belongs to the Special Issue New Concepts in Women’s Bone Health)

Review

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17 pages, 2364 KiB

Open AccessReview

Exercise Early and Often: Effects of Physical Activity and Exercise on Women’s Bone Health

by Karen L. Troy, Megan E. Mancuso, Tiffiny A. Butler and Joshua E. Johnson

Int. J. Environ. Res. Public Health 2018, 15(5), 878; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph15050878 - 28 Apr 2018

Cited by 107 | Viewed by 22579

Abstract

In 2011 over 1.7 million people were hospitalized because of a fragility fracture, and direct costs associated with osteoporosis treatment exceeded 70 billion dollars in the United States. Failure to reach and maintain optimal peak bone mass during adulthood is a critical factor in determining fragility fracture risk later in life. Physical activity is a widely accessible, low cost, and highly modifiable contributor to bone health. Exercise is especially effective during adolescence, a time period when nearly 50% of peak adult bone mass is gained. Here, we review the evidence linking exercise and physical activity to bone health in women. Bone structure and quality will be discussed, especially in the context of clinical diagnosis of osteoporosis. We review the mechanisms governing bone metabolism in the context of physical activity and exercise. Questions such as, when during life is exercise most effective, and what specific types of exercises improve bone health, are addressed. Finally, we discuss some emerging areas of research on this topic, and summarize areas of need and opportunity. Full article

(This article belongs to the Special Issue New Concepts in Women’s Bone Health)

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