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. 1989 Sep-Oct;104(Suppl):14–20.

Risk factors for osteoporosis and associated fractures.

J L Kelsey 1
PMCID: PMC1580372  PMID: 2517695

Abstract

Established risk factors for osteoporosis and associated fractures are increasing age, female sex, white race, removal of the ovaries at an early age, prolonged immobility, and prolonged use of corticosteroids. Obesity and use of estrogen replacement therapy are protective. Factors that probably or possibly increase risk in postmenopausal white women include a low calcium intake, cigarette smoking, and, at least for hip fractures, use of long half-life psychotrophic drugs and heavy alcohol consumption. Factors probably or possibly associated with a decreased risk include ingestion of vitamin D and its metabolites, fluoride levels of 2 ppm or more in drinking water, moderate physical activity, pregnancies and breast feeding, use of thiazide diuretics, and progestogens. Some evidence suggests that calcium intake and physical activity at young ages may be important determinants of peak bone mass. Few studies have been undertaken in males and blacks, although at least some risk factors in males may be similar to those in females. Preventive efforts may be aimed at increasing peak bone mass at young ages, preventing bone loss in postmenopausal women, and preventing fractures and their adverse consequences in older people with osteoporosis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ALFFRAM P. A. AN EPIDEMIOLOGIC STUDY OF CERVICAL AND TROCHANTERIC FRACTURES OF THE FEMUR IN AN URBAN POPULATION. ANALYSIS OF 1,664 CASES WITH SPECIAL REFERENCE TO ETIOLOGIC FACTORS. Acta Orthop Scand Suppl. 1964;65:SUPPL 65–7109. doi: 10.3109/ort.1964.35.suppl-65.01. [DOI] [PubMed] [Google Scholar]
  2. Adinoff A. D., Hollister J. R. Steroid-induced fractures and bone loss in patients with asthma. N Engl J Med. 1983 Aug 4;309(5):265–268. doi: 10.1056/NEJM198308043090502. [DOI] [PubMed] [Google Scholar]
  3. Adland-Davenport P., McKenzie M. W., Notelovitz M., McKenzie L. C., Pendergast J. F. Thiazide diuretics and bone mineral content in postmenopausal women. Am J Obstet Gynecol. 1985 Jul 15;152(6 Pt 1):630–634. doi: 10.1016/s0002-9378(85)80035-1. [DOI] [PubMed] [Google Scholar]
  4. Albanese A. A., Edelson A. H., Lorenze E. J., Jr, Woodhull M. L., Wein E. H. Problems of bone health in elderly. Ten-year study. N Y State J Med. 1975 Feb;75(3):326–336. [PubMed] [Google Scholar]
  5. Alffram P. A., Hernborg J., Nilsson B. E. The influence of a high fluoride content in the drinking water on the bone mineral mass in man. Acta Orthop Scand. 1969;40(2):137–142. doi: 10.3109/17453676908989494. [DOI] [PubMed] [Google Scholar]
  6. Aloia J. F., Cohn S. H., Babu T., Abesamis C., Kalici N., Ellis K. Skeletal mass and body composition in marathon runners. Metabolism. 1978 Dec;27(12):1793–1796. doi: 10.1016/0026-0495(78)90265-2. [DOI] [PubMed] [Google Scholar]
  7. Aloia J. F., Cohn S. H., Ostuni J. A., Cane R., Ellis K. Prevention of involutional bone loss by exercise. Ann Intern Med. 1978 Sep;89(3):356–358. doi: 10.7326/0003-4819-89-3-356. [DOI] [PubMed] [Google Scholar]
  8. Aloia J. F., Cohn S. H., Vaswani A., Yeh J. K., Yuen K., Ellis K. Risk factors for postmenopausal osteoporosis. Am J Med. 1985 Jan;78(1):95–100. doi: 10.1016/0002-9343(85)90468-1. [DOI] [PubMed] [Google Scholar]
  9. Aloia J. F., Vaswani A. N., Yeh J. K., Ross P., Ellis K., Cohn S. H. Determinants of bone mass in postmenopausal women. Arch Intern Med. 1983 Sep;143(9):1700–1704. [PubMed] [Google Scholar]
  10. BOLLET A. J., ENGH G., PARSON W. EPIDEMIOLOGY OF OSTEOPOROSIS; SEX AND RACE INCIDENCE OF HIP FRACTURES. Arch Intern Med. 1965 Aug;116:191–194. doi: 10.1001/archinte.1965.03870020031009. [DOI] [PubMed] [Google Scholar]
  11. Bell N. H., Greene A., Epstein S., Oexmann M. J., Shaw S., Shary J. Evidence for alteration of the vitamin D-endocrine system in blacks. J Clin Invest. 1985 Aug;76(2):470–473. doi: 10.1172/JCI111995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Bernstein D. S., Sadowsky N., Hegsted D. M., Guri C. D., Stare F. J. Prevalence of osteoporosis in high- and low-fluoride areas in North Dakota. JAMA. 1966 Oct 31;198(5):499–504. [PubMed] [Google Scholar]
  13. Cann C. E., Genant H. K., Ettinger B., Gordan G. S. Spinal mineral loss in oophorectomized women. Determination by quantitative computed tomography. JAMA. 1980 Nov 7;244(18):2056–2059. [PubMed] [Google Scholar]
  14. Cann C. E., Martin M. C., Genant H. K., Jaffe R. B. Decreased spinal mineral content in amenorrheic women. JAMA. 1984 Feb 3;251(5):626–629. [PubMed] [Google Scholar]
  15. Christiansen C., Christensen M. S., McNair P., Hagen C., Stocklund K. E., Transbøl I. Prevention of early postmenopausal bone loss: controlled 2-year study in 315 normal females. Eur J Clin Invest. 1980 Aug;10(4):273–279. doi: 10.1111/j.1365-2362.1980.tb00033.x. [DOI] [PubMed] [Google Scholar]
  16. Christiansen C., Christensen M. S., Transbøl I. Bone mass in postmenopausal women after withdrawal of oestrogen/gestagen replacement therapy. Lancet. 1981 Feb 28;1(8218):459–461. doi: 10.1016/s0140-6736(81)91848-1. [DOI] [PubMed] [Google Scholar]
  17. Christiansen C., Riis B. J., Nilas L., Rødbro P., Deftos L. Uncoupling of bone formation and resorption by combined oestrogen and progestagen therapy in postmenopausal osteoporosis. Lancet. 1985 Oct 12;2(8459):800–801. doi: 10.1016/s0140-6736(85)90794-9. [DOI] [PubMed] [Google Scholar]
  18. Christiansen C., Rødbro P. Serum vitamin D metabolites in younger and elderly postmenopausal women. Calcif Tissue Int. 1984 Jan;36(1):19–24. doi: 10.1007/BF02405289. [DOI] [PubMed] [Google Scholar]
  19. Cohn S. H., Abesamis C., Yasumura S., Aloia J. F., Zanzi I., Ellis K. J. Comparative skeletal mass and radial bone mineral content in black and white women. Metabolism. 1977 Feb;26(2):171–178. doi: 10.1016/0026-0495(77)90052-x. [DOI] [PubMed] [Google Scholar]
  20. Dalén N., Hallberg D., Lamke B. Bone mass in obese subjects. Acta Med Scand. 1975 May;197(5):353–355. doi: 10.1111/j.0954-6820.1975.tb04933.x. [DOI] [PubMed] [Google Scholar]
  21. Daniell H. W. Osteoporosis of the slender smoker. Vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity. Arch Intern Med. 1976 Mar;136(3):298–304. doi: 10.1001/archinte.136.3.298. [DOI] [PubMed] [Google Scholar]
  22. Dequeker J., De Muylder E. Long-term progestogen treatment and bone remodelling in peri-menopausal women: a longitudinal study. Maturitas. 1982 Dec;4(4):309–313. doi: 10.1016/0378-5122(82)90063-9. [DOI] [PubMed] [Google Scholar]
  23. Donaldson C. L., Hulley S. B., Vogel J. M., Hattner R. S., Bayers J. H., McMillan D. E. Effect of prolonged bed rest on bone mineral. Metabolism. 1970 Dec;19(12):1071–1084. doi: 10.1016/0026-0495(70)90032-6. [DOI] [PubMed] [Google Scholar]
  24. Drinkwater B. L., Nilson K., Chesnut C. H., 3rd, Bremner W. J., Shainholtz S., Southworth M. B. Bone mineral content of amenorrheic and eumenorrheic athletes. N Engl J Med. 1984 Aug 2;311(5):277–281. doi: 10.1056/NEJM198408023110501. [DOI] [PubMed] [Google Scholar]
  25. Farmer M. E., White L. R., Brody J. A., Bailey K. R. Race and sex differences in hip fracture incidence. Am J Public Health. 1984 Dec;74(12):1374–1380. doi: 10.2105/ajph.74.12.1374. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Francis R. M., Peacock M., Taylor G. A., Storer J. H., Nordin B. E. Calcium malabsorption in elderly women with vertebral fractures: evidence for resistance to the action of vitamin D metabolites on the bowel. Clin Sci (Lond) 1984 Jan;66(1):103–107. doi: 10.1042/cs0660103. [DOI] [PubMed] [Google Scholar]
  27. Gallagher J. C., Jerpbak C. M., Jee W. S., Johnson K. A., DeLuca H. F., Riggs B. L. 1,25-Dihydroxyvitamin D3: short- and long-term effects on bone and calcium metabolism in patients with postmenopausal osteoporosis. Proc Natl Acad Sci U S A. 1982 May;79(10):3325–3329. doi: 10.1073/pnas.79.10.3325. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Gallagher J. C., Riggs B. L., Eisman J., Hamstra A., Arnaud S. B., DeLuca H. F. Intestinal calcium absorption and serum vitamin D metabolites in normal subjects and osteoporotic patients: effect of age and dietary calcium. J Clin Invest. 1979 Sep;64(3):729–736. doi: 10.1172/JCI109516. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Garn S. M., Clark D. C. Nutrition, growth, development, and maturation: findings from the ten-state nutrition survey of 1968-1970. Pediatrics. 1975 Aug;56(2):306–319. [PubMed] [Google Scholar]
  30. Garn S. M., Sandusky S. T., Nagy J. M., McCann M. B. Advanced skeletal development in low-income Negro children. J Pediatr. 1972 Jun;80(6):965–969. doi: 10.1016/s0022-3476(72)80008-8. [DOI] [PubMed] [Google Scholar]
  31. Genant H. K., Cann C. E., Ettinger B., Gordan G. S. Quantitative computed tomography of vertebral spongiosa: a sensitive method for detecting early bone loss after oophorectomy. Ann Intern Med. 1982 Nov;97(5):699–705. doi: 10.7326/0003-4819-97-5-699. [DOI] [PubMed] [Google Scholar]
  32. Goggin J. E., Haddon W., Jr, Hambly G. S., Hoveland J. R. Incidence of femoral fractures in postmenopausal women. Before and after water fluoridation. Public Health Rep. 1965 Nov;80(11):1005–1012. [PMC free article] [PubMed] [Google Scholar]
  33. Hahn T. J., Boisseau V. C., Avioli L. V. Effect of chronic corticosteroid administration on diaphyseal and metaphyseal bone mass. J Clin Endocrinol Metab. 1974 Aug;39(2):274–282. doi: 10.1210/jcem-39-2-274. [DOI] [PubMed] [Google Scholar]
  34. Hahn T. J. Corticosteroid-induced osteopenia. Arch Intern Med. 1978 May 15;138(Spec No):882–885. [PubMed] [Google Scholar]
  35. Hale W. E., Stewart R. B., Marks R. G. Central nervous system symptoms of elderly subjects using antihypertensive drugs. J Am Geriatr Soc. 1984 Jan;32(1):5–10. doi: 10.1111/j.1532-5415.1984.tb05142.x. [DOI] [PubMed] [Google Scholar]
  36. Horsman A., Gallagher J. C., Simpson M., Nordin B. E. Prospective trial of oestrogen and calcium in postmenopausal women. Br Med J. 1977 Sep 24;2(6090):789–792. doi: 10.1136/bmj.2.6090.789. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Horsman A., Jones M., Francis R., Nordin C. The effect of estrogen dose on postmenopausal bone loss. N Engl J Med. 1983 Dec 8;309(23):1405–1407. doi: 10.1056/NEJM198312083092301. [DOI] [PubMed] [Google Scholar]
  38. Huddleston A. L., Rockwell D., Kulund D. N., Harrison R. B. Bone mass in lifetime tennis athletes. JAMA. 1980 Sep 5;244(10):1107–1109. [PubMed] [Google Scholar]
  39. Hurxthal L. M., Vose G. P. The relationship of dietary calcium intake to radiographic bone density in normal and osteoporotic persons. Calcif Tissue Res. 1969;4(3):245–256. doi: 10.1007/BF02279127. [DOI] [PubMed] [Google Scholar]
  40. Hutchinson T. A., Polansky S. M., Feinstein A. R. Post-menopausal oestrogens protect against fractures of hip and distal radius. A case-control study. Lancet. 1979 Oct 6;2(8145):705–709. doi: 10.1016/s0140-6736(79)90640-8. [DOI] [PubMed] [Google Scholar]
  41. Iskrant A. P. The etiology of fractured hips in females. Am J Public Health Nations Health. 1968 Mar;58(3):485–490. doi: 10.2105/ajph.58.3.485. [DOI] [PMC free article] [PubMed] [Google Scholar]
  42. Jensen G. F., Christiansen C., Transbøl I. Treatment of post menopausal osteoporosis. A controlled therapeutic trial comparing oestrogen/gestagen, 1,25-dihydroxy-vitamin D3 and calcium. Clin Endocrinol (Oxf) 1982 May;16(5):515–524. doi: 10.1111/j.1365-2265.1982.tb02769.x. [DOI] [PubMed] [Google Scholar]
  43. Jensen J., Christiansen C., Rødbro P. Cigarette smoking, serum estrogens, and bone loss during hormone-replacement therapy early after menopause. N Engl J Med. 1985 Oct 17;313(16):973–975. doi: 10.1056/NEJM198510173131602. [DOI] [PubMed] [Google Scholar]
  44. Johnston C. C., Jr, Smith D. M., Yu P. L., Deiss W. P., Jr In vivo measurement of bone mass in the radius. Metabolism. 1968 Dec;17(12):1140–1153. doi: 10.1016/0026-0495(68)90094-2. [DOI] [PubMed] [Google Scholar]
  45. Kesson C. M., Morris N., McCutcheon A. Generalized Osteoporosis in Old Age. Ann Rheum Dis. 1947;6(3):146–161. [PMC free article] [PubMed] [Google Scholar]
  46. Korns R. F. Relationship of water fluoridation to bone density in two N.Y. towns. Public Health Rep. 1969 Sep;84(9):815–825. [PMC free article] [PubMed] [Google Scholar]
  47. Kreiger N., Kelsey J. L., Holford T. R., O'Connor T. An epidemiologic study of hip fracture in postmenopausal women. Am J Epidemiol. 1982 Jul;116(1):141–148. doi: 10.1093/oxfordjournals.aje.a113388. [DOI] [PubMed] [Google Scholar]
  48. Krølner B., Toft B., Pors Nielsen S., Tøndevold E. Physical exercise as prophylaxis against involutional vertebral bone loss: a controlled trial. Clin Sci (Lond) 1983 May;64(5):541–546. doi: 10.1042/cs0640541. [DOI] [PubMed] [Google Scholar]
  49. Kumanyika S. Obesity in black women. Epidemiol Rev. 1987;9:31–50. doi: 10.1093/oxfordjournals.epirev.a036307. [DOI] [PubMed] [Google Scholar]
  50. Lamke B., Sjöberg H. E., Sylvén M. Bone mineral content in women with Colles' fracture: effect of calcium supplementation. Acta Orthop Scand. 1978 Apr;49(2):143–146. doi: 10.3109/17453677809005740. [DOI] [PubMed] [Google Scholar]
  51. Lindsay R., Hart D. M., Aitken J. M., MacDonald E. B., Anderson J. B., Clarke A. C. Long-term prevention of postmenopausal osteoporosis by oestrogen. Evidence for an increased bone mass after delayed onset of oestrogen treatment. Lancet. 1976 May 15;1(7968):1038–1041. doi: 10.1016/s0140-6736(76)92217-0. [DOI] [PubMed] [Google Scholar]
  52. Lindsay R., Hart D. M., MacLean A., Clark A. C., Kraszewski A., Garwood J. Bone response to termination of oestrogen treatment. Lancet. 1978 Jun 24;1(8078):1325–1327. doi: 10.1016/s0140-6736(78)92402-9. [DOI] [PubMed] [Google Scholar]
  53. Lips P., Netelenbos J. C., Jongen M. J., van Ginkel F. C., Althuis A. L., van Schaik C. L., van der Vijgh W. J., Vermeiden J. P., van der Meer C. Histomorphometric profile and vitamin D status in patients with femoral neck fracture. Metab Bone Dis Relat Res. 1982;4(2):85–93. doi: 10.1016/0221-8747(82)90021-2. [DOI] [PubMed] [Google Scholar]
  54. Loré F., Nuti R., Vattimo A., Caniggia A. Vitamin D metabolites in postmenopausal osteoporosis. Horm Metab Res. 1984 Jan;16(1):58–58. doi: 10.1055/s-2007-1014696. [DOI] [PubMed] [Google Scholar]
  55. Lund B., Sørensen O. H., Lund B., Agner E. Serum 1,25-dihydroxyvitamin D in normal subjects and in patients with postmenopausal osteopenia. Influence of age, renal function and oestrogen therapy. Horm Metab Res. 1982 May;14(5):271–274. doi: 10.1055/s-2007-1018990. [DOI] [PubMed] [Google Scholar]
  56. MacDonald P. C., Edman C. D., Hemsell D. L., Porter J. C., Siiteri P. K. Effect of obesity on conversion of plasma androstenedione to estrone in postmenopausal women with and without endometrial cancer. Am J Obstet Gynecol. 1978 Feb 15;130(4):448–455. doi: 10.1016/0002-9378(78)90287-9. [DOI] [PubMed] [Google Scholar]
  57. Madans J., Kleinman J. C., Cornoni-Huntley J. The relationship between hip fracture and water fluoridation: an analysis of national data. Am J Public Health. 1983 Mar;73(3):296–298. doi: 10.2105/ajph.73.3.296. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Mangaroo J., Glasser J. H., Roht L. H., Kapadia A. S. Prevalence of bone demineralization in the United States. Bone. 1985;6(3):135–139. doi: 10.1016/8756-3282(85)90045-6. [DOI] [PubMed] [Google Scholar]
  59. Marcus R., Cann C., Madvig P., Minkoff J., Goddard M., Bayer M., Martin M., Gaudiani L., Haskell W., Genant H. Menstrual function and bone mass in elite women distance runners. Endocrine and metabolic features. Ann Intern Med. 1985 Feb;102(2):158–163. doi: 10.7326/0003-4819-102-2-158. [DOI] [PubMed] [Google Scholar]
  60. Marshall D. H., Horsman A., Nordin B. E. The prevention and management of post-menopausal osteoporosis. Acta Obstet Gynecol Scand Suppl. 1977;65:49–56. doi: 10.3109/00016347709156341. [DOI] [PubMed] [Google Scholar]
  61. Matković V., Kostial K., Simonović I., Buzina R., Brodarec A., Nordin B. E. Bone status and fracture rates in two regions of Yugoslavia. Am J Clin Nutr. 1979 Mar;32(3):540–549. doi: 10.1093/ajcn/32.3.540. [DOI] [PubMed] [Google Scholar]
  62. Mazess R. B. On aging bone loss. Clin Orthop Relat Res. 1982 May;(165):239–252. [PubMed] [Google Scholar]
  63. Meema H. E., Meema S. The relationship of diabetes mellitus and body weight to osteoporosis in elderly females. Can Med Assoc J. 1967 Jan 21;96(3):132–139. [PMC free article] [PubMed] [Google Scholar]
  64. Nachtigall L. E., Nachtigall R. H., Nachtigall R. D., Beckman E. M. Estrogen replacement therapy I: a 10-year prospective study in the relationship to osteoporosis. Obstet Gynecol. 1979 Mar;53(3):277–281. [PubMed] [Google Scholar]
  65. Nillson B. E., Westlin N. E. The bone mineral content in the forearm of women with colles' fracture. Acta Orthop Scand. 1974;45(6):836–844. doi: 10.3109/17453677408989694. [DOI] [PubMed] [Google Scholar]
  66. Nilsson B. E. Conditions contributing to fracture of the femoral neck. Acta Chir Scand. 1970;136(5):383–384. [PubMed] [Google Scholar]
  67. Nordin B. E., Horsman A., Crilly R. G., Marshall D. H., Simpson M. Treatment of spinal osteoporosis in postmenopausal women. Br Med J. 1980 Feb 16;280(6212):451–454. doi: 10.1136/bmj.280.6212.451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  68. Nordin B. E., Robertson A., Seamark R. F., Bridges A., Philcox J. C., Need A. G., Horowitz M., Morris H. A., Deam S. The relation between calcium absorption, serum dehydroepiandrosterone, and vertebral mineral density in postmenopausal women. J Clin Endocrinol Metab. 1985 Apr;60(4):651–657. doi: 10.1210/jcem-60-4-651. [DOI] [PubMed] [Google Scholar]
  69. Paganini-Hill A., Ross R. K., Gerkins V. R., Henderson B. E., Arthur M., Mack T. M. Menopausal estrogen therapy and hip fractures. Ann Intern Med. 1981 Jul;95(1):28–31. doi: 10.7326/0003-4819-95-1-28. [DOI] [PubMed] [Google Scholar]
  70. Ray W. A., Griffin M. R., Schaffner W., Baugh D. K., Melton L. J., 3rd Psychotropic drug use and the risk of hip fracture. N Engl J Med. 1987 Feb 12;316(7):363–369. doi: 10.1056/NEJM198702123160702. [DOI] [PubMed] [Google Scholar]
  71. Recker R. R., Heaney R. P. The effect of milk supplements on calcium metabolism, bone metabolism and calcium balance. Am J Clin Nutr. 1985 Feb;41(2):254–263. doi: 10.1093/ajcn/41.2.254. [DOI] [PubMed] [Google Scholar]
  72. Recker R. R., Saville P. D., Heaney R. P. Effect of estrogens and calcium carbonate on bone loss in postmenopausal women. Ann Intern Med. 1977 Dec;87(6):649–655. doi: 10.7326/0003-4819-87-6-649. [DOI] [PubMed] [Google Scholar]
  73. Riggs B. L., Seeman E., Hodgson S. F., Taves D. R., O'Fallon W. M. Effect of the fluoride/calcium regimen on vertebral fracture occurrence in postmenopausal osteoporosis. Comparison with conventional therapy. N Engl J Med. 1982 Feb 25;306(8):446–450. doi: 10.1056/NEJM198202253060802. [DOI] [PubMed] [Google Scholar]
  74. Riggs B. L., Wahner H. W., Melton L. J., 3rd, Richelson L. S., Judd H. L., O'Fallon W. M. Dietary calcium intake and rates of bone loss in women. J Clin Invest. 1987 Oct;80(4):979–982. doi: 10.1172/JCI113191. [DOI] [PMC free article] [PubMed] [Google Scholar]
  75. Rigotti N. A., Nussbaum S. R., Herzog D. B., Neer R. M. Osteoporosis in women with anorexia nervosa. N Engl J Med. 1984 Dec 20;311(25):1601–1606. doi: 10.1056/NEJM198412203112503. [DOI] [PubMed] [Google Scholar]
  76. Riis B., Thomsen K., Christiansen C. Does calcium supplementation prevent postmenopausal bone loss? A double-blind, controlled clinical study. N Engl J Med. 1987 Jan 22;316(4):173–177. doi: 10.1056/NEJM198701223160401. [DOI] [PubMed] [Google Scholar]
  77. SMITH R. W., Jr, FRAME B. CONCURRENT AXIAL AND APPENDICULAR OSTEOPOROSIS: ITS RELATION TO CALCIUM CONSUMPTION. N Engl J Med. 1965 Jul 8;273:73–78. doi: 10.1056/NEJM196507082730203. [DOI] [PubMed] [Google Scholar]
  78. Saville P. D., Nilsson B. E. Height and weight in symptomatic postmenopausal osteoporosis. Clin Orthop Relat Res. 1966 Mar-Apr;45:49–54. [PubMed] [Google Scholar]
  79. Seeman E., Melton L. J., 3rd, O'Fallon W. M., Riggs B. L. Risk factors for spinal osteoporosis in men. Am J Med. 1983 Dec;75(6):977–983. doi: 10.1016/0002-9343(83)90878-1. [DOI] [PubMed] [Google Scholar]
  80. Selby P. L., Peacock M., Barkworth S. A., Brown W. B., Taylor G. A. Early effects of ethinyloestradiol and norethisterone treatment in post-menopausal women on bone resorption and calcium regulating hormones. Clin Sci (Lond) 1985 Sep;69(3):265–271. doi: 10.1042/cs0690265. [DOI] [PubMed] [Google Scholar]
  81. Simonen O., Laitinen O. Does fluoridation of drinking-water prevent bone fragility and osteoporosis? Lancet. 1985 Aug 24;2(8452):432–434. doi: 10.1016/s0140-6736(85)92748-5. [DOI] [PubMed] [Google Scholar]
  82. Smith D. M., Johnston C. C., Jr, Yu P. L. In vivo measurement of bone mass. Its use in demineralized states such as osteoporosis. JAMA. 1972 Jan 17;219(3):325–329. [PubMed] [Google Scholar]
  83. Smith E. L., Jr, Reddan W., Smith P. E. Physical activity and calcium modalities for bone mineral increase in aged women. Med Sci Sports Exerc. 1981;13(1):60–64. [PubMed] [Google Scholar]
  84. Smith E. L., Reddan W. Proceedings: Physical activity--a modality for bone accretion in the aged. AJR Am J Roentgenol. 1976 Jun;126(6):1297–1297. doi: 10.2214/ajr.126.6.1297. [DOI] [PubMed] [Google Scholar]
  85. Smith R. W., Jr, Rizek J. Epidemiologic studies of osteoporosis in Women of Puerto Rico and southeastern Michigan with special reference to age, race, national origin and to other related or associated findings. Clin Orthop Relat Res. 1966 Mar-Apr;45:31–48. [PubMed] [Google Scholar]
  86. Sowers M. R., Wallace R. B., Lemke J. H. Correlates of mid-radius bone density among postmenopausal women: a community study. Am J Clin Nutr. 1985 May;41(5):1045–1053. doi: 10.1093/ajcn/41.5.1045. [DOI] [PubMed] [Google Scholar]
  87. Sowers M., Wallace R. B., Lemke J. H. Correlates of forearm bone mass among women during maximal bone mineralization. Prev Med. 1985 Sep;14(5):585–596. doi: 10.1016/0091-7435(85)90079-9. [DOI] [PubMed] [Google Scholar]
  88. Szmukler G. I., Brown S. W., Parsons V., Darby A. Premature loss of bone in chronic anorexia nervosa. Br Med J (Clin Res Ed) 1985 Jan 5;290(6461):26–27. doi: 10.1136/bmj.290.6461.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  89. Tsai K. S., Heath H., 3rd, Kumar R., Riggs B. L. Impaired vitamin D metabolism with aging in women. Possible role in pathogenesis of senile osteoporosis. J Clin Invest. 1984 Jun;73(6):1668–1672. doi: 10.1172/JCI111373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  90. WHEDON G. D., SHORR E. Metabolic studies in paralytic acute anterior poliomyelitis. II. Alterations in calcium and phosphorus metabolism. J Clin Invest. 1957 Jun;36(6 Pt 2):966–981. doi: 10.1172/JCI103496. [DOI] [PMC free article] [PubMed] [Google Scholar]
  91. Wasnich R. D., Benfante R. J., Yano K., Heilbrun L., Vogel J. M. Thiazide effect on the mineral content of bone. N Engl J Med. 1983 Aug 11;309(6):344–347. doi: 10.1056/NEJM198308113090605. [DOI] [PubMed] [Google Scholar]
  92. Wasnich R. D., Ross P. D., Heilbrun L. K., Vogel J. M., Yano K., Benfante R. J. Differential effects of thiazide and estrogen upon bone mineral content and fracture prevalence. Obstet Gynecol. 1986 Apr;67(4):457–462. [PubMed] [Google Scholar]
  93. Weiss N. S., Ure C. L., Ballard J. H., Williams A. R., Daling J. R. Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen. N Engl J Med. 1980 Nov 20;303(21):1195–1198. doi: 10.1056/NEJM198011203032102. [DOI] [PubMed] [Google Scholar]
  94. Williams A. R., Weiss N. S., Ure C. L., Ballard J., Daling J. R. Effect of weight, smoking, and estrogen use on the risk of hip and forearm fractures in postmenopausal women. Obstet Gynecol. 1982 Dec;60(6):695–699. [PubMed] [Google Scholar]
  95. Wootton R., Brereton P. J., Clark M. B., Hesp R., Hodkinson H. M., Klenerman L., Reeve J., Slavin G., Tellez-Yudilevich M. Fractured neck of femur in the elderly: an attempt to identify patients at risk. Clin Sci (Lond) 1979 Jul;57(1):93–101. doi: 10.1042/cs0570093. [DOI] [PubMed] [Google Scholar]
  96. Wootton R., Bryson E., Elsasser U., Freeman H., Green J. R., Hesp R., Hudson E. A., Klenerman L., Smith T., Zanelli J. Risk factors for fractured neck of femur in the elderly. Age Ageing. 1982 Aug;11(3):160–168. doi: 10.1093/ageing/11.3.160. [DOI] [PubMed] [Google Scholar]
  97. Wyshak G. Hip fracture in elderly women and reproductive history. J Gerontol. 1981 Jul;36(4):424–427. doi: 10.1093/geronj/36.4.424. [DOI] [PubMed] [Google Scholar]

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