Purpose: Osteoporosis is a systemic disease in which bone density is reduced, leading to weakness of the skeleton and increased vulnerability to fractures. The purpose of this study was to compare known or suspected risk factors (medical, gynecological, and lifestyle characteristics) related to bone loss between 60 matched pairs of black and white postmenopausal women.Methods: The two racial groups were matched one for one on selective anthropometric variables [age (years), standing height (cm), and body weight (k-)] in order to equate age and body size between groups. Information on risk factors was obtained from an orally administered questionnaire and body composition variables (in addition to those used for matching) assessed by anthropometry and total body dual energy X-ray absorptiometry (DXA). Four skinfold sites (chest, triceps, mid-axillary, and abdomen) were measured with Harpendon calipers and four body circumferences (chest, forearm contracted, waist, and gluteal) were assessed with a Gulick tape. DXA radius, spine, femur, and whole body measurements were obtained on a Hologic QDR-2000 with software version 7.20.Results: White women reported significantly higher proportions of alcohol use, family history of broken bones, and a greater utilization of hormones, calcium and vitamins than did black women. Black women reported a greater numbers who had other diseases (i.e., overactive thyroid, diabetes, rheumatoid arthritis, or kidney stones). Although age and body weight were similar in both groups, black women had greater lean tissue and less body fat than white women. Blacks had significantly higher bone mineral density across all body sites with the exception of the mid- and ultra-distal radius.Conclusion: On the basis of these data, it was concluded that part of the difference often observed in bone density between black and white postmenopausal women might be due to lifestyle factors. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

BACKGROUND:Many women are unaware of risk factors for and consequences of osteoporosis. Hence, patient education is an essential step in preventing and managing osteoporosis. Unfortunately, numerous studies have demonstrated a mismatch between the reading difficulty of typical patient education materials and the reading ability of many American adults.METHODS:We examined the readability and quality of web-based information on osteoporosis using the Suitability Assessment of Materials (SAM) and DISCERN instruments. The three most widely used Internet search engines, Google, Yahoo, and MSN, were selected based on popularity according to Nielsen/Net Ratings. The search term osteoporosis was entered to generate the first 30 websites listed by each of the three search engines. Several websites appeared on all three search engines; we identified 27 unique websites.RESULTS:Overall, 51.9% of materials were rated by the SAM as not suitable. Most materials scored poorly for their reading level (82.6% were rated not suitable), with an average reading level at grade 11.5 +/- 2.8. The mean DISCERN score for overall description of treatment options was 35.7 +/- 18.0, indicating inadequate quality. Most materials had low quality in a number of indicators, including accuracy and biased presentation of information.CONCLUSIONS:Web-based osteoporosis information is written above the reading ability of most American adults, and much of it lacks adequate quality.

1361 PURPOSE: The purpose of this study was to educate a group of women (aged 65–89 years) about home safety and to evaluate the number of changes made during the study period inside and outside their homes to improve safety and prevent falling. METHODS: Forty (n = 40) postmenopausal women, who had a history of falling but had been medically screened excluding those with vestibular dysfunction, were admitted to study. A questionnaire, modified from the work of Baker(1997), was given pre- and post-study to evaluate home safety factors (12 factors inside the home and 4 factors outside the home). Six education sessions were given where suggested changes included removing dangerous obstacles and/or installing helpful materials. Education sessions were interspersed across a 15-week exercise program. Femoral bone mineral density was measured with Hologic QDR 2000 dual energy x-Ray absorptiometry (DXA). Safety changes were tabulated during the 15-week study period and during a 1-year follow-up period and were evaluated for the entire groups as well as for two age categories (younger 65–72 years, n = 19; and older 73–89, n = 21). RESULTS: Results combined from both study periods for the entire group revealed that 37 changes were made inside and 8 outside the home. In descending order, these changes were: for inside [additional outlets replaced extension cords (n = 8), small throw rugs removed (n = 7), grab bars installed in bathroom and shower areas (n = 6), night-lights installed in hallways and bathrooms (n = 5), cordless telephones purchased (n = 5), clutter removed from walkways (n = 4), and area rugs securely taped (n = 2)] and for outside [easy open latches installed (n = 3), brighter lighting put at entrances (n = 2) handrails on steps installed (n = 2) and steps into home repaired (n = 1)]. The younger subjects made more changes than older subjects 28 to 17 but probably because some of the older women had previously made some of these changes on their own. CONCLUSION: On the basis of these data, it was concluded that elderly women responded to home safety education and that this type of information should be included in fall prevention programs.

OBJECTIVEWhile African-American women tend to have greater bone mineral density (BMD) than caucasian women, they are still at risk of developing osteoporosis later in life. Clinical decision rules (i.e., algorithms) have been developed to assist clinicians identify women at greatest risk of low BMD. However, such tools have only been validated in caucasian and Asian populations. Accordingly, the objective of this study was to compare the performance of five clinical decision rules in identifying postmenopausal African-American women at greatest risk for low femoral BMD.METHODOLOGYOne hundred-seventy-four (n=174) postmenopausal African-American women completed a valid and reliable oral questionnaire to assess lifestyle characteristics, and completed height and weight measures. BMD at the femoral neck was measured via dual energy x-ray absorptiometry (DXA). We calculated sensitivity, specificity, positive predictive value, and negative predictive value for identifying African-American women with low BMD (T-Score < or = -2.0 SD) using five clinical decision rules: Age, Body Size, No Estrogen (ABONE), Osteoporosis Risk Assessment Instrument (ORAI), Osteoporosis Self-Assessment Tool (OST), Simple Calculated Osteoporosis Risk Estimation (SCORE), and body weight less than 70 kg.RESULTSApproximately 30% of African-American women had low BMD, half of whom had osteoporosis (BMD T-Score < or = -2.5 SD). Sensitivity for identifying women with a low BMD (T-Score < or = -2.0 SD) ranged from 65.57-83.61%, while specificity ranged from 53.85-78.85%. Positive predictive values ranged from 80.95-87.91%, while negative predictive values ranged from 48.44-58.33%.CONCLUSIONOur data suggest that the clinical decision rules analyzed in this study have some usefulness for identifying postmenopausal African-American women with low BMD. However, there is a need to establish cut-points for these clinical decision rules in a larger, more diverse sample of African-American women.

0768 A variety of written physical activity educational materials (PAEMs) have been developed by organizations within the private and public sectors. PAEMs have addressed important topics such as, the health benefits of physical activity, guidelines for physical activity participation, and helpful hints/strategies to adopt a physically active lifestyle. Several studies have suggested that a large percentage of the general population reads <6th grade level, even though actual grade attainment may be much higher. Because of these findings, health literacy experts suggest that health education materials be written at a 6th grade level. PURPOSE: The purpose of this study was to evaluate the readability of English-language written PAEMs available to the general public. METHODS: Written PAEMs (n = 20) were collected from government agencies (e.g., National Institutes of Health), national organizations (e.g., American Heart Association), and pharmaceutical corporations (e.g., Pfizer). Calculation of readability (i.e., grade level) was done using McLauglin's (Simplified Measure of Gobbledygoop) SMOG formula. The SMOG is accurate, has shown to highly correlate with other readability formulas and has been recommended by the American Cancer Society for written materials. RESULTS: All PAEMs evaluated in this study were written above the recommended 6th grade reading level. The mean SMOG grade level of written PAEMs was 10.58 ± 1.87 (range 8–16). PAEMs averaged 53.32 ± 18.71 >3-syllable words per piece. Words such as, “metabolism,” “glucose uptake,” “circulation,” and “hyperextension” appeared routinely throughout PAEMs. CONCLUSIONS: Currently, PAEMs are written at a level that many American adults are unable to comprehend. To be effective in helping adults make informed choices regarding physical activity, PAEMs must be understandable to the clientele for whom they are intended.

This study assessed differences in bone-mineral density (BMD) and lean and fat tissues between 5 age groups of White men age 65–93 years. Lean and fat tissues were measured with absorptiometry and anthropometry, and BMD, with dual-energy X-ray absorptiometry. Forearm, spinal, and femoral T scores were used to classify BMD as normal, osteopenic, or osteoporotic. A questionnaire evaluated previous physical activity, calcium intake, and bone fractures. Significantly lower values in body weight, lean tissue, and forearm BMD occurred in the older age groups. Significant, positive relationships were found between total lean tissue and radial, spinal, and hip BMDs. For the total group, osteopenic and osteoporotic T scores, respectively, were femoral neck 70.6% and 9.8%, radius 27.5% and 25.5%, and spine 25.5% and 7.8%. Differences in BMD values were found between levels of lifestyle factors (dietary calcium and history of previous fractures). In conclusion, elderly men should be encouraged to maintain adequate total lean tissue because of its association with BMD.

OBJECTIVE To evaluate the accountability of osteoporosis information available in selected mass-circulating women's magazines (n=8) and a sample of newspapers (n=2). METHODS Osteoporosis articles (n=132) were assessed for sources of information used, incidence/prevalence statistics, risks factors, and prevention measures. RESULTS Expert sources were highlighted in the majority of articles, whereas incidence/ prevalence statistics were described in less than half of the articles. Risk factors and prevention measures were outlined in most articles; however, much of the information presented was ambiguous and incomplete. CONCLUSIONS It appears that the reporting of osteoporosis in women's magazines and newspapers is not entirely balanced; thus, future coverage should provide greater detail when reporting risks and preventive measures.

OBJECTIVEOsteoporosis is a significant public health problem associated with increased mortality and morbidity. Our aim in this cross-sectional study was to investigate the relationship between lifetime physical activity and calcium intake and bone mineral density (BMD) and BMC (bone mineral content) in 42 regularly menstruating Caucasian women (age 21.26+/-1.91 years, BMI 23.83+/-5.85).METHODSBMD and BMC at the lumbar spine (L2-L4), hip (femoral neck, trochanter, total), and total body were assessed by dual energy x-ray absorptiometry (DXA). Lifetime history of physical activity and calcium intake was obtained by a structured interview using valid and reliable instruments.RESULTSMeasures of both lifetime physical activity and calcium intake were highly correlated. In stepwise multiple regression analyses, lean mass was the most important and consistent factor for predicting BMD and BMC at all skeletal sites (attributable r2 = 28.8%-78.7%). Lifetime physical activity contributed to 3.0% of the variation in total body BMD, and life-time weight-bearing physical activity explained 15.1% of variance in lumbar spine BMC. Current calcium intake predicted 6% of the variance in BMD at the femoral neck and trochanter.CONCLUSIONSWe found lean mass to be a powerful predictor of BMD and BMC in young women. Because lean mass can be modified to some extent by physical activity, public health efforts must be directed at increasing physical activity throughout the lifespan. Furthermore, our results suggest that adequate calcium intake may help to enhance bone mass, thus decreasing the risk of osteoporotic fracture later in life.

512 This study assessed body composition among 3 groups of postmenopausal women classified by femoral bone density as normal (n=28), osteopenic (n=101), or osteoporotic (n=52) according to WHO standards. Ss were volunteers and at least 5 yrs past menopause. Standing height and body weight were measured on Detecto Scales. Sitting height was measured with the subjects seated on a stool and a tape secured to the wall behind them. Eight skinfolds (triceps, chest, midaxillary, abdomen, subscapular, suprallium. calf, & thigh) were assessed with Harpendon Calipers according to the procedures of Jackson (1980) and 8 muscle circumferences (contracted forearm, contracted biceps, relaxed biceps, chest, waist, thigh, gluteal, & calf) were measured with a Gulick Tape according to the procedures of Lohman (1991). Percent Body Fat (%BF) was obtained with DEXA using the Hologic QDR-2000. Results of one-way ANOVAs with Newman-Keuls Multiple Comparison Tests, used to assess group differences, revealed: 1) Osteopenic and osteoporotic groups significantly (p<.05) shorter in sitting height than the normals (84. 16±3.99 and 85.49±2.83 to 86.81±3.25cm, respectively), 2) Body weight significantly decreased between groups (normals=75.82±14.76kg, osteopenics=67.61±12.02kg, and osteoporotics=60.88±7.97kg), 3) Normal group had significantly more%BF by DEXA than the osteopenic and osteoporotic groups (44.50±6.45% to 41.76±7.72% and 39.46±7.83%, respectively). 4) Normals had larger sum of 8 skinfolds and body girths than other two groups. It was concluded that body composition varied significantly between the 3 groups and may have been a contributing factor to bone density.

1654 This study evaluated lifestyle factors (i.e., genetics, nutrition, gynecology, physical activity, and unrelated medical conditions) among 3 groups of postmenopausal women who were classified by femoral and spinal bone mass as normal (n=48), osteopenic (n=95), or osteoporotic (n=38) according to WHO standards. The classifications were: 1) Normal Group had bone masses of the spine and the hip greater than -1 SD, 2) Osteoporotic Group had either bone below -2.5 SDs, and 3) Osteopenic Group had either or both bones between-1 SD and -2.5 SDs and neither bone below -2.5 SDs. Lifestyle factors during the last 10 years were assessed from an orally administered questionnaire. All bone measurements were made with DEXA (Hologic QDR 2000 Array Beam). Results of the questionnaire data analyzed with Overall Chi-Squares (OCS) and Ridit Chi-Squares (RCS) at p<.05 revealed 4 factors significantly differed among groups: 1) Normals had significantly (OCS p=0.006, RCS p=0.002) fewer non-traumatic and traumatic fractures (major traumas such as automobile accidents were eliminated) than the other two groups, 2) Osteoporotic group had significantly (OCS p=0.018 RCS p=0.005) more close relatives who had experienced at least one or more non-traumatic fractures, 3) Significantly(OCS p=0.001, RCS p=0.001) more osteoporotic subjects experienced menopause naturally while more of the normal group experienced it surgically, and 4) Osteoporotic groups had significantly (OCS p=0.005, RCS p=0.002) more metabolic related diseases than either of the other two groups. On the basis of these data it was concluded that important lifestyles differences existed between the 3 bone density groups in this study.

1566 We calculated principal component (PC) scores for N=101 postmenopausal subjects (Ss) from anthropometry: 8 skinfolds, AGE (yrs), standing and sitting height (HT1, HT2; cm), body weight (WT; kg), body mass index (BMI; kg/m**2), and gluteal girth (GG; cm). Uncorrelated PC scores, arranged in descending order of (maximized) variability, were examined separately and as surrogate predictors for raw variables in multiple regression of body density (BD). Such models predict body composition when hydrostatic weightin is not feasible. The separate PC analysis was validated against N=139 Ss, restricting ages to 50-70 in both groups. Considering skinfold sites only, PC1 was approximately proportional to the sum of all 8 skinfolds and explained 60.9% of the total system variability (TSV). PC2 contrasted subscapular, chest, midaxillary, suprailiac sites vs. triceps, abdominal thing, and calf (13.2% TSV). Similar patterns were seen in the validation sample: PC1 (69.9% TSV), PC2 (9.6% TSV), although the sign changed for the abdominal site in PC2. Among non-skinfold variables alone, each positively loaded on PC1 (47.0% TSV), and PC2 contrasted HT1 and HT2 vs. the other non-skinfold variables (32.7% TSV). Combining variables, the results were less interpretable, although each variable positively loaded on PC1 (47.2% TSV) while PC2 was dominated by a contrast between HT1 and HT2 vs. most of the skinfolds (except for chest and triceps) and explained appreciably more variation (15.7% TSV). Whether to include PC3 was marginal (9.3% TSV). In the PC regression of BD using these combined PCs as independent variables, PC1 was the best single surrogate predictor(R2=55.3%), while BMI was the best single raw predictor (R2=46.2%). For two-predictor models, PC1 and PC2 together explained very little additional variation in BD (R2=59.1%). This was comparable to the best two-predictor model of original variables (age and GG, R2=56.0%). These analyses suggest (1) one and possibly two functions of all 8 skinfolds, and two or three functions overall, are probably sufficient for most statistical purposes; (2) skinfold constrasts between trunk sites and extremities seems to be independent of the sum of all 8 skinfolds. We conclude the PC method can improve prediction accuracy, enhance interpretability, and identify redundancy.

1658 This study evaluated lifestyle factors (i.e., genetics, nutrition, gynecology, physical activity, and unrelated medical conditions) among 3 groups of postmenopausal women who were classified by spinal bone density as normal (n=70), osteopenic (n=77), or osteoporotic (n=34) according to WHO standards. Lifestyle factors during the last 10 years were assessed from an orally administered questionnaire. Lumbar Spine (LS) was measured from two views: Anterior/Posterior (AP) and Lateral (L) with DEXA (Hologic QDR 2000 Array Beam). Questionnaire data were analyzed with Overall Chi-Squares (OCS) and Ridit Chi-Squares (RCS) at p<.05. Results revealed 3 factors differed among groups across the past 10 years: 1) Normal group had significantly higher recreational and dally activities than other two groups (OCS p=0.033, RCS p=0.024) with activity classified as low, moderate, and high, 2) Normals had significantly (OCS p=0.001, RCS p=0.001) fewer non-traumatic and traumatic fractures (major traumas such as car accidents were eliminated) than the other two groups, and 3) Osteoporotic group had significantly (OCS p=0.036, RCS p=0.027) more close relatives who had experienced at least one or more non-traumatic fractures compared to the other two groups. Five factors did not reach statistical significance in this study partly because of the high health consciousness of the entire sample: 1) calcium intake (dietary and supplementation), 2) HRT usage, 3) physical activity associated with occupational work, 4) alcohol consumption, and 5) cigarette smoking. On the basis of these data it was concluded that lifestyles differed slightly between the 3 bone density groups in this study.

We compared lumbar and femoral bone density in 129 black (M age=61.0 +/- 12.7 yrs) and 130 white (M age 62.7 +/- 8.4 yrs) postmenopausal women volunteers. A total of 44/129 (34%) black Ss and 84/130 (65%) of white Ss were currently taking hormone replacement therapy (HRT) as prescribed by their personal physicians. Standing height and body weight were obtained on Detecto scales. We measured the bone tissue with a Hologic QDR-2000 densitometer, and compared the bone density for the L2-L4 lumbar spine (SP), and the total femur(HIP) sites, adjusting for years past menopause (YPM: yrs) and body mass index(BMI: wt(kg)/ht(m2)]. The following means and adjusted means were obtained: This table shows that, after adjusting for body mass index and years past menopause, the overall L2-L4 regional differences appear to be less clinically striking. The adjusted racial differences in the total hip, although a bit more pronounced, are not statistically significant. Additional analyses, however, did yield some significant differences at various subsites (data not shown). We believe that the consideration of weight-bearing hypotheses and other lifestyle and dietary factors could possibly erode the often apparently large racial differences, suggesting that blacks with these identified lifestyle factors (or their correlates) may have similar risks for osteoporotic fractures as their white counterparts.

This study compared femoral bone sites between two racial groups of similarly aged postmenopausal women. One hundred twenty nine black women(age=61.0±12.7 yrs) and 130 white women (age=62.7±8.4 yrs) volunteered for this study. Height and weight were obtained and a questionnaire was given orally to assess activity, gynecological, medical, and nutritional histories. Bone measurements (Bone Mineral Content, BMC: Bone Area, BA: and Bone Mineral Density, BMD) were obtained at 5 femoral sites(Femoral Neck, FN; Trochanter, T; Inter Trochanter, IT; Ward's Triangle, WT; and Total Femur, TF) with Hologic QDR 2000 Bone Densitometer. Two-way ANOVAs(2 races by 4 age groups, <50, 50-59, 60-69, 70+ yrs) were used to determine differences in femoral bone between races, age groups, and for race by age interactions. The interactions compared bone change across age groups between the two races. Significant (p<.05) results revealed: 1) white women were taller (162.7 ±5.6 to 160.52±5.6 cm) but black women weighed more (83.3±21.2 to 65.0±12.3 kg), 2) black women had greater BMC and BMD values at all 5 femoral sites but no difference in BA, except at the T and TF sites where white women had larger BAs(10.876±1.458 to 10.402±1.414 and 34.467±3.197 to 33.326±3.872 cm2, respectively), 3) losses in BMD occurred across age groups in both races, and 4) no significant race by age interactions. It was concluded that black women had higher femoral BMC and BMD values but both races lost bone at similar rates. Thus, black postmenopausal women become at risk for osteoporotic fractures at an older age than white women.

This study compared anthropometric measurements between two racial groups of similarly aged postmenopausal women. One hundred twenty nine black women(age=61.0±12.7 yrs) and 130 white women (age=62.7±8.4 yrs) volunteered for this study. Standing and sitting heights, body weight, 4 skinfolds, and 4 body girths were obtained on both racial groups. Body Mass Index [BMI wt (kg)/ht (m2)] and Waist to Hip Ratio (WHR) were also calculated. Skinfolds (tricep. Tr; chest, Ch; midaxillary, Ma; and abdomen, Ab) were measured serially with Harpend en Calipers and body girths (forearm, chest, waist, gluteal) with a Gulick Tape according to Lohman. et al. (1980). Peak rt and l f t hand grips were measured with a dynamometer. Significant (p<.05)“t” tests between the two racial groups revealed: 1) white subjects (Ss) had taller mean sitting and standing heights than black Ss(86.7±2.9 to 82.6±3.4 cm and 162.5±5.6 to 160.5±5.6 cm. respectively) but black Ss weighed more (83.3±21.2 to 65.0±12.3 kg, respectively); 2) black Ss had larger values for BMI(32.3±8.1 to 24.5±4.3 kg/m2). WHR (.84±.08 to.78±.06), skinfolds (Tr=29.1±10.3 to 25.3±6.8 mm; Ch=21.8 ±8.9 to 14.5±5.8 mm; Ma=27.0±11.1 to 18.4±7.8 mm and Ab=43.7±13.2 to 29.8±8.9 mm, respectively) and 4 body girths; and 3) white Ss had greater peak rt and lft hand grip strengths (26.7±4.9 to 22.3±9.1 kg and 23.6±19.8 kg to 19.8±7.5 kg, respectively) than black Ss. It was concluded that the high level of body fat overall and the concentration of it in the mid area of the body put the black Ss at risk for diabetes, hypertension, and other diseases associated with obesity.

This study compared lean, fat, and bone tissue masses between two racial groups of similarly aged postmenopausal women. One hundred twenty nine black women (M age=61.0±12.7 yrs) and 130 white women (M age=62.7±8.4 yrs) volunteered for this study. Standing height and body weight were obtained on Detecto scales. Measurement of the three body tissues was made with an Hologic QDR 2000 Bone Densitometer. Tissue assessments were subdivided into 6 body segments and combined for the total body. Significant (p<.05)“t” tests, used to determine racial differences in height, weight and tissue masses for 6 body segments and for total body, revealed: 1) white subjects (Ss) were taller (162.7 ±5.6 to 160.52±5.6 cm) but black Ss weighed more (83.3±21.2 to 65.0±12.3 kg), 2) black Ss had greater lean, fat, and bone tissue masses than white Ss at each body segment and for the total body (M total lean=43.4±6.7 to 37.1±4.2 kg; M total fat=38.7± 15.7 to 26.9±9.8 kg; and M total bone=2.3±0.4 to 2.0±0.3 kg, respectively). Significant(p<.05) one-way ANOVAS, used in each racial group across 4 cross-sectional age groups, <50, 50-59, 60-69, 70+ yrs, revealed black and white Ss lost significant lean and bone tissue masses (9.9% to 8.1% and 16.1% to 17.5%, respectively) between youngest and oldest groups but only white Ss lost fat tissue mass across age groups. It was concluded in this study, that black Ss had greater lean, fat, and bone mass tissues in 6 body segments and total body than white Ss. However, both racial groups lost lean and bone tissues similarly while only white Ss lost fat tissue across age groups.