Original Article
Prevention of Postmenopausal Osteoporosis — A Comparative Study of Exercise, Calcium Supplementation, and Hormone-Replacement Therapy
N Engl J Med 1991; 325:1189-1195October 24, 1991
- Abstract
- Abstract
Background.
Osteoporosis among older women is a major public health problem. We studied the effects of three approaches to the prevention of osteoporosis in women with low bone density.
Methods.
One hundred twenty postmenopausal women (mean [±SD] age, 56±4) who were selected because they had low forearm bone density were enrolled in a double-blind, placebo-controlled, randomized study comparing the effects of an exercise regimen (exercise group, n = 41), exercise plus dietary calcium supplementation (exercise—calcium group, n = 39), and exercise plus continuous replacement of estrogen and progesterone (exercise—estrogen group, n = 40). Periodically during the two-year study period, we measured the women's bone density at three forearm sites, measured indexes of calcium metabolism, and recorded symptom scores. A comparison group of 42 women (mean age, 55.5 ±3.1) with normal bone density was also followed for two years.
Results.
Significant bone loss in the distal forearm occurred in the group with normal bone density (control group) and the exercise group (change, -2.7 percent and -2.6 percent of the base-line value per year, respectively). Bone loss at the distal forearm site was significantly lower in the exercise—calcium group (-0.5 percent of the base-line value per year), and bone density increased at this site in the exercise—estrogen group (+2.7 percent of the base-line value per year). Bone loss at the median forearm site was significantly lower in the exercise—calcium group (-1.3 percent of the base-line value per year) than in the exercise group (-2.4 percent), and bone density at this site increased significantly in the exercise—estrogen group (+0.8 percent of the base-line value per year). Breast tenderness occurred in 47 percent of the women in the exercise—estrogen group but in only 20 percent in the other two treatment groups. Vaginal bleeding occurred at some time in 52 percent of the women who had not had a hysterectomy in the exercise—estrogen group, as compared with 11 percent and 12.5 percent, respectively, in the exercise and exercise—calcium groups.
Conclusions.
In postmenopausal women with low bone density, bone loss can be slowed or prevented by exercise plus calcium supplementation or estrogen—progesterone replacement. Although the exercise—estrogen regimen was more effective than exercise and calcium supplementation in increasing bone mass, it also caused more side effects. (N Engl J Med 1991;325: 1189–95.)
Media in This Article
Figure 1
Effects of the Three Interventions on Bone Density at Distal, Median, and Proximal Forearm Sites during the Two-Year Study Period.Figure 2
Relation of Physical Activity and Calcitriol Level to Changes in Distal-Forearm Bone Density.Article Activity
- Article
THE high prevalence of bone fractures among women with osteoporosis makes prevention of this disease important. Bone densitometry makes it possible to quantify the risk of fracture in both the appendicular and the axial skeleton.1 2 3 4 The forearm is a good site for bone-density screening5 because of the ease of measurement and the relatively low cost, although the correlation coefficient for bone-density values measured at various skeletal sites is only about 0.5 to 0.7.6 , 7
We studied the effects of three approaches to the prevention of bone loss. The first was an exercise regimen that has been proved, at least in some studies,8 to be effective in slowing bone loss. In a second regimen, calcium supplementation was added to the exercise program, since we thought the combination of these two approaches might be more effective than either alone. Calcium supplementation has also been shown to be effective in some studies9 but not in others.10 The third regimen combined exercise with continuous replacement of estrogen and progesterone. Hormone replacement has been shown to maintain bone mass11 , 12 and, in retrospective case–control studies, to be effective in preventing fractures.13 , 14 In addition to the effects of these interventions on bone density, we studied their effects on calcitropic hormones and calcium metabolism in order to elucidate their mechanisms of action. We also studied side effects, which are important in planning any community-based intervention program.
For this study we selected women who were at increased risk for fracture because their bone density was lower than a fracture threshold set close to 1 SD below the mean for premenopausal women. This level was based on previous data suggesting that bone-density values below it were associated with an increased prevalence of fracture.15 For purposes of comparison, we also studied women with bone-density values above the fracture threshold, who did not receive any specific intervention (control group).
Methods
Subjects
We recruited subjects for the study by means of articles in the media inviting women to participate in a study of the prevention of osteoporosis. The respondents were initially screened with a short questionnaire administered over the telephone. Women were eligible for the study if they were 43 years of age or older, had been postmenopausal for 1 to 10 years, did not have hypertension or any other chronic disease, were nonsmokers, and were not taking estrogen, other steroid hormones, or anticonvulsant or thiazide diuretic drugs. The date of menopause was defined as the date of the last menstrual period. For women who had undergone hysterectomy or oophorectomy, the date of menopause was considered the date of the operation. For women who were unsure whether oophorectomy was performed at the time of hysterectomy, the date of menopause was taken as the date of onset of hot flashes. All the women had serum levels of follicle-stimulating hormone that were greater than 40 IU per liter, confirming their postmenopausal status. The 374 women who met these eligibility criteria (all of whom were white) had their forearm bone density measured. In 202 women the distal bone density was not more than 1 SD below the mean for premenopausal women (i.e., was ≥290 mg per square centimeter), and they were therefore not considered to be at high risk for osteoporotic fracture. Forty-two women selected at random from this group were designated the normal-bone-density (control) group.
The 172 women with bone-density values less than 290 mg per square centimeter at the distal forearm site were asked to attend a seminar to discuss the trial, at which 120 agreed to participate. These women were instructed on how to complete a four-day diet and exercise record, which they brought back to a morning clinic. They were then randomly assigned to one of the three study groups by being given a study number that corresponded to the number of a sealed envelope describing the treatment category. The envelopes, which had been put in random order by shuffling before the study, were kept in the hospital pharmacy and opened by the pharmacist, who was the only person who knew the women's treatment assignments. The assignments were stratified according to whether the women's distal bone density was 245 to 289 mg per square centimeter or less than 245 mg per square centimeter. There were 72 women in the higher-density stratum and 48 in the lower. The study protocol was approved by the Human Rights Committee of the University of Western Australia, and each woman gave written informed consent.
Study Protocol
The treatment regimens were as follows: exercise alone (exercise group, n = 41), exercise plus 1 g of elemental calcium nightly in the form of calcium lactate—gluconate (Sandoz, Basel, Switzerland) (exercise—calcium group, n = 39), or exercise plus 2.5 mg of medroxyprogesterone acetate (Upjohn, Sydney, Australia) nightly throughout the two-year study period and 0.625 mg of estropipate (Abbott, Sydney, Australia) nightly for one month, then 1.25 mg nightly for the remainder of the study period (exercise—estrogen group, n = 40). Identical-appearing placebo medications were made available by the three companies, so that every woman in the treatment groups took three tablets every night. Compliance was checked by counting tablets; 89 percent of the exercise—calcium group and 91 percent of the exercise—estrogen group took the assigned medication for at least 10 weeks during each 12 weeks of the study period.
The exercise regimen consisted of one weekly exercise class supervised by a trained physiotherapist and two brisk 30-minute walks per week. At the exercise classes the women participated in low-impact aerobic exercise for one hour; 30 percent of the time was devoted to arm exercises. Only 56 percent of the exercise group, 24 percent of the exercise—calcium group, and 44 percent of the exercise-estrogen group attended a minimum of 10 classes in any 12-week period. Many substituted other activities such as walking, however. The women were asked not to change their diets during the study.
Analytic Methods and Follow-up
Forearm bone density was measured every three months, and the women were examined every six months during the two-year study period. Forearm bone densitometry was performed with a Molsgaard BMA 1100 forearm bone densitometer (Molsgaard, Horsholm, Denmark), which uses a water bath to allow for differing volumes of soft tissue. Bone density was measured at three forearm sites. The distal site was defined as a site 1 cm long just distal to the point where the radius and ulna were separated by 2 mm.15 Trabecular bone is considered to make up 60 percent of the bone mass at this site16; the coefficient of variation for readings at this site was 1.6 percent in 13 normal premenopausal women. The median site was defined as a site 2.6 cm long just proximal to the site at which the radius and ulna are separated by 8 mm; 15 percent of this site is made up of trabecular bone. The proximal site was defined as a site 1 cm long 63.5 mm proximal to the ulna styloid; it contains mostly cortical bone and less than 5 percent trabecular bone. The coefficients of variation for measurements at the median and proximal sites in the same 13 normal premenopausal women were 1.3 percent and 1.5 percent, respectively. At the end of the study, vertebral bone mineral density was measured by quantitative digital radiography with a QDR 1000 machine (Hologic, Waltham, Mass.).
A 24-hour urine sample, a fasting 2-hour urine sample, and a fasting blood sample were collected before the study began and at intervals of six months during the study period. The urine samples were analyzed for creatinine, calcium, and phosphorus with use of a Technicon SMAC analyzer (Technicon, Tarrytown, N.Y.), and hydroxyproline was measured colorimetrically in an acid hydrolysate of the urine. Plasma creatinine, alkaline phosphatase, and phosphorus concentrations were measured with a Technicon SMAC analyzer. Dialyzable calcium was measured in serum with modification of a technique for total calcium estimation.17 Serum calcitriol (1,25-dihydroxycholecalciferol) was measured with a column-extraction technique, followed by assay with calf-thymus cytosol-binding protein18; the intraassay and interassay coefficients of variation for the calcitriol assay were 21 percent and 24 percent, respectively. The serum level of intact parathyroid hormone was measured by an "immunochemiluminometric" method19; the intraassay and interassay coefficients of variation were 3.6 percent and 6.2 percent, respectively. Serum 25-hydroxyvitamin D (25-OH-D) was measured with an extraction technique,20 followed by a competitive-binding assay with diluted human serum. Serum vitamin D—binding protein was measured by radioimmunoassay with use of antiserum supplied by Dr. R. Bouillon. Serum parathyroid hormone, calcitriol, vitamin D—binding protein, and 25-OH-D concentrations were measured in all base-line samples and in samples obtained at other times from 15 randomly selected women from each group. The glomerular filtration rate was calculated from the creatinine clearance. The renal phosphate threshold was calculated by the method of Bijvoet.21
At intervals of six months, the women recorded their physical activity for four days. From these diaries the most active two hours of the day were scored with tables of the metabolic equivalents of various activities22 (a measure of aerobic activity) to generate a physical-activity score. One metabolic equivalent is defined as the energy consumed per minute of sitting at rest; the activities were measured in relation to this standard. At the beginning and the end of the study, the women completed four-day diet records with the assistance of a trained dietitian. The calcium content of the diet was determined by a technique that scores only foods containing high levels of calcium as determined from Australian nutritional data. This estimate correlated closely with the estimate derived from the complete coding of the four-day records.
The women were assigned a symptom score based on the frequency of eight symptoms potentially related to menopause: hot flashes, headaches, anxiety, sleeplessness, libido, dyspareunia, breast discomfort, and vaginal bleeding. The scores were recorded at base line, after one month, after three months, and thereafter at intervals of three months throughout the study by the same interviewer, who did not know what medication the women were receiving. The women were asked to rate the frequency of symptoms on a three-point scale, with 0 representing the absence of symptoms, 1 monthly symptoms, 2 weekly symptoms, and 3 daily symptoms. The findings were simplified to absent or present, since the results with these two categories were similar to those derived from the analysis of weighted scores.
Statistical Analysis
Statistical analysis was conducted with use of the SPSS/PC statistical package. The base-line results were analyzed by one-way analysis of variance. If the F test was significant, Duncan's test was used to evaluate individual group differences. For the three treatment groups, the changes in bone density with time were calculated from the slope of the regression line through each woman's results, fitted by least-squares analysis, if three or more data points were available. Thus, if the woman remained in the study for at least six months, her results were included in the analysis. Differences in the rate of increase or decrease in bone density during the two years of the study were evaluated by comparing the slopes of the regression lines for the groups with analysis of variance. Interactions between categorical variables were analyzed by multivariate analysis of variance. When significant time or treatment effects were found, one-way analysis of variance and Duncan's test were performed to determine which points were significantly different from each other. Interactions between continuous variables were analyzed by linear regression analysis with use of the least-squares method and by stepwise multiple regression analysis. Only effects that were significant at the level of ≤0.05 in a two-tailed test are reported.
Results
The base-line data on the four groups (the three treatment groups and the control group) are shown in Table 1.Table 1
Base-Line Characteristics of the Three Treatment Groups and the Group with Normal Bone Density (Controls).* The women in the normal-bone-density (control) group had a higher bone density at all three forearm sites and also had been postmenopausal for less time than the women in the other groups. The mean base-line physical-activity score was similar in the three treatment groups (Table 1), and it increased significantly in all three groups during the study (Table 2Table 2
Changes in Forearm Bone Density and Other Indexes in the Three Treatment Groups and the Group with Normal Bone Density (Controls) during the Two-Year Study Period.*). Measured calcium intake, not including the dietary calcium supplement, was similar in the four groups (Table 2). During the course of the study eight women withdrew from the exercise—estrogen group, six from the exercise group, and three from the exercise—calcium group.Bone Density
The changes in bone density at the distal forearm site in the three treatment groups are shown in Figure 1Figure 1
Effects of the Three Interventions on Bone Density at Distal, Median, and Proximal Forearm Sites during the Two-Year Study Period.. The rate of bone loss in the exercise group was similar to that in the control group (Table 2). The rate of bone loss at two sites was significantly lower in the exercise—calcium group than in either the exercise group or the control group. In the exercise—calcium group, the rate of change in bone density at the distal site did not differ significantly from zero, but significant bone loss occurred at the proximal and median sites. The exercise—estrogen group had an increase in bone density at all three sites that was significantly different from the changes in the exercise—calcium group and the exercise group (Table 2 and Fig. 1). Vertebral bone mineral density measured in the women who remained in the study after two years was slightly but not significantly higher in the exercise—estrogen group than in the other two treatment groups (Table 2).Base-Line Determinants of the Bone-Density Response
In the exercise group, the change in distal-forearm bone density was positively correlated with the physical-activity level at base line (Fig. 2Figure 2
Relation of Physical Activity and Calcitriol Level to Changes in Distal-Forearm Bone Density.); multiple regression analysis indicated that this was the only significant determinant of change in bone density in this group (change in distal bone density = activity × 0.07–31.8; r = 0.37; P = 0.02). In the exercise—calcium group, the change in distal bone density was positively correlated with the base-line serum calcitriol level (Fig. 2) and the number of years since menopause, a correlation confirmed by multiple regression analysis (change in distal bone density = calcitriol × 0.10 + years since menopause × 0.25 - 15.8; r = 0.64; P = 0.001). In this group the change in bone density was not correlated with base-line dietary calcium intake. In the exercise—estrogen group, the changes in distal bone density were positively correlated with the number of years since menopause in both linear and multiple regression analyses (change in distal bone density = years since menopause × 1.6 - 1.7; r = 0.51; P = 0.003). The changes in bone density at the median and proximal sites were not correlated with any base-line values.Biochemical Results
There was a significant positive correlation between the base-line serum levels of parathyroid hormone and calcitriol in the 120 women with low bone density (r = 0.28, P = 0.05). The ratio of urinary hydroxyproline to creatinine, a measure of bone resorption, decreased in both the exercise—calcium and exercise—estrogen groups (Fig. 3Figure 3
Effects of Exercise (Open Circles), Exercise plus Calcium Supplementation (Solid Triangles), and Exercise plus Hormone Replacement (Solid Circles) on the Serum Calcitriol Level, Calcium Excretion, the Hydroxyproline:Creatinine Ratio, and the Ratio of Calcium Excretion to the Serum Level of Dialyzable Calcium during the Two-Year Study Period.). Urinary calcium excretion decreased after six months in the exercise—estrogen group to a greater extent than could be accounted for by the decrease in filtered calcium load, measured by the dialyzable calcium concentration (Fig. 3). The women in the exercise—estrogen group also had a significant increase in the serum calcitriol level (Fig. 3) with no change in the levels of 25-OH-D or vitamin D—binding protein (Table 3Table 3
Serum and Urinary Biochemical Indexes in the Three Treatment Groups before and after 24 Months of Treatment.*). The increase in the calcitriol level at six months was correlated with the decrease in the plasma phosphorus concentration (r = -0.53, P = 0.02) but not with the decrease in renal phosphate threshold or serum levels of parathyroid hormone or dialyzable calcium.Symptoms
There were significant effects of treatment, time, or both, according to multivariate analysis of variance, on the frequency of hot flashes, vaginal bleeding, breast discomfort, sleeplessness, and dyspareunia, whereas the frequency of headache, anxiety, and libido did not change during the study (data not shown). Fewer women in the exercise—estrogen group had hot flashes than in the exercise—calcium and exercise groups after three months of treatment (Fig. 4Figure 4
Percentage of Women in Each Group Who Had Hot Flashes, Vaginal Bleeding, and Breast Discomfort during the Two-Year Study Period.), but the proportion of women with hot flashes in the exercise and exercise—calcium groups decreased significantly during the study. In the exercise—estrogen group, sleeplessness also improved (from 38 percent at base line to 25 percent at two years, P = 0.001), as did dyspareunia (from 38 percent at base line to 9 percent at two years, P = 0.004). There was no change in the frequency of these symptoms in the other two groups. The proportion of women who had vaginal bleeding during the study was higher in the exercise—estrogen group than in the other two groups (Fig. 4). Altogether 52 percent of the 30 women who had not undergone hysterectomy in the exercise—estrogen group had vaginal bleeding at some time during the study, as compared with 11 percent of the 30 women without hysterectomy in the exercise group and 12.5 percent of the 34 in the exercise—calcium group. Seven women in the exercise—estrogen group required dilation and curettage. The proportion of women who had breast discomfort after one month and thereafter was higher in this group than in the other two groups (Fig. 4); four women in the group withdrew because of this symptom. Altogether, 47 percent of the women in the exercise—estrogen group had breast discomfort, as compared with 20 percent in the other two groups; in 28 percent in the exercise—estrogen group the breast discomfort persisted for more than six months, as compared with 8 percent in the exercise group and 12 percent in the exercise—calcium group.Discussion
Both exercise plus calcium supplementation and exercise plus hormone replacement were effective in slowing or stopping bone loss in women considered to be at increased risk of osteoporotic fracture on the basis of a low base-line bone density. Thus, bone-density screening and intervention may be effective in preventing osteoporosis.
Although physical activity increased 8 percent in the exercise group, on average the exercise program alone was ineffective in preventing bone loss. There was a relation, however, between the base-line level of physical activity and the subsequent effect of the intervention on distal-forearm bone density; thus, if the women had a metabolic-equivalent score equal to moderate-to-brisk walking for two hours per day there was no bone loss. Not surprisingly, few women were this active.
Two recent studies have suggested an effect of dietary calcium supplementation on forearm bone density. In one, an effect on cortical bone was found only in women who had been postmenopausal for more than five years and who had a base-line calcium intake of less than 400 mg per day.9 In the other, the effects of calcium supplementation on forearm cortical bone were more marked than its effects on vertebral bone.12 We found that calcium supplementation had an effect on trabecular and cortical bone (in the median forearm) but a stronger effect on trabecular bone (in the distal forearm). This may be so because the trabecular bone in women with low bone mass was more responsive to the beneficial effect of dietary supplementation and exercise. Alternatively, the effect of exercise on trabecular bone found in the exercise group suggests the possibility of synergism between the exercise and calcium components of the regimen, as has been suggested in premenopausal women.23 The relation we observed between the effectiveness of calcium supplementation and the number of years since menopause supports previous data.9 We found no relation with base-line calcium intake, however, perhaps because the mean base-line calcium intake was much higher in this population than in the other study.9
The biochemical data provide insights into the causes of postmenopausal bone loss and the mode of action of calcium supplementation. The positive correlation between serum calcitriol and parathyroid hormone levels in these women at base line suggests an ongoing stimulus to the production of these hormones, which in the normal course of events should achieve a homeostatically mediated steady state. We previously found that the deprivation of dietary calcium stimulated the secretion of both parathyroid hormone and calcitriol in postmenopausal women.24 , 25 Therefore, the women in this study who had high serum concentrations of parathyroid hormone and calcitriol may have been calcium-deficient. Certainly dietary calcium supplementation reduced bone loss and urinary hydroxyproline excretion, a measure of bone resorption. Interestingly, the efficacy of calcium supplementation was dependent on serum calcitriol levels. Because the active transport of calcium across the gut is dependent on calcitriol,26 the calcitriol level probably determines the effectiveness of oral calcium supplementation by determining the fraction absorbed.
The exercise—estrogen regimen also reduced bone resorption and increased bone mass, presumably by a direct effect on bone. However, the kidney, like bone, contains estrogen receptors,27 so that the reduction in urinary calcium excretion independent of changes in the serum level of dialyzable calcium and the filtered calcium load may indicate a direct effect of estrogen on renal calcium handling. The recent documentation of increased urinary calcium excretion in postmenopausal women28 suggests that the loss of calcium in urine could be an important factor in postmenopausal bone loss.
The 5.4 percent increase in bone density in the distal forearm in the exercise—estrogen group was encouraging, although it did appear to plateau at about 18 months. These data clearly indicate that the continuous combined estrogen—progesterone regimen can induce an increase in bone density. However, many women treated with hormone replacement to prevent bone loss are asymptomatic. Thus, the incidence of deleterious side effects of medication is important; in this regard, the group of women we studied differs from those who have menopausal symptoms as a primary problem. Our double-blind treatment format allowed the objective evaluation of side effects of continuous estrogen—progesterone therapy. Vaginal bleeding was an important problem; nevertheless, the incidence was much lower than with cyclical progesterone administration. Breast tenderness was another important problem, which might be alleviated by introducing estrogen more slowly or at a lower final dose. In considering the acceptability of estrogen, the beneficial effects of a reduction in hot flashes, dyspareunia, and sleeplessness must not be neglected.
These results have important implications for preventing osteoporosis. It may be appropriate to advise women with intermediate bone-density values to adopt the exercise and calcium regimen and to reserve estrogen for women with low bone density. Thus, an intervention based on bone-density screening may prove to be cost effective. The alternative approach, that of using a common intervention for all women, may be more cost effective but would have to rely on increasing dietary calcium intake and exercise rather than the administration of estrogen, because of the need for medical supervision with hormone-replacement therapy.
Supported by the National Health and Medical Research Council, the King Edward Memorial Hospital for Women Research Foundation, Sandoz Australia, and Upjohn Australia.
We are indebted to the pharmacy of Sir Charles Gairdner Hospital, which kindly dispensed the drugs.
Source Information
From the University Department of Medicine (R.L.P., I.M.D., M.M.H.), the Department of Endocrinology and Diabetes (R.L.P., R.I.P., N.K.H.), and the Department of Clinical Biochemistry (P.G.W.), Sir Charles Gairdner Hospital, Nedlands, Western Australia; and King Edward Memorial Hospital for Women, Subiaco, Western Australia (M.S.). Address reprint requests to Dr. Prince at the University Department of Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.
- References
References
1
Scientific Advisory Board of the National Osteoporosis Foundation
Medline2
Hui
CrossRef | Web of Science | Medline3
Ross
CrossRef | Web of Science | Medline4
Cummings 5
Nordin
Web of Science | Medline6
Krølner
CrossRef | Web of Science | Medline7
Mazess
Web of Science | Medline8
Chow
CrossRef | Web of Science | Medline9
Dawson-Hughes
Full Text | Web of Science | Medline10
Riggs
CrossRef | Web of Science | Medline11
Lindsay
CrossRef | Web of Science | Medline12
Riis
Full Text | Web of Science | Medline13
Weiss
Full Text | Web of Science | Medline14
Hutchinson
CrossRef | Web of Science | Medline15
Price
CrossRef | Web of Science | Medline16
Schlenker
CrossRef | Medline17
Prince
CrossRef | Web of Science | Medline18
Nicholson
CrossRef | Web of Science | Medline19
St John
CrossRef | Web of Science | Medline20
Kent
CrossRef | Web of Science | Medline21
Bijvoet
Web of Science | Medline22
McArdle WD, Katch FI, Katch VL. Exercise physiology: energy, nutrition, and human performance. 2nd ed. Philadelphia: Lea & Febiger, 1986:642–9.
23
Kanders
CrossRef | Web of Science | Medline24
Prince
CrossRef | Web of Science | Medline25
Prince
CrossRef | Web of Science | Medline26
Sheikh
CrossRef | Web of Science | Medline27
Hagenfeldt
CrossRef | Medline28
Nordin
CrossRef | Web of Science | Medline
- Citing Articles (162)
Citing Articles
1
Sue Shapses, Norman Pollock, Richard Lewis. 2011. Obesity, Adipose Tissue and Bone. .
CrossRef2
Magdalena Fernández García, José A. Riancho Moral, José Luis Hernández Hernández. (2011) Síndrome calcio-alcalinos: actualización de un antiguo problema clínico. Medicina Clínica 137:6, 269-272
CrossRef3
Tracey E Howe, Beverley Shea, Lesley J Dawson, Fiona Downie, Ann Murray, Craig Ross, Robin T Harbour, Lynn M Caldwell, Gisela Creed, Tracey E Howe. 2011. Exercise for preventing and treating osteoporosis in postmenopausal women. .
CrossRef4
La-or Chailurkit, Anuk Kruavit, Rajata Rajatanavin. (2011) Vitamin D status and bone health in healthy Thai elderly women. Nutrition 27:2, 160-164
CrossRef5
Bakhtyar Tartibian, Behzad Hajizadeh Maleki, Jill Kanaley, Karim Sadeghi. (2011) Long-term aerobic exercise and omega-3 supplementation modulate osteoporosis through inflammatory mechanisms in post-menopausal women: a randomized, repeated measures study. Nutrition & Metabolism 8:1, 71
CrossRef6
Stephanie L. Hines, Jeff A. Sloan, Pamela J. Atherton, Edith A. Perez, Shaker R. Dakhil, David B. Johnson, Pavan S. Reddy, Robert J. Dalton, Bassam I. Mattar, Charles L. Loprinzi. (2010) Zoledronic acid for treatment of osteopenia and osteoporosis in women with primary breast cancer undergoing adjuvant aromatase inhibitor therapy. The Breast 19:2, 92-96
CrossRef7
B. E. C. Nordin. (2009) The effect of calcium supplementation on bone loss in 32 controlled trials in postmenopausal women. Osteoporosis International 20:12, 2135-2143
CrossRef8
Vijay K. Kapoor, Janhvi Dureja, Renu Chadha. (2009) Synthetic drugs with anti-ageing effects. Drug Discovery Today 14:17-18, 899-904
CrossRef9
Mustapha Irnaten, Nicolas Blanchard-Gutton, Jeppe Praetorius, Brian J. Harvey. (2009) Rapid effects of 17β-estradiol on TRPV5 epithelial Ca2+ channels in rat renal cells. Steroids 74:8, 642-649
CrossRef10
S. Kukuljan, C. A. Nowson, S. L. Bass, K. Sanders, G. C. Nicholson, M. J. Seibel, J. Salmon, R. M. Daly. (2009) Effects of a multi-component exercise program and calcium–vitamin-D3-fortified milk on bone mineral density in older men: a randomised controlled trial. Osteoporosis International 20:7, 1241-1251
CrossRef11
Michael M. Altaweel, Robert P. Hanzlik, James N. Ver Hoeve, Janis Eells, Baoyan Zhang. (2009) Ocular and Systemic Safety Evaluation of Calcium Formate as a Dietary Supplement. Journal of Ocular Pharmacology and Therapeutics 25:3, 223-230
CrossRef12
Shawn Simonson, Catherine Ratzin-Jackson. 2009. Endurance Training. , 317-352.
CrossRef13
Germán Vicente-Rodríguez, Juan Ezquerra, María Isabel Mesana, Juan Miguel Fernández-Alvira, Juan Pablo Rey-López, José Antonio Casajus, Luis Alberto Moreno. (2008) Independent and combined effect of nutrition and exercise on bone mass development. Journal of Bone and Mineral Metabolism 26:5, 416-424
CrossRef14
Kun Zhu, David Bruce, Nicole Austin, Amanda Devine, Peter R Ebeling, Richard L Prince. (2008) Randomized Controlled Trial of the Effects of Calcium With or Without Vitamin D on Bone Structure and Bone-Related Chemistry in Elderly Women With Vitamin D Insufficiency. Journal of Bone and Mineral Research 23:8, 1343-1348
CrossRef15
Gill Levitt, Debra Eshelman. 2008. Long-Term Effects of Cancer Treatment. , 167-191.
CrossRef16
P. Eser, J. Cook, J. Black, R. Iles, R. M. Daly, R. Ptasznik, S. L. Bass. (2008) Interaction between playing golf and HRT on vertebral bone properties in post-menopausal women measured by QCT. Osteoporosis International 19:3, 311-319
CrossRef17
Susan A. New. 2008. Diet and Osteoporosis: Where are We Now?. , 121-129.
CrossRef18
Laurent Maïmoun, David Simar, Corinne Caillaud, Edouard Peruchon, Charles Sultan, Michel Rossi, Denis Mariano-Goulart. (2008) Effect of antioxidants and exercise on bone metabolism. Journal of Sports Sciences 26:3, 251-258
CrossRef19
Philip D. Chilibeck, Stephen M. Cornish. (2008) Effect of estrogenic compounds (estrogen or phytoestrogens) combined with exercise on bone and muscle mass in older individuals. Applied Physiology, Nutrition, and Metabolism 33:1, 200-212
CrossRef20
Vicki S. Conn, Adam R. Hafdahl, Sharon A. Brown, Lori M. Brown. (2008) Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. Patient Education and Counseling 70:2, 157-172
CrossRef21
Judith Moreines, Richard Cotter, Leon Ellenbogen. 2007. Potential Benefits for the Use of Vitamin and Mineral Supplements. , 193-219.
CrossRef22
Anne Z. Hoch, Sophia Lal, Jason W. Jurva, David D. Gutterman. (2007) The Female Athlete Triad and Cardiovascular Dysfunction. Physical Medicine and Rehabilitation Clinics of North America 18:3, 385-400
CrossRef23
Sydney Bonnick, Susan Broy, Fran Kaiser, Carol Teutsch, Elizabeth Rosenberg, Paul DeLucca, Mary Melton. (2007) Treatment with alendronate plus calcium, alendronate alone, or calcium alone for postmenopausal low bone mineral density. Current Medical Research and Opinion 23:6, 1341-1349
CrossRef24
J. Woo, A. Hong, E. Lau, H. Lynn. (2007) A randomised controlled trial of Tai Chi and resistance exercise on bone health, muscle strength and balance in community-living elderly people. Age and Ageing 36:3, 262-268
CrossRef25
Lee S. Simon. (2007) Osteoporosis. Rheumatic Disease Clinics of North America 33:1, 149-176
CrossRef26
Indra Ramasamy. (2006) Recent advances in physiological calcium homeostasis / Neuere Forschungsergebnisse zur physiologischen Kalziumhomöostase. LaboratoriumsMedizin 30:6, 453-491
CrossRef27
M WANG, S FLANAGAN, J SONG, G GREENDALE, G SALEM. (2006) Relationships among body weight, joint moments generated during functional activities, and hip bone mass in older adults. Clinical Biomechanics 21:7, 717-725
CrossRef28
Hwansik Hwang, Jongmyon Bae, Seungwook Hwang, Hoonki Park, Inyoung Kim. (2006) Effects of breath-hold diving on bone mineral density of women divers. Joint Bone Spine 73:4, 419-423
CrossRef29
Robert H. Boone, Angela M. Cheung, Larisa M. Girlan, E. Jenny Heathcote. (2006) Osteoporosis in Primary Biliary Cirrhosis: A Randomized Trial of the Efficacy and Feasibility of Estrogen/Progestin. Digestive Diseases and Sciences 51:6, 1103-1112
CrossRef30
Douglas P. Beall, Heidi B. Henslee, Heather R. Webb, R Hal Scofield. (2006) Milk-Alkali Syndrome: A Historical Review and Description of the Modern Version of the Syndrome. The American Journal of the Medical Sciences 331:5, 233-242
CrossRef31
E. M. C. LAU, P. SAMBROOK, E. SEEMAN, K. H. LEONG, P. C. LEUNG, P. DELMAS. (2006) Guidelines for diagnosing, prevention and treatment of osteoporosis in Asia. APLAR Journal of Rheumatology 9:1, 24-36
CrossRef32
Indra Ramasamy. (2006) Recent advances in physiological calcium homeostasis. Clinical Chemistry and Laboratory Medicine 44:3, 237-273
CrossRef33
B. K. Pedersen, B. Saltin. (2006) Evidence for prescribing exercise as therapy in chronic disease. Scandinavian Journal of Medicine and Science in Sports 16:S1, 3-63
CrossRef34
T T Lambers, R J M Bindels, J G J Hoenderop. (2006) Coordinated control of renal Ca2+ handling. Kidney International 69:4, 650-654
CrossRef35
Beverley Shea, George A Wells, Ann Cranney, Nicole Zytaruk, Lauren Griffith, Candyce Hamel, Zulma Ortiz, Joan Peterson, Peter Tugwell, Vivian Welch, Beverley Shea. 2006. Calcium supplementation on bone loss in postmenopausal women. .
CrossRef36
Seiichiro Aoe, Takao Koyama, Yasuhiro Toba, Akira Itabashi, Yukihiro Takada. (2005) A controlled trial of the effect of milk basic protein (MBP) supplementation on bone metabolism in healthy menopausal women. Osteoporosis International 16:12, 2123-2128
CrossRef37
Tom Nijenhuis, Joost G. J. Hoenderop, René J. M. Bindels. (2005) TRPV5 and TRPV6 in Ca2+ (re)absorption: regulating Ca2+ entry at the gate. Pflügers Archiv - European Journal of Physiology 451:1, 181-192
CrossRef38
Miguel A. Checa, L. Rio, J. Rosales, X. Nogués, J. Vila, R. Carreras. (2005) Timing of follow-up densitometry in hormone replacement therapy users for optimal osteoporosis prevention. Osteoporosis International 16:8, 937-942
CrossRef39
Ingrid Bergström, Bo Freyschuss, Britt-Marie Landgren. (2005) Physical training and hormone replacement therapy reduce the decrease in bone mineral density in perimenopausal women: a pilot study. Osteoporosis International 16:7, 823-828
CrossRef40
Monique Abel, Joost G. J. Hoenderop, René J. M. Bindels. (2005) The epithelial calcium channels TRPV5 and TRPV6: regulation and implications for disease. Naunyn-Schmiedeberg's Archives of Pharmacology 371:4, 295-306
CrossRef41
H. Hagino, M. Kuraoka, Y. Kameyama, T. Okano, R. Teshima. (2005) Effect of a selective agonist for prostaglandin E receptor subtype EP4 (ONO-4819) on the cortical bone response to mechanical loading. Bone 36:3, 444-453
CrossRef42
Katarina T Borer. (2005) Physical Activity in the Prevention and Amelioration of Osteoporosis in Women. Sports Medicine 35:9, 779-830
CrossRef43
Faryal S. Mirza, Karen M. Prestwood. (2004) Bone health and aging: implications for menopause. Endocrinology & Metabolism Clinics of North America 33:4, 741-759
CrossRef44
Amanda Devine, Satvinder S Dhaliwal, Ian M Dick, Jens Bollerslev, Richard L Prince. (2004) Physical Activity and Calcium Consumption Are Important Determinants of Lower Limb Bone Mass in Older Women. Journal of Bone and Mineral Research 19:10, 1634-1639
CrossRef45
(2004) Homocysteine as a Predictive Factor for Hip Fracture in Older Persons. New England Journal of Medicine 351:10, 1027-1030
Full Text46
S. P. Pereira, J. O'Donohue, C. Moniz, M. G. Phillips, H. Abraha, M. Buxton-Thomas, R. Williams. (2004) Transdermal hormone replacement therapy improves vertebral bone density in primary biliary cirrhosis: results of a 1-year controlled trial. Alimentary Pharmacology and Therapeutics 19:5, 563-570
CrossRef47
Philip D. Chilibeck. (2004) Exercise and Estrogen or Estrogen Alternatives (Phytoestrogens, Bisphosphonates) for Preservation of Bone Mineral in Postmenopausal Women. Canadian Journal of Applied Physiology 29:1, 59-75
CrossRef48
BJ Shea, JD Adachi, A Cranney, L Griffith, G Guyatt, C Hamel, Z Ortiz, J Peterson, VA Robinson, P Tugwell, G Wells, N Zytaruk, Beverley Shea. 2004. Calcium supplementation on bone loss in postmenopausal women. .
CrossRef49
Ian M. Dick, Jie Liu, Paul Glendenning, Richard L Prince. (2003) Estrogen and androgen regulation of plasma membrane calcium pump activity in immortalized distal tubule kidney cells. Molecular and Cellular Endocrinology 212:1-2, 11-18
CrossRef50
Sylvia Christakos, Richard Prince. (2003) Estrogen, Vitamin D, and Calcium Transport. Journal of Bone and Mineral Research 18:10, 1737-1739
CrossRef51
SJ Van Cromphaut, K Rummens, I Stockmans, E Van Herck, FA Dijcks, Agh Ederveen, P Carmeliet, J Verhaeghe, R Bouillon, G Carmeliet. (2003) Intestinal Calcium Transporter Genes Are Upregulated by Estrogens and the Reproductive Cycle Through Vitamin D Receptor-Independent Mechanisms. Journal of Bone and Mineral Research 18:10, 1725-1736
CrossRef52
Lorraine A Fitzpatrick. (2003) Alternatives to estrogen. Medical Clinics of North America 87:5, 1091-1113
CrossRef53
Dennis T. Villareal, Ellen F. Binder, Kevin E. Yarasheski, Daniel B. Williams, Marybeth Brown, David R. Sinacore, Wendy M. Kohrt. (2003) Effects of Exercise Training Added to Ongoing Hormone Replacement Therapy on Bone Mineral Density in Frail Elderly Women. Journal of the American Geriatrics Society 51:7, 985-990
CrossRef54
Elisabeth Sornay-Rendu, Patrick Garnero, Françoise Munoz, François Duboeuf, Pierre D Delmas. (2003) Effect of withdrawal of hormone replacement therapy on bone mass and bone turnover: the OFELY study. Bone 33:1, 159-166
CrossRef55
Karen Chapman-Novakofski, Ellen Evans, Teresa C. Gallagher. (2003) Preventing Osteoporosis. Journal of Nutrition For the Elderly 22:4, 83-97
CrossRef56
Joonas Sirola, Heikki Kröger, Risto Honkanen, Lorenzo Sandini, Marjo Tuppurainen, Jukka S Jurvelin, Seppo Saarikoski. (2003) Smoking May Impair the Bone Protective Effects of Nutritional Calcium: A Population-Based Approach. Journal of Bone and Mineral Research 18:6, 1036-1042
CrossRef57
LOUIS YUGE, IZUMI HIDE, TAKANORI KUMAGAI, YASUHIRO KUMEI, SIN'ICHI TAKEDA, MASAMOTO KANNO, MASANORI SUGIYAMA, KATSUKO KATAOKA. (2003) CELL DIFFERENTIATION AND p38MAPK CASCADE ARE INHIBITED IN HUMAN OSTEOBLASTS CULTURED IN A THREE-DIMENSIONAL CLINOSTAT. In Vitro Cellular & Developmental Biology - Animal 39:1, 89
CrossRef58
E. Offord. 2003. Phytoestrogens and bone health. , 88-106.
CrossRef59
Joost G.J Hoenderop, Bernd Nilius, René J.M Bindels. (2002) ECaC: the gatekeeper of transepithelial Ca2+ transport. Biochimica et Biophysica Acta (BBA) - Proteins & Proteomics 1600:1-2, 6-11
CrossRef60
S. Pedersen. (2002) Long-term outcomes in paediatric asthma. Allergy 57:s74, 58-74
CrossRef61
P D Chilibeck, K S Davison, S J Whiting, Y Suzuki, C L Janzen, P Peloso. (2002) The effect of strength training combined with bisphosphonate (etidronate) therapy on bone mineral, lean tissue, and fat mass in postmenopausal women. Canadian Journal of Physiology and Pharmacology 80:10, 941-950
CrossRef62
Sundar Srinivasan, David A. Weimer, Steven C. Agans, Steven D. Bain, Ted S. Gross. (2002) Low-Magnitude Mechanical Loading Becomes Osteogenic When Rest Is Inserted Between Each Load Cycle. Journal of Bone and Mineral Research 17:9, 1613-1620
CrossRef63
S Cheng, S Sipilä, D.R Taaffe, J Puolakka, H Suominen. (2002) Change in bone mass distribution induced by hormone replacement therapy and high-impact physical exercise in post-menopausal women. Bone 31:1, 126-135
CrossRef64
Daphne J. Theodorou, Stavroula J. Theodorou, David J. Sartoris. (2002) Treatment of osteoporosis: Current status and recent advances. Comprehensive Therapy 28:2, 109-122
CrossRef65
Donatella Bonaiuti, Beverley Shea, Roberto Iovine, Stefano Negrini, Vivian Welch, Han HCG Kemper, George A Wells, Peter Tugwell, Ann Cranney, Donatella Bonaiuti. 2002. Exercise for preventing and treating osteoporosis in postmenopausal women. .
CrossRef66
Ted S. Gross, Sundar Srinivasan, Chung C. Liu, Thomas L. Clemens, Steven D. Bain. (2002) Noninvasive Loading of the Murine Tibia: An In Vivo Model for the Study of Mechanotransduction. Journal of Bone and Mineral Research 17:3, 493-501
CrossRef67
E Puntila, H Kröger, T Lakka, M Tuppurainen, J Jurvelin, R Honkanen. (2001) Leisure-time physical activity and rate of bone loss among peri- and postmenopausal women: a longitudinal study. Bone 29:5, 442-446
CrossRef68
Allen Perelson, Leon Ellenbogen. 2001. Rationale for Use of Vitamin and Mineral Supplements. .
CrossRef69
E. M. C. Lau, J. Woo, V. Lam, A. Hong. (2001) Milk Supplementation of the Diet of Postmenopausal Chinese Women on a Low Calcium Intake Retards Bone Loss. Journal of Bone and Mineral Research 16:9, 1704-1709
CrossRef70
Petra Platen. (2001) The importance of sport and physical exercise in the prevention and therapy of osteoporosis. European Journal of Sport Science 1:3, 1-20
CrossRef71
F. Branca, A. B. Hanley, B Pool-Zobel, H. Verhagen. (2001) Biomarkers in disease and health. British Journal of Nutrition 86:S1, S55
CrossRef72
Katherine M Newton, Andrea Z LaCroix, Diana S.M Buist, Lynda A Anderson, Kristin Delaney. (2001) What factors account for hormone replacement therapy prescribing frequency?. Maturitas 39:1, 1-10
CrossRef73
Seichiro AOE, Yasuhiro TOBA, Jun-ichi YAMAMURA, Hiroshi KAWAKAMI, Masatoshi YAHIRO, Masayoshi KUMEGAWA, Akira ITABASHI, Yukihiro TAKADA. (2001) Controlled Trial of the Effects of Milk Basic Protein(MBP) Supplementation on Bone Metabolism in Healthy Adult Women.. Bioscience, Biotechnology, and Biochemistry 65:4, 913-918
CrossRef74
Sarah Henzell, Satvinder Dhaliwal, Richard Pontifex, Faye Gill, Roger Price, Robert Retallack, Richard Prince. (2000) Precision Error of Fan-Beam Dual X-Ray Absorptiometry Scans at Spine, Hip, and Forearm. Journal of Clinical Densitometry 3:4, 359-364
CrossRef75
Ho-Jae Han, Yeune-Hee Lee, Soo-Hyun Park. (2000) Estradiol-17?-BSA stimulates Ca2+ uptake through nongenomic pathways in primary rabbit kidney proximal tubule cells: Involvement of cAMP and PKC. Journal of Cellular Physiology 183:1, 37-44
CrossRef76
M. G. E. Peterson, T. Galsworthy, J. Lane, P. L. Wilson, J. Wingate, D. Lapiano, J. Andariese. (2000) Maintenance of Bone Density: Outcomes Over Five Years of Attendance at an Osteoporosis Center. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 55:3, M141-M146
CrossRef77
Cora E. Lewis, Janet Y. Groff, Carla J. Herman, Robert E. McKeown, Lynne S. Wilcox. (2000) Overview of Women's Decision Making Regarding Elective Hysterectomy, Oophorectomy, and Hormone Replacement Therapy. Journal of Women's Health & Gender-Based Medicine 9:supplement 2, 5-14
CrossRef78
T. V. Nguyen, J. R. Center, J. A. Eisman. (2000) Osteoporosis in Elderly Men and Women: Effects of Dietary Calcium, Physical Activity, and Body Mass Index. Journal of Bone and Mineral Research 15:2, 322-331
CrossRef79
Shuichi Obuchi, Haruhiko Sato, Hiroshi Shibata, Motonaga Kojima, Masuo Shirataka, Masaharu Maeda. (2000) Analysis of Compression Force in the Hip Joint during Impulsive Exercises. A Preliminary Study for Developing Exercise Protocol for Osteoporosis.. Journal of the Japanese Physical Therapy Association 3:1, 7-11
CrossRef80
Noriko Kikuchi, Mamoru Urabe, Koichi Iwasa, Tomoharu Okubo, Hiroshi Tsuchiya, Tetsuya Hosoda, Hiroshi Tatsumi, Hideo Honjo. (2000) Atheroprotective effect of estriol and estrone sulfate on human vascular smooth muscle cells. The Journal of Steroid Biochemistry and Molecular Biology 72:1-2, 71-78
CrossRef81
Sue C. Kaste, Russell W. Chesney, Melissa M. Hudson, Robert H. Lustig, Susan R. Rose, Laura D. Carbone. (1999) Bone Mineral Status During and After Therapy of Childhood Cancer: An Increasing Population with Multiple Risk Factors for Impaired Bone Health. Journal of Bone and Mineral Research 14:12, 2010-2014
CrossRef82
1999. Dairy Foods and Osteoporosis. .
CrossRef83
Kirsti Uusi-Rasi, Harri Sievänen, Ilkka Vuori, Ari Heinonen, Pekka Kannus, Matti Pasanen, Marjo Rinne, Pekka Oja. (1999) Long-Term Recreational Gymnastics, Estrogen Use, and Selected Risk Factors for Osteoporotic Fractures. Journal of Bone and Mineral Research 14:7, 1231-1238
CrossRef84
ARLINE D. BOHANNON. (1999) Osteoporosis and African American Women. Journal of Women's Health & Gender-Based Medicine 8:5, 609-615
CrossRef85
Robert M. Russell, Helen Rasmussen, Fada. (1999) The Impact of Nutritional Needs of Older Adults on Recommended Food Intakes. Nutrition in Clinical Care 2:3, 164-176
CrossRef86
van Hoof, van der Mooren, Swinkels, Sweep, Merkus, Th. J. Benraad. (1999) Female sex hormone replacement therapy increases serum free 1,25-dihydroxyvitamin D3: a 1-year prospective study. Clinical Endocrinology 50:4, 511-516
CrossRef87
Eero S. Kyllönen, H. Kalervo Väänänen, J. Heikki V. Vanharanta, Jorma E. Heikkinen. (1999) Influence of Estrogen-Progestin Treatment on Back Pain and Disability Among Slim Premenopausal Women With Low Lumbar Spine Bone Mineral Density. Spine 24:7, 704-708
CrossRef88
Toshiyuki Yasui, Masayo Yamada, Hiromi Kinoshita, Hirokazu Uemura, Naoto Yoneda, Minoru Irahara, Toshihiro Aono, Satoshi Sunahara, Yasuyori Mito, Fumihiko Kurimoto, Keishi Hata. (1999) Combination of automatic HPLC-RIA method for determination of estrone and estradiol in serum. Journal of Clinical Laboratory Analysis 13:6, 266-272
CrossRef89
B. E. CHRISTOPHER NORDIN, ALLAN G. NEED, TRACY STEURER, HOWARD A. MORRIS, BARRY E. CHATTERTON, MICHAEL HOROWITZ. (1998) Nutrition, Osteoporosis, and Aging. Annals of the New York Academy of Sciences 854:1 TOWARDS PROLO, 336-351
CrossRef90
George A. Kelley. (1998) Aerobic Exercise and Bone Density at the Hip in Postmenopausal Women: A Meta-Analysis. Preventive Medicine 27:6, 798-807
CrossRef91
EVELYN P. WHITLOCK, RICHARD E. JOHNSON, THOMAS M. VOGT. (1998) Recent Patterns of Hormone Replacement Therapy Use in a Large Managed Care Organization. Journal of Women's Health 7:8, 1017-1026
CrossRef92
Cemil Akgül, Mukaddes Canbaz, Pervin Vural, Alkan Yildirim, Nadire Geren. (1998) Hormone replacement therapy and urinary prostaglandins in postmenopausal women. Maturitas 30:1, 79-83
CrossRef93
T. V. Nguyen, P. N. Sambrook, J. A. Eisman. (1998) Bone Loss, Physical Activity, and Weight Change in Elderly Women: The Dubbo Osteoporosis Epidemiology Study. Journal of Bone and Mineral Research 13:9, 1458-1467
CrossRef94
S. E. Gariballa, A. J. Sinclair. (1998) Nutrition, ageing and ill health. British Journal of Nutrition 80:01, 7
CrossRef95
B. Lawrence Riggs, W. Michael O'Fallon, Joan Muhs, Michael K. O'Connor, Rajiv Kumar, L. Joseph Melton. (1998) Long-Term Effects of Calcium Supplementation on Serum Parathyroid Hormone Level, Bone Turnover, and Bone Loss in Elderly Women. Journal of Bone and Mineral Research 13:2, 168-174
CrossRef96
Kirsti Uusi-Rasi, Harri Sievänen, Ilkka Vuori, Matti Pasanen, Ari Heinonen, Pekka Oja. (1998) Associations of Physical Activity and Calcium Intake with Bone Mass and Size in Healthy Women at Different Ages. Journal of Bone and Mineral Research 13:1, 133-142
CrossRef97
Henry B. Betts. (1998) News and Notes. American Journal of Physical Medicine & Rehabilitation 77:1, 89
CrossRef98
D. Henry, J. Robertson, D. O'connell, W. Gillespie. (1998) A systematic review of the skeletal effects of estrogen therapy in postmenopausal women. I. An assessment of the quality of randomized trials published between 1977 and 1995. Climacteric 1:2, 92-111
CrossRef99
Karl J Obrant. (1998) Prevention of osteoporotic fractures-should orthopedic surgeons care?. Acta Orthopaedica 69:4, 333-338
CrossRef100
D. Mackerras, T. Lumley. (1997) First- and second-year effects in trials of calcium supplementation on the loss of bone density in postmenopausal women. Bone 21:6, 527-533
CrossRef101
R. Honkanen, H. Kröger, E. Alhava, P. Turpeinen, M. Tuppurainen, S. Saarikoski. (1997) Lactose intolerance associated with fractures of weight-bearing bones in finnish women aged 38–57 years. Bone 21:6, 473-477
CrossRef102
William B. Ershler, S.Mitchell Harman, Evan T. Keller. (1997) Immunologic aspects of osteoporosis. Developmental & Comparative Immunology 21:6, 487-499
CrossRef103
David M. Reid, Susan A. New. (1997) Nutritional influences on bone mass. Proceedings of the Nutrition Society 56:03, 977-987
CrossRef104
S. Kudlacek, F. Pietschmann, P. Bernecker, H. Resch, R. Willvonseder. (1997) THE IMPACT OF A SENIOR DANCING PROGRAM ON SPINAL AND PERIPHERAL BONE MASS1. American Journal of Physical Medicine & Rehabilitation 76:6, 477-481
CrossRef105
R. M. Joakimsen, J. H. Magnus, V. Fønnebø. (1997) Physical activity and predisposition for hip fractures: A review. Osteoporosis International 7:6, 503-513
CrossRef106
E. Puntila, H. Kröger, T. Lakka, R. Honkanen, M. Tuppurainen. (1997) Physical activity in adolescence and bone density in periand postmenopausal women: A population-based study. Bone 21:4, 363-367
CrossRef107
J. Duquette, T. Honeyman, A. Hoffman, S. Ahmadi, D. Baran. (1997) Effect of bovine bone constituents on broadband ultrasound attenuation measurements. Bone 21:3, 289-294
CrossRef108
Saeko Fujiwara, Fumiyoshi Kasagi, Michiko Yamada, Kazunori Kodama. (1997) Risk Factors for Hip Fracture in a Japanese Cohort. Journal of Bone and Mineral Research 12:7, 998-1004
CrossRef109
B.E.Christopher Nordin. (1997) Calcium and osteoporosis. Nutrition 13:7-8, 664-686
CrossRef110
Gianfranco Caselli, Marco Mantovanini, Carmelo A. Gandolfi, Marcello Allegretti, Simonetta Fiorentino, Luigi Pellegrini, Gabriella Melillo, Riccardo Bertini, Wilma Sabbatini, Roberto Anacardio, Gaetano Clavenna, Giancarlo Sciortino, Anna Teti. (1997) Tartronates: A New Generation of Drugs Affecting Bone Metabolism. Journal of Bone and Mineral Research 12:6, 972-981
CrossRef111
Ian M Dick, Richard L Prince. (1997) Estrogen effects on the renal handling of calcium in the ovariectomized perfused rat. Kidney International 51:6, 1719-1728
CrossRef112
R.A. Criddle, M.-H. Zheng, I.M. Dick, B. Callus, R.L. Prince. (1997) Estrogen responsiveness of renal calbindin-D28k gene expression in rat kidney. Journal of Cellular Biochemistry 65:3, 340-348
CrossRef113
R. L. Prince, I. Dick. (1997) Oestrogen effects on calcium membrane transport: A new view of the inter-relationship between oestrogen deficiency and age-related osteoporosis. Osteoporosis International 7:S3, 150-154
CrossRef114
B. E. C. Nordin. (1997) The calcium controversy. Osteoporosis International 7:S3, 17-23
CrossRef115
J Block. (1997) Interpreting studies of exercise and osteoporosis: A call for rigor. Controlled Clinical Trials 18:1, 54-57
CrossRef116
Morris Notelovitz. (1997) Estrogen Therapy and Osteoporosis: Principles & Practice. The American Journal of the Medical Sciences 313:1, 2-12
CrossRef117
Judy A. Stevens, Kenneth E. Powell, Suzanne M. Smith, Phyllis A. Wingo, Richard W. Sattin. (1997) Physical activity, functional limitations, and the risk of fall-related fractures in community-dwelling elderly. Annals of Epidemiology 7:1, 54-61
CrossRef118
W. Most, L. van der Wee-Pals, A. Ederveen, S. Papapoulos, C. Löwik. (1997) Ovariectomy and orchidectomy induce a transient increase in the osteoclastogenic potential of bone marrow cells in the mouse. Bone 20:1, 27-30
CrossRef119
E Eriksen. (1996) European and North American Experience with HRT for the Prevention of Osteoporosis. Bone 19:5, 179S-183S
CrossRef120
Bonny L. Specker. (1996) Evidence for an interaction between calcium intake and physical activity on changes in bone mineral density. Journal of Bone and Mineral Research 11:10, 1539-1544
CrossRef121
Roman M. Kowalchuk&NA;, Thomas A. Corcoran, Solomon R. Pollack, Marvin E. Steinberg. (1996) Effects of Etidronate and Oophorectomy on the Zeta Potential of Rat Bone. Clinical Orthopaedics and Related Research 328, 241-249
CrossRef122
W. Van Dokkum, V. De La Guéronnière, G. Schaafsma, C. Bouley, J. Luten, C. Latgé. (1996) Bioavailability of calcium of fresh cheeses, enteral food and mineral water. A study with stable calcium isotopes in young adult women. British Journal of Nutrition 75:06, 893
CrossRef123
T. Fujita, T. Ohue, Y. Fujii, A. Miyauchi, Y. Takagi. (1996) Heated oyster shell-seaweed calcium (AAA Ca) on osteoporosis. Calcified Tissue International 58:4, 226-230
CrossRef124
P. Lips. (1996) Prevention of hip fractures: Drug therapy. Bone 18:3, S159-S163
CrossRef125
M. Nelson. (1996) Anaemia in adolescent girls: Effects on cognitive function and activity. Proceedings of the Nutrition Society 55:1B, 359-367
CrossRef126
John D. Wark. (1996) Osteoporotic fractures: background and prevention strategies. Maturitas 23:2, 193-207
CrossRef127
STEVEN N. BLAIR, EDWARD HORTON, ARTHUR S. LEON, I-MIN LEE, BARBARA L. DRINKWATER, ROD K. DISHMAN, MAUREEN MACKEY, MICHELLE L. KIENHOLZ. (1996) Physical activity, nutrition, and chronic disease. Medicine & Science in Sports & Exercise 28:3, 335-349
CrossRef128
Ross L Prentice, Jacques E Rossouw, Susan R Johnson, Lawrence S Freedman, Anne McTiernan. (1996) The Role of Randomized Controlled Trials in Assessing the Benefits and Risks of Long-Term Hormone Replacement Therapy: Example of the Womenʼs Health Initiative. Menopause 3:2, 71-76
CrossRef129
Juliet E. Compston. (1995) The role of vitamin D and calcium supplementation in the prevention of osteoporotic fractures in the elderly. Clinical Endocrinology 43:4, 393-405
CrossRef130
J.W. Davis, P.D. Ross, N.E. Johnson, R.D. Wasnich. (1995) Estrogen and calcium supplement use among Japanese-American women: Effects upon bone loss when used singly and in combination. Bone 17:4, 369-373
CrossRef131
J.A. FRANKLYN, J. BETTERIDGE, R. HOLDER, M.C. SHEPPARD. (1995) Effect of Estrogen Replacement Therapy upon Bone Mineral Density in Thyroxine-Treated Postmenopausal Women with a Past History of Thyrotoxicosis. Thyroid 5:5, 359-363
CrossRef132
J.W.W. Studd, K. McCarthy, D. Zamblera, H.G. Burger, S. Silberberg, B. Wren, M.P. Dain, L.Le Lann, C. Vandepol. (1995) Efficacy and tolerance of Menorest® compared to Premarin® in the treatment of postmenopausal women. A randomised, multicentre, double-blind, double-dummy study. Maturitas 22:2, 105-114
CrossRef133
Wendy M. Kohrt, David B. Snead, Eduardo Slatopolsky, Stanley J. Birge. (1995) Additive effects of weight-bearing exercise and estrogen on bone mineral density in older women. Journal of Bone and Mineral Research 10:9, 1303-1311
CrossRef134
J. M. Kaufman. (1995) Role of calcium and vitamin D in the prevention and the treatment of postmenopausal osteoporosis: An overview. Clinical Rheumatology 14:S3, 9-13
CrossRef135
Ian M. Dick, Richard L. Prince, John J. Kelly, Ken K. Y. Ho. (1995) Oestrogen effects on calcitriol levels in post-menopausal women: a comparison of oral versus transdermal administration. Clinical Endocrinology 43:2, 219-224
CrossRef136
Marie Luz Villa, Robert Marcus, Romelia Ramírez Delay, Jennifer L. Kelsey. (1995) Factors contributing to skeletal health of postmenopausal Mexican-American women. Journal of Bone and Mineral Research 10:8, 1233-1242
CrossRef137
Julia M. Shelley, Anthony M. A. Smith, Emma Dudley, Lorraine Dennerstein. (1995) Use of hormone replacement therapy by Melbourne women. Australian Journal of Public Health 19:4, 387-392
CrossRef138
Richard Prince, Amanda Devine, Ian Dick, Arthur Criddle, Deborah Kerr, Neil Kent, Andrew Randell, Roger Price. (1995) The effects of calcium supplementation (milk powder or tablets) and exercise on bone density in postmenopausal women. Journal of Bone and Mineral Research 10:7, 1068-1075
CrossRef139
Richard L. Prince, Ian Dick, Amanda Devine, Roger I. Price, Donald H. Gutteridge, Deborah Kerr, Arthur Criddle, Peter Garcia-Webb, Andrew St. John. (1995) The effects of menopause and age on calcitropic hormones: A cross-sectional study of 655 healthy women aged 35 to 90. Journal of Bone and Mineral Research 10:6, 835-842
CrossRef140
J. P. Barlet, V. Coxam, M. J. Davicco. (1995) Exercice Physique et Squelette. Archives Of Physiology And Biochemistry 103:6, 681-698
CrossRef141
Douglas J. Marchant. (1995) The Impact of Exogenous Hormones on Breast Cancer Risk Myth vs Reality: An Overview. The Breast Journal 1:1, 58-61
CrossRef142
J.Eileen Hay. (1995) Bone disease in cholestatic liver disease. Gastroenterology 108:1, 276-283
CrossRef143
Susan H. Allen. (1994) Exercise considerations for postmenopausal women with osteoporosis. Arthritis Care & Research 7:4, 205-214
CrossRef144
Elizabeth Geelhoed, Anthony Harris, Richard Prince. (1994) Cost-effectiveness analysis of hormone replacement therapy and lifestyle intervention for hip fracture. Australian Journal of Public Health 18:2, 153-160
CrossRef145
S. C. Ho, P. C. Leung, R. Swaminathan, C. Chan, S. S. G. Chan, Y. K. Fan, R. Lindsay. (1994) Determinants of bone mass in Chinese women aged 21–40 years. II. Pattern of dietary calcium intake and association with bone mineral density. Osteoporosis International 4:3, 167-175
CrossRef146
Robert W. Rebar. (1994) Unanswered questions in hormonal replacement therapy. Experimental Gerontology 29:3-4, 447-461
CrossRef147
Robert P. Heaney, M. Janet Barger-Lux. (1994) Low Calcium Intake: The Culprit in Many Chronic Diseases. Journal of Dairy Science 77:5, 1155-1160
CrossRef148
Eckhard Schönau, Anja Radermacher, Ulrike Wentzlik, Klaus Klein, Dietrich Michalk. (1994) The determination of ultrasound velocity in the os calcis, thumb and patella during childhood. European Journal of Pediatrics 153:4, 252-256
CrossRef149
E. Mathieu, J. Merregaert. (1994) Characterization of the stromal osteogenic cell line MN7: mRNA steady-state level of selected osteogenic markers depends on cell density and is influenced by 17β-estradiol. Journal of Bone and Mineral Research 9:2, 183-192
CrossRef150
Douglas J. Marchant. (1994) Supplemental estrogen replacement. Cancer 74:S1, 512-517
CrossRef151
John J. B. Anderson. (1993) The value of calcium supplements: A review. Journal of Bone and Mineral Metabolism 11:2, S11-S15
CrossRef152
L Rosenberg. (1993) Hormone replacement therapy: the need for reconsideration.. American Journal of Public Health 83:12, 1670-1673
CrossRef153
Richard Prince, Ian Dick, Amanda Devine, Deborah Kerr, R. Arthur Criddle, Roger Price, Peter Garcia Webb. (1993) Importance of bone resorption in the determination of bone density in women more than 10 years past the menopause. Journal of Bone and Mineral Research 8:11, 1273-1279
CrossRef154
Lars Nordsletten, Trine Sand Kaastad, Sigmund Skjeldal, Ole J. Kirkeby, Olav Reikerås, Arne Ekeland. (1993) Training increases the in vivo strength of the lower leg: An experimental study in the rat. Journal of Bone and Mineral Research 8:9, 1089-1095
CrossRef155
E.I. Barengolts, D.J. Curry, M.S. Bapna, S.C. Kukreja. (1993) Effects of endurance exercise on bone mass and mechanical properties in intact and ovariectomized rats. Journal of Bone and Mineral Research 8:8, 937-942
CrossRef156
Kokai Kin, J.H. Lee Edmund, Kazuhiro Kushida, David J. Sartoris, Akihiro Ohmura, Paul L. Clopton, Tetsuo Inoue. (1993) Bone density and body composition on the pacific rim: A comparison between japan-born and u.s.-born japanese-American women. Journal of Bone and Mineral Research 8:7, 861-869
CrossRef157
Ronald S. Swerdloff, Christina Wang. (1993) Androgens and aging in men. Experimental Gerontology 28:4-5, 435-446
CrossRef158
Douglas J. Marchant. (1993) Estrogen-replacement therapy after breast cancer risks versus benefits. Cancer 71:S6, 2169-2176
CrossRef159
Reid, Ian R.Ames, Ruth W.Evans, Margaret C.Gamble, Gregory D.Sharpe, Susan J.. (1993) Effect of Calcium Supplementation on Bone Loss in Postmenopausal Women. New England Journal of Medicine 328:7, 460-464
Full Text160
J. J. B. Anderson, F. A. Tylavsky, L. Halioua, J. A. Metz. (1993) Determinants of peak bone mass in young adult women: A review. Osteoporosis International 3:S1, 32-36
CrossRef161
D Chaouat, Y Tsouderos. (1993) Les thérapeutiques médicamenteuses préventives de l'ostéoporose postménopausique. La Revue de Médecine Interne 14:9, 877-887
CrossRef162
Wood, Alastair J.J., , Riggs, B. Lawrence, Melton, L. Joseph III, . (1992) The Prevention and Treatment of Osteoporosis. New England Journal of Medicine 327:9, 620-627
Full Text
