Assessing population risk for postmenopausal osteoporosis: a new strategy using data from the Behavioral Risk Factor Surveillance System (BRFSS).

UNLABELLED: Osteoporosis public health measures are hindered by the inability to easily identify subclinical disease. We have now estimated state-specific osteoporosis prevalences using a simple formula (OST Index) to analyze age and weight of 62,882 older women; the prevalences determined are similar to those based on BMD. This new method has potential use for guiding implementation of osteoporosis prevention/treatment programs. INTRODUCTION: Although osteoporosis-related fractures are a major U.S. public health issue, population-based prevention programs have not yet been developed. One contributing factor has been lack of a suitable screening test to detect asymptomatic high-risk individuals. MATERIALS AND METHODS: We estimated state-specific prevalences of postmenopausal osteoporosis using the Osteoporosis Self-Assessment Tool Index (OST Index; [self-reported weight in kg - age] x 0.2) to analyze data from 62,882 women >or=50 yr of age who participated in the 2002 Behavioral Risk Factor Surveillance System (BRFSS). The OST Index, designed to assess an individual's risk of disease, has previously been shown to have modest positive and high negative predictive value for osteoporosis defined by BMD criteria. Based on this index, women from each state were distributed among high-, moderate-, and low-risk OST categories. Calculated percentages for each category were weighted to U.S. Census Bureau population projections for 2002. By adjusting results to reflect previously validated percentages of women with osteoporosis in each risk category, we estimated the prevalence of postmenopausal osteoporosis in each state. RESULTS: Our calculated weighted prevalence estimates agreed closely with those of the National Osteoporosis Foundation derived from actual femoral neck BMD measurements obtained in the third National Health and Nutrition Examination Survey (1988-1994) and projected to U.S. census state population predictions for 2002. Comparison of unweighted BRFSS-OST results and NHANES BMD data revealed similar percentages of osteoporosis among all women >or=50 yr of age (BRFSS, 18.5%; NHANES, 18.0%; p = 0.47) and also among white women (BRFSS, 19.0%; NHANES, 20.0%; p = 0.28). However, the percentages of osteoporosis among blacks and Hispanics did not correspond, at least partly because of the lack of race-specific reference standards for BMD measurements and OST index ranges. CONCLUSIONS: Analysis of readily available BRFSS data with the OST index formula is a simple, no-cost technique that provides state prevalence estimates of postmenopausal osteoporosis that could be used to guide allocation of resources to statewide osteoporosis prevention programs.

The efficacy and safety of multivitamin and mineral supplement use to prevent cancer and chronic disease in adults: a systematic review for a National Institutes of Health state-of-the-science conference.

BACKGROUND: Multivitamin and mineral supplements are the most commonly used dietary supplements in the United States. PURPOSE: To synthesize studies on the efficacy and safety of multivitamin/mineral supplement use in primary prevention of cancer and chronic disease in the general population. DATA SOURCES: English-language literature search of the MEDLINE, EMBASE, and Cochrane databases through February 2006 and hand-searching of pertinent journals and articles. STUDY SELECTION: Randomized, controlled trials in adults were reviewed to assess efficacy, and randomized, controlled trials and observational studies in adults or children were reviewed to assess safety. DATA EXTRACTION: Paired reviewers extracted data and independently assessed study quality. DATA SYNTHESIS: 12 articles from 5 randomized, controlled trials that assessed efficacy and 8 articles from 4 randomized, controlled trials and 3 case reports on adverse effects were identified. Study quality was rated fair for the studies on cancer, cardiovascular disease, cataracts, or age-related macular degeneration and poor for the studies on hypertension. In a poorly nourished Chinese population, combined supplementation with beta-carotene, alpha-tocopherol, and selenium reduced the incidence of and mortality rate from gastric cancer and the overall mortality rate from cancer by 13% to 21%. In a French trial, combined supplementation with vitamin C, vitamin E, beta-carotene, selenium, and zinc reduced the rate of cancer by 31% in men but not in women. Multivitamin and mineral supplements had no significant effect on cardiovascular disease or cataracts, except that combined beta-carotene, selenium, alpha-tocopherol, retinol, and zinc supplementation reduced the mortality rate from stroke by 29% in the Linxian study and that a combination of 7 vitamins and minerals stabilized visual acuity loss in a small trial. Combined zinc and antioxidants slowed the progression of advanced age-related macular degeneration in high-risk persons. No consistent adverse effects of multivitamin and mineral supplements were evident. LIMITATIONS: Only randomized, controlled trials were considered for efficacy assessment. Special nutritional needs, such as use of folic acid by pregnant women to prevent birth defects, were not addressed. Findings may not apply to use of commercial multivitamin supplements by the general U.S. population. CONCLUSIONS: Evidence is insufficient to prove the presence or absence of benefits from use of multivitamin and mineral supplements to prevent cancer and chronic disease.

Disparities in osteoporosis screening between at-risk African-American and white women.

BACKGROUND: Despite a lower prevalence of osteoporosis in African-American women, they remain at risk and experience a greater mortality than white women after sustaining a hip fracture. Lack of recognition of risk factors may occur in African-American women, raising the possibility that disparities in screening practices may exist. OBJECTIVE: To determine whether there is a difference in physician screening for osteoporosis in postmenopausal, at-risk African-American and white women. METHODS: We conducted a retrospective chart review at an urban academic hospital and a suburban community hospital. Subjects included 205 African-American and white women, age > or = 65 years and weight < or = 127 pounds, who were seen in Internal Medicine clinics. The main outcome was dual-energy x-ray absorptiometry (DXA) scan referral. We investigated physician and patient factors associated with referral. Secondary outcomes included evidence of discussion of osteoporosis and prescription of medications to prevent osteoporosis. RESULTS: Significantly fewer African-American than white women were referred for a DXA scan (OR 0.39%, 95% confidence interval (CI): 0.22 to 0.68). Physicians were also less likely to mention consideration of osteoporosis in medical records (0.27, 0.15 to 0.48) and to recommend calcium and vitamin D supplementation for this population (0.21, 0.11 to 0.37). If referred, African-American women had comparable DXA completion rates when compared with white women. No physician characteristics were significantly associated with DXA referral patterns. CONCLUSIONS: Our study found a significant disparity in the recommendation for osteoporosis screening for African-American versus white women of similar risk, as well as evidence of disparate osteoporosis prevention and treatment, confirming results of other studies. Future educational and research initiatives should target this inequality.