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Biomedical subjects

Marjo Tuppurainen

Publications and source records attributed to Marjo Tuppurainen.

12 recordsLinked to original sources
PubMed2006

Distance of walking in childhood and femoral bone density in perimenopausal women.

Kuopio osteoporosis risk factor and prevention (OSTPRE) study is a population-based study from Eastern Finland. At baseline in 1989-91, bone densitometry of lumbar spine and femoral neck as assessed by DXA was carried out on women aged 48-58 (n = 3,222). In 1993, menarcheal age and health habits during adolescence were inquired from a postal inquiry. In 1996, a random sample of 254 women who had been premenopausal at baseline was interviewed over phone. They were asked how many kilometers per day they had walked to school and back, in each grade of primary school. The study sample (N = 185) was formed by excluding women with menarcheal age of >14 or <11 years. Women with any reported HRT history were also excluded. The mean age of the study sample was 50.7 (1.63) years, weight 70.8 (13.1) kg, height 161.5 (5.0) cm, and mean walking distance to and fro from the school at ages from 9 to 11 years was 2.7 (1.7) km. In regression analysis, the walking distance was associated with femoral BMD (r = 0.18, P = 0.015). After adjusting for baseline age, weight and height, this association persisted (P = 0.025). When walking distance was categorized as I = 0-0.549 km, II = 0.55-1.99 km, III = 2.0-4.99 and IV = 5.0 km and more, the respective means for femoral BMDs were 0.92, 0.97, 0.98 and 1.01 g/cm(2). Statistical significance persisted after adjusting for height, weight, age, grip strength, calcium intake, smoking, place of residence, use of contraceptive pills, physical load of work and baseline physical activity (P = 0.032). A 10 year follow-up revealed no changes in bone loss rate between the groups and femoral BMD benefits persisted (repeated measures analysis = NS). Walking distance was not associated with spinal bone density. Even though walking is a low impact activity, walking before menarche may have a moderate but long-lasting positive effect on femoral peak bone density. Lack of walking and similar low impact physical activities during peak growth years may have a negative effect on peak bone mass formation.

Aging↗
PubMed2006

Effects of ospemifene and raloxifene on biochemical markers of bone turnover in postmenopausal women.

Ospemifene is a novel selective estrogen receptor modulator (SERM) that is initially being developed for the treatment of vaginal atrophy in postmenopausal women. However, it also shows promise in the prevention and treatment of osteoporosis. As a part of a phase II trial, we compared the effects of ospemifene and raloxifene on bone turnover in postmenopausal women. The study was conducted as a randomized, double-blind study in which 118 healthy postmenopausal women received 30 (n = 29), 60 (n = 30), or 90 mg (n = 30) ospemifene or 60 mg (n = 29) raloxifene for 3 months. Bone resorption was assessed by measuring the urinary outputs of N- and C-terminal cross-linking telopeptides of type I collagen (NTX and CTX, respectively). Bone formation was assessed by measuring bone-specific alkaline phosphatase (bone ALP), osteocalcin (OC), procollagen type I N propeptide (PINP), and procollagen type I C propeptide (PICP) in serum. All markers were studied before and at 3 months and 2-4 weeks after cessation of the medication. Urine NTX outputs decreased in all study groups, and the only statistically significant difference in NTX was observed between raloxifene and 30 mg ospemifene, which was reduced more in the raloxifene group. The output of CTX decreased most clearly in 60- and 90-mg ospemifene groups, but no significant differences between study groups emerged. A significant difference was found between the 90-mg ospemifene group and raloxifene in PINP in favor of ospemifene. No other differences in bone formation markers emerged between ospemifene and raloxifene. The study confirms the bone-restoring activity of ospemifene, which is comparable to that of raloxifene.

Biomarkers↗
PubMed2005

Associations between grip strength change and axial postmenopausal bone loss--a 10-year population-based follow-up study.

The aim of the present study was to investigate the associations between grip strength change and postmenopausal bone loss. The study population, 622 peri- and postmenopausal women, was a random sample of the OSTPRE-study cohort (n=13,100) in Kuopio, Finland. Bone mineral density (BMD) at the lumbar spine (LS) and femoral neck (FN) was measured with dual X-ray absorptiometry and grip strength with a pneumatic squeeze dynamometer at baseline in 1989-1991, at the 5-year follow-up in 1994-1997 and at the 10-year follow-up in 1999-2001. Women were divided into three groups according to the change in age-grouped grip strength quartile they belonged to in each measurement (n in 5-year/10-year follow-up): "decreased" (n=150/n=140), "maintained" (n=314/n=320) and "improved" (n=158/n=162). Women within the improved group had significantly lower bone loss at both FN and LS in comparison to the other two groups after 10 years of follow-up (P<0.01). Furthermore, in HRT non-users (n=305) the difference between the improved group and maintained group was only modest (P=0.04). In contrast, in HRT users (n=310) the mean annual BMD change among the improved group was positive (bone gain 0.11%/year) and differed significantly in comparison to modest bone loss in the decreased and maintained groups in both LS and FN (P<0.01). The linear trend between grip strength quartile change and LS/FN bone loss was significant in HRT users (P<0.001) in contrast to HRT non-users (P=NS) in the linear regression model. Any of these differences were not affected by adjustments for age, weight, height and other potential confounders. In conclusion, the present study suggests that improvement in age-grouped grip strength quartile is strongly associated with axial bone loss among postmenopausal women. This effect seemed to interact positively with estrogen repletion status. These results encourage performing further clinical studies on associations between muscle strength changes and bone loss.

Absorptiometry, Photon↗
PubMed2005

High bone mineral density among perimenopausal women.

Studies regarding high bone mineral density (HBMD) are few. In the population-based Kuopio Osteoporosis Risk Factor and Prevention Study, BMDs of women were measured from 1990-1991 and 1995-1997. The mean age of the 1,873 women studied was 53.5 years at baseline (range 48.0-59.6). In all, 248 women were excluded because of BMD measurement errors or artifacts: 41 from the HBMD group (20.6%) and 207 (12.4%) from the control group. The final study group consisted of 1,551 women, 168 in the HBMD group (baseline lumbar BMD >1.23 g/cm2; femoral BMD >1.01 g/cm2, and 5-year follow-up lumbar BMD >1.21 g/cm2; femoral BMD >0.98 g/cm2, respectively) and 1,383 in the control group. The predictors for HBMD in the multivariate regression analysis were as follows: hormone therapy (HT) during the follow-up from 0.5 to 2 years and for over 2 years (OR 2.06, CI: 1.11-3.81 and OR 2.16, CI 1.43-3.26) and being overweight (BMI from 25 kg/m2 to 30 kg/m2, and BMI >30 kg/m2) at baseline (OR 2.84, CI: 1.82-4.42; OR 5.94, CI: 3.47-10.16, respectively). High physical activity while 11-18 years of age was associated with HBMD (OR 1.69, CI: 1.17-2.45). Parity predicted HBMD so that after one to two births the OR was 2.66 (CI: 1.03-6.88) and 3.03 (CI: 1.16-7.90) after three or more births. Menopause was negatively associated with HBMD (OR 0.57, CI 0.38-0.85). There were more premenopausal women in the HBMD group (53.9 vs. 34.6%, P <0.001). The HBMD group showed fewer fractures. In conclusion, being overweight, parity, HT use, premenopause and high physical activity in adolescence seemed to be predictors for persistently high BMD in early postmenopausal women. We suggest that the fracture risk is low in these women, and thus they are neither primary candidates for BMD screening nor for osteoporosis medication.

Bone Density↗
PubMed2004

Factors related to postmenopausal muscle performance: a cross-sectional population-based study.

The aim of the present study was to investigate cross-sectionally the association of postmenopausal muscle strength with simple performance tests. A random sample of 1,166 naturally postmenopausal women (born 1932-1941) was selected from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort. Grip and quadriceps strength were measured with strain gauge dynamometers and reported in both absolute values (KPa and kg) and per kilogram of body mass (N cm(-2) kg(-1) and N kg(-1)). In addition, two performance tests, 'ability to stand on one foot' and 'ability to squat down to touch the floor' were carried out. A five-category self-assessment of overall health ('very good', 'good', 'moderate', 'bad', and 'very bad') was obtained by postal questionnaire. The women that were able to stand on one foot and able to squat down to touch the floor had greater grip and quadriceps strength than their counterparts ( P<0.001 and P<0.03 in ANOVA, respectively). In addition, self-assessed health had a strong positive association with muscle strength in the grip and leg extensor muscles in ANOVA ( P<0.001 between 'very good' and 'moderate' or poorer state of health) and regression model ( P<0.001). Adjustment for age, duration of menopause, body mass, height, physical activity level, use of HRT, and number of diseases and medications did not change any of the main effects. Also, there were no differences in results between absolute measurement values and values reported per kilogram of body mass. According to the present study, a simple performance test may be useful in the prediction of postmenopausal muscle strength. Furthermore, self-assessed state of health is strongly associated with muscle strength in postmenopausal women.

Body Constitution↗
PubMed2003

Smoking may impair the bone protective effects of nutritional calcium: a population-based approach.

Postmenopausal women were randomly selected to investigate the effects of smoking on prevention of bone loss with nutritional calcium. DXA was performed twice, and smoking and calcium intake habits were inquired through the mail in 954 women. Smoking dampened the bone protective effects of nutritional calcium. This may reflect the pathophysiology underlying smoking-induced bone loss postmenopause. This study evaluated the effect of smoking on the bone protective properties of nutritional calcium. Of the random sample of 954 peri- and postmenopausal women selected from the Osteoporosis Risk Factor and Prevention (OSTPRE) study cohort (n = 13,100) in Kuopio, Finland, 182 had smoked at some time (ever smokers) and 772 had never smoked. Women were divided in tertiles according to self-reported dairy nutritional calcium intake (mg/day): < 648 (1st), 648-927 (2nd), > 927 (3rd). Bone mineral density at lumbar spine (LS) and femoral neck (FN) was measured with DXA at baseline in 1989-1991 and at the 5-year follow-up in 1994-1997. In a linear regression model, nutritional calcium intake did not predict annual bone loss in smokers. These results were similar in the subanalysis on 71 current smokers (at both baseline and 5-year measurements) and on 85 past smokers. In never smokers, a statistically significant linear trend was observed between calcium intake and annual bone loss at LS, but at FN only after adjustment for age, weight, hormone replacement therapy (HRT), and other covariates. In analysis of covariance (ANCOVA), no differences in bone loss rate were observed between calcium intake tertiles among smokers. In nonsmokers, the annual bone loss rate was lower in the second (-0.41%) and the third (-0.35%) tertile compared with the first tertile (-0.61%) at LS (p < 0.05) and lower in the third tertile (-0.55%) than in first tertile (-0.72%) at FN after adjustment for age, weight, HRT, and other covariates (p < 0.05). When smokers were added to the nonsmoker group, the differences in bone loss rate between calcium intake tertiles disappeared. In addition, in ANCOVA, the term of interaction between smoking and calcium intake was statistically significant at LS only. In conclusion, smoking seems to impair the bone protective effects of nutritional calcium in postmenopausal women, more clearly in LS than FN.

Bone Density↗
PubMed2002

Comparison of cycle control with a combined contraceptive vaginal ring and oral levonorgestrel/ethinyl estradiol.

OBJECTIVE: The purpose of this study was to compare cycle control and tolerability of the NuvaRing (NV Organon, Oss, The Netherlands), a novel combined contraceptive vaginal ring, with a standard combined oral contraceptive pill. STUDY DESIGN: Healthy women aged 18 to 40 years who requested contraception received either NuvaRing or a combined oral contraceptive containing 30 microg ethinyl estradiol and 150 microg levonorgestrel for 6 cycles in 3 similarly designed studies. Each cycle comprised 3 weeks of ring or pill use, followed by 1 ring- or pill-free week. RESULTS: Two hundred forty-seven women began the studies, 121 women with NuvaRing and 126 women with the combined oral contraceptive. Withdrawal bleeding occurred in virtually all cycles in both groups. In the NuvaRing groups, the incidence of irregular bleeding was < or =5% in all cycles; this was lower than the combined oral contraceptive groups (5.4%-38.8%). Furthermore, the incidence of a normal intended bleeding pattern was significantly higher in the NuvaRing groups than in the combined oral contraceptive groups (P <.01). Both contraceptives were well tolerated. CONCLUSION: NuvaRing has excellent cycle control and is well tolerated.

Administration, Oral↗
PubMedDate not supplied

Does postmenopausal hormone replacement therapy affect cardiac autonomic regulation in osteoporotic women?

OBJECTIVE: Postmenopausal hormone replacement therapy (HRT) has been associated with reduced risk of cardiovascular disease; however, the mechanisms remain obscure, and it is not known whether this applies to regimens containing both estrogen and progestin. One possibility is that estrogen would act via enhancement of cardiac autonomic regulation. DESIGN: In this prospective, controlled study of 6-months duration, 22 osteoporotic, postmenopausal women in the intervention group were treated with combined estradiol hemihydrate corresponding to estradiol 2 mg and norethisterone acetate 1 mg with or without clodronate (HRT group). Nine women in the control group received clodronate only. Indices of heart rate variability (HRV) by power spectral analyses and baroreceptor sensitivity (BRS) by phenylephrine test were measured before and after 3 and 6 months of treatment. RESULTS: The total power of HRV remained identical within the groups, although it was higher at 3 and 6-month measurements in the control group than the HRT group. This was mainly due to lower very low frequency and high frequency power in the HRT group. However, no changes in the low frequency/high frequency-ratio of HRV, an index of sympathovagal balance, were observed between and within the groups. Further, during the intervention, no significant changes in BRS (baseline and 6 months: 5.0 +/- 2.1 and 5.1 +/- 2.5 ms/mmHg) within the HRT group was observed. CONCLUSIONS: The impact of estrogen and progesterone on cardiac autonomic regulation seems to be quite modest. Therefore, cardiac morbidity and mortality are probably not mediated by their effects on cardiac autonomic regulation. However, the effects of estrogen alone or more selective estrogen receptor modulators need yet to be clarified in future studies.

Anthropometry↗