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ARTICLE |

Endogenous Estrogen Levels and Calcium Intakes in Postmenopausal Women: Title and subTitle BreakRelationships With Cortical Bone Measures FREE

Jane A. Cauley, DPH; James P. Gutai, MD; Lewis H. Kuller, MD, DPH; Dorothea LeDonne; Rivka B. Sandler, PhD; Donald Sashin, PhD; John G. Powell, MS
[+] Author Affiliations

Reprint requests to the Department of Epidemiology, A525, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261 (Dr Cauley).


JAMA. 1988;260(21):3150-3155. doi:10.1001/jama.1988.03410210062037
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To examine the interactions between hormone levels and calcium with cortical bone, we have attempted to combine risk factors for the development of peak skeletal mass with factors that may be related to the maintenance of bone integrity after menopause. A total of 174 postmenopausal women participated in our study. There was little relationship found between androgen hormones and radial bone density. Estrone levels were independently related to radial bone density. Examination of the relationship of calcium intake to bone revealed a protective effect solely in women who reported high "lifetime" calcium intakes. Taking calcium and estrone together revealed an additive relationship between the two factors, in that women with high estrone and high calcium levels had significantly greater bone density than women with less calcium and/or estrone. The results suggest that a lifetime of adequate calcium intake coupled with adequate levels of serum estrogens could maximize bone density after menopause.

(JAMA 1988;260:3150-3155)

REFERENCES

Riggs BL:  Pathogenesis of osteoporosis . Am J Obstet Gynecol 1987;;156:1342-1346.
Kelsey JL, Hoffman S:  Risk factors for hip fracture . N Engl J Med 1987;;316:404-406.
 Osteoporosis, editorial . Lancet 1987;;2:833-835.
Nachtigall LE, Nachtigall RH, Nachtigall RD, et al:  Estrogen replacement therapy: I. A ten-year prospective study of the relationship to osteoporosis . Obstet Gynecol 1979;;53:277-281.
WeissNS, Ure CL, Ballard JH, et al:  Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen . N Engl J Med 1980;;303:1195-1198.
Longcope C, Baker RS, Hui SL, et al:  Androgen and estrogen dynamics in women with vertebral crush fractures . Maturitas 1984;;6:390-418.
Pelc B, Marshall DH, Guha P, et al:  The relation between plasma androstenedione, plasma oestrone and androstenedione to estrone conversion rates in postmenopausal women with and without fractures . Clin Sci 1978;;54:125-131.
Cauley JA, Gutai JP, Sandler RB, et al:  The relationship of endogenous estrogen to bone density and bone area in normal postmenopausal women . Am J Epidemiol 1986;;124:752-761.
Sandler RB, Slemenda CW, LaPorte RE, et al:  Postmenopausal bone density and milk consumption in childhood and adolescence . Am J Clin Nutr 1985;;42:270-274.
Heaney RP, Recker RR, Saville PD:  Calcium balance and calcium requirements in middle-aged women . Am J Clin Nutr 1977;;30:1603-1611.
Heaney RP, Gallagher JC, Johnston CC, et al:  Calcium nutrition and bone health in the elderly . Am J Clin Nutr 1982;;36:986-1013.
Marcus R:  The relationship of dietary calcium to the maintenance of skeletal integrity in man—an interface of endocrinology and nutrition . Metabolism 1982;;31:93-102.
Parfitt AM:  Dietary risk factors for age-related bone loss and fractures . Lancet 1983;;2:1181-1185.
Consensus development conference:  Prophylaxis and treatment of osteoporosis . Br Med J 1987;;295:914-915.
Heaney RP, Recker RR, Saville PD:  Menopausal changes in calcium balance performance . J Lab Clin Med 1978;;953-963.
Gallagher JC, Riggs BL, DeLuca H:  Effect of estrogen on calcium absorption and serum vitamin D metabolites in postmenopausal osteoporosis . J Clin Endocrinol Metab 1980;;51:1359-1364.
Nordin BEC, Horsman A, Brook R, et al:  The relationship between oestrogen status and bone loss in post-menopausal women . Clin Endocrinol 1976;;5( (suppl) ):353-361.
Ettinger B, Genant HK, Cann CE:  Postmenopausal bone loss is prevented by treatment with low dosage estrogen with calcium . Ann Intern Med 1987;;106:40-45.
Radfar N, Ansusingha K, Kenny F:  Circulating bound and free estradiol and estrone during normal growth and development . J Pediatr 1976;;89:719-723.
Korenman S, Stevens R, Carpenter LA, et al:  Estradiol radioimmunoassay without chromatography . J Clin Endocrinol Metab 1974;;39:718-720.
DeLacerda L, Kowarski A, Johanson AH, et al:  Integrated concentration and circadian variation of plasma testosterone in normal men . J Clin Endocrinol Metab 1973;;37:366-371.
Carr RT, Mikhail G, Flickinger GL:  Column chromatography of steroids on sephadex LH-20 . J Clin Endocrinol Metab 1971;;33:358-363.
Sashin D, Sternglass EJ, Sandler RB, et al:  The development and evaluation of a CT technique for measurement of density of cortical bone in the appendicular skeleton, abstracted . J Comput Assist Tomogr 1983;;7:1.
Schlenker RA:  Percentages of cortical and trabecular bone mineral mass in the radius and ulna . AJR 1976;;126:1309-1312.
Sandler RB, LaPorte RE, Sashin D, et al:  Determinants of bone mass in menopause . Prev Med 1982;;11:269-280.
Sandler RB, Cauley JA, Hom DL, et al:  The effects of walking on the cross-sectional dimensions of the radius in postmenopausal women . Calcif Tissue Int 1987;;41:65-69.
Nutritive Value of American Foods , agriculture handbook 456. US Dept of Agriculture, 1975;.
Paffenbarger RS Jr, Wing AL, Hyde RT:  Physical activity as an index of heart attack risk in college alumni . Am J Epidemiol 1978;;108:161-175.
LaPorte RE, Kuller LH, Kupfer DJ, et al:  An objective measure of physical activity for epidemiologic research . Am J Epidemiol 1979;;109:158-168.
The Lipid Research Clinics Population Studies Data Book: The Prevalence Study , publication (NIH) 80-1527. US Dept of Health and Human Services 1980;, vol 1.
Block G, Dresser CM, Hartman AM, et al:  Nutrient sources in the American diet: Quantitative data from the NHANESII survey: I. Vitamins and minerals . Am J Epidemiol 1985;;122:13-26.
Judd HL:  Hormonal dynamics associated with the menopause . Clin Obstet Gynecol 1976;;19:775-788.
Longcope C, Franz C, Morello C, et al:  Steroid and gonadotropin levels in women during the perimenopausal years . Maturitas 1986;;8:189-196.
Nie NH, Hull CH, Jenkins JG, et al: Statistical Package for the Social Sciences . New York, McGraw-Hill International Book Co, 1975;.
Kirshner MA, Schneider G, Ertel RH, et al:  Obesity, androgens and cancer risk . Cancer Res 1982;;42( (suppl) ):3281S-3285S.
Siiteri PK, Murai JT, Hammond GL, et al:  The serum transport of steroid hormones . Recent Prog Horm Res 1982;;38:457-510.
Kiel DP, Felson DT, Anderson JJ, et al:  Hip fracture and the use of estrogens in postmenopausal women . N Engl J Med 1987;;317:1169-1174.
Cauley JA, Gutai JP, Kuller LH, et al:  The epidemiology of serum sex hormones in postmenopausal women . Am J Epidemiol , in press.
Dawson-Hughes B, Jacques P, Shipp C:  Dietary calcium intake and bone loss from the spine in healthy postmenopausal women . Am J Clin Nutr 1987;;46:685-687.
Nicar MJ, Pac CY:  Calcium bioavailability from calcium carbonate and calcium citrate . J Clin Endocrinol Metab 1985;;61:391-393.
Sheikh MS, Santa Ana CA, Nicar MJ, et al:  Gastrointestinal absorption of calcium from milk and calcium salts . N Engl J Med 1987;;317:532-536.
Recker RR:  Calcium absorption and achlorhydria . N Engl J Med 1985;;313:70-73.
Bo-Linn GW, Davis GR, Buddris DJ, et al:  An elaboration of the importance of gastric acid secretion in the absorption of dietary calcium . J Clin Invest 1984;;73:640-647.

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Riggs BL:  Pathogenesis of osteoporosis . Am J Obstet Gynecol 1987;;156:1342-1346.
Kelsey JL, Hoffman S:  Risk factors for hip fracture . N Engl J Med 1987;;316:404-406.
 Osteoporosis, editorial . Lancet 1987;;2:833-835.
Nachtigall LE, Nachtigall RH, Nachtigall RD, et al:  Estrogen replacement therapy: I. A ten-year prospective study of the relationship to osteoporosis . Obstet Gynecol 1979;;53:277-281.
WeissNS, Ure CL, Ballard JH, et al:  Decreased risk of fractures of the hip and lower forearm with postmenopausal use of estrogen . N Engl J Med 1980;;303:1195-1198.
Longcope C, Baker RS, Hui SL, et al:  Androgen and estrogen dynamics in women with vertebral crush fractures . Maturitas 1984;;6:390-418.
Pelc B, Marshall DH, Guha P, et al:  The relation between plasma androstenedione, plasma oestrone and androstenedione to estrone conversion rates in postmenopausal women with and without fractures . Clin Sci 1978;;54:125-131.
Cauley JA, Gutai JP, Sandler RB, et al:  The relationship of endogenous estrogen to bone density and bone area in normal postmenopausal women . Am J Epidemiol 1986;;124:752-761.
Sandler RB, Slemenda CW, LaPorte RE, et al:  Postmenopausal bone density and milk consumption in childhood and adolescence . Am J Clin Nutr 1985;;42:270-274.
Heaney RP, Recker RR, Saville PD:  Calcium balance and calcium requirements in middle-aged women . Am J Clin Nutr 1977;;30:1603-1611.
Heaney RP, Gallagher JC, Johnston CC, et al:  Calcium nutrition and bone health in the elderly . Am J Clin Nutr 1982;;36:986-1013.
Marcus R:  The relationship of dietary calcium to the maintenance of skeletal integrity in man—an interface of endocrinology and nutrition . Metabolism 1982;;31:93-102.
Parfitt AM:  Dietary risk factors for age-related bone loss and fractures . Lancet 1983;;2:1181-1185.
Consensus development conference:  Prophylaxis and treatment of osteoporosis . Br Med J 1987;;295:914-915.
Heaney RP, Recker RR, Saville PD:  Menopausal changes in calcium balance performance . J Lab Clin Med 1978;;953-963.
Gallagher JC, Riggs BL, DeLuca H:  Effect of estrogen on calcium absorption and serum vitamin D metabolites in postmenopausal osteoporosis . J Clin Endocrinol Metab 1980;;51:1359-1364.
Nordin BEC, Horsman A, Brook R, et al:  The relationship between oestrogen status and bone loss in post-menopausal women . Clin Endocrinol 1976;;5( (suppl) ):353-361.
Ettinger B, Genant HK, Cann CE:  Postmenopausal bone loss is prevented by treatment with low dosage estrogen with calcium . Ann Intern Med 1987;;106:40-45.
Radfar N, Ansusingha K, Kenny F:  Circulating bound and free estradiol and estrone during normal growth and development . J Pediatr 1976;;89:719-723.
Korenman S, Stevens R, Carpenter LA, et al:  Estradiol radioimmunoassay without chromatography . J Clin Endocrinol Metab 1974;;39:718-720.
DeLacerda L, Kowarski A, Johanson AH, et al:  Integrated concentration and circadian variation of plasma testosterone in normal men . J Clin Endocrinol Metab 1973;;37:366-371.
Carr RT, Mikhail G, Flickinger GL:  Column chromatography of steroids on sephadex LH-20 . J Clin Endocrinol Metab 1971;;33:358-363.
Sashin D, Sternglass EJ, Sandler RB, et al:  The development and evaluation of a CT technique for measurement of density of cortical bone in the appendicular skeleton, abstracted . J Comput Assist Tomogr 1983;;7:1.
Schlenker RA:  Percentages of cortical and trabecular bone mineral mass in the radius and ulna . AJR 1976;;126:1309-1312.
Sandler RB, LaPorte RE, Sashin D, et al:  Determinants of bone mass in menopause . Prev Med 1982;;11:269-280.
Sandler RB, Cauley JA, Hom DL, et al:  The effects of walking on the cross-sectional dimensions of the radius in postmenopausal women . Calcif Tissue Int 1987;;41:65-69.
Nutritive Value of American Foods , agriculture handbook 456. US Dept of Agriculture, 1975;.
Paffenbarger RS Jr, Wing AL, Hyde RT:  Physical activity as an index of heart attack risk in college alumni . Am J Epidemiol 1978;;108:161-175.
LaPorte RE, Kuller LH, Kupfer DJ, et al:  An objective measure of physical activity for epidemiologic research . Am J Epidemiol 1979;;109:158-168.
The Lipid Research Clinics Population Studies Data Book: The Prevalence Study , publication (NIH) 80-1527. US Dept of Health and Human Services 1980;, vol 1.
Block G, Dresser CM, Hartman AM, et al:  Nutrient sources in the American diet: Quantitative data from the NHANESII survey: I. Vitamins and minerals . Am J Epidemiol 1985;;122:13-26.
Judd HL:  Hormonal dynamics associated with the menopause . Clin Obstet Gynecol 1976;;19:775-788.
Longcope C, Franz C, Morello C, et al:  Steroid and gonadotropin levels in women during the perimenopausal years . Maturitas 1986;;8:189-196.
Nie NH, Hull CH, Jenkins JG, et al: Statistical Package for the Social Sciences . New York, McGraw-Hill International Book Co, 1975;.
Kirshner MA, Schneider G, Ertel RH, et al:  Obesity, androgens and cancer risk . Cancer Res 1982;;42( (suppl) ):3281S-3285S.
Siiteri PK, Murai JT, Hammond GL, et al:  The serum transport of steroid hormones . Recent Prog Horm Res 1982;;38:457-510.
Kiel DP, Felson DT, Anderson JJ, et al:  Hip fracture and the use of estrogens in postmenopausal women . N Engl J Med 1987;;317:1169-1174.
Cauley JA, Gutai JP, Kuller LH, et al:  The epidemiology of serum sex hormones in postmenopausal women . Am J Epidemiol , in press.
Dawson-Hughes B, Jacques P, Shipp C:  Dietary calcium intake and bone loss from the spine in healthy postmenopausal women . Am J Clin Nutr 1987;;46:685-687.
Nicar MJ, Pac CY:  Calcium bioavailability from calcium carbonate and calcium citrate . J Clin Endocrinol Metab 1985;;61:391-393.
Sheikh MS, Santa Ana CA, Nicar MJ, et al:  Gastrointestinal absorption of calcium from milk and calcium salts . N Engl J Med 1987;;317:532-536.
Recker RR:  Calcium absorption and achlorhydria . N Engl J Med 1985;;313:70-73.
Bo-Linn GW, Davis GR, Buddris DJ, et al:  An elaboration of the importance of gastric acid secretion in the absorption of dietary calcium . J Clin Invest 1984;;73:640-647.
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