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Osteoporosis: HELP
Articles by Marcia L. Stefanick
Based on 6 articles published since 2008
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Between 2008 and 2019, Marcia L. Stefanick wrote the following 6 articles about Osteoporosis.
 
+ Citations + Abstracts
1 Clinical Trial Risk Factors for Hip Fracture in Older Men: The Osteoporotic Fractures in Men Study (MrOS). 2016

Cauley, Jane A / Cawthon, Peggy M / Peters, Katherine E / Cummings, Steven R / Ensrud, Kristine E / Bauer, Douglas C / Taylor, Brent C / Shikany, James M / Hoffman, Andrew R / Lane, Nancy E / Kado, Deborah M / Stefanick, Marcia L / Orwoll, Eric S / Anonymous8770861. ·University of Pittsburgh, Pittsburgh, PA, USA. jcauley@edc.pitt.edu. · California Pacific Medical Center Research Institute, San Francisco, CA, USA. · University of California, San Francisco, San Francisco, CA, USA. · Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA. · Department of Medicine, University of Minnesota, Minneapolis, MN, USA. · Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA. · University of Alabama at Birmingham, Birmingham, AL, USA. · Stanford University, Stanford, CA, USA. · University of California, Davis, Davis, CA, USA. · University of California, San Diego, San Diego, CA, USA. · Oregon Health & Science University, Portland, OR, USA. ·J Bone Miner Res · Pubmed #26988112.

ABSTRACT: Almost 30% of hip fractures occur in men; the mortality, morbidity, and loss of independence after hip fractures are greater in men than in women. To comprehensively evaluate risk factors for hip fracture in older men, we performed a prospective study of 5994 men, primarily white, age 65+ years recruited at six US clinical centers. During a mean of 8.6 years of 97% complete follow-up, 178 men experienced incident hip fractures. Information on risk factors including femoral neck bone mineral density (FNBMD) was obtained at the baseline visit. Cox proportional hazards models were used to calculate the hazard ratio (HR) with 95% confidence intervals; Fine and Gray models adjusted for competing mortality risk. Older age (≥75 years), low FNBMD, currently smoking, greater height and height loss since age 25 years, history of fracture, use of tricyclic antidepressants, history of myocardial infarction or angina, hyperthyroidism or Parkinson's disease, lower protein intake, and lower executive function were all associated with an increased hip fracture risk. Further adjustment for competing mortality attenuated HR for smoking, hyperthyroidism, and Parkinson's disease. The incidence rate of hip fracture per 1000 person-years (PY) was greatest in men with FNBMD T-scores <-2.5 (white women reference database) who also had 4+ risk factors, 33.4. Men age ≥80 years with 3+ major comorbidities experienced hip fracture at rates of 14.52 versus 0.88 per 1000 PY in men age <70 years with zero comorbidities. Older men with low FNBMD, multiple risk factors, and multimorbidity have a high risk of hip fracture. Many of these assessments can easily be incorporated into routine clinical practice and may lead to improved risk stratification. © 2016 American Society for Bone and Mineral Research.

2 Article Associations of Parity, Breastfeeding, and Fractures in the Women's Health Observational Study. 2017

Crandall, Carolyn J / Liu, Jingmin / Cauley, Jane / Newcomb, Polly A / Manson, JoAnn E / Vitolins, Mara Z / Jacobson, Lisette T / Rykman, Kelli K / Stefanick, Marcia L. ·Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California; the Women's Health Initiative Clinical Coordinating Center and the Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, Washington; the Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; the Department of Medicine, Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; the Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina; the Department of Preventive Medicine and Public Health, University of Kansas School of Medicine-Wichita, Wichita, Kansas; the Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, Iowa; and the Departments of Medicine and Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California. ·Obstet Gynecol · Pubmed #28594759.

ABSTRACT: OBJECTIVE: To examine associations of several aspects of parity and history of lactation with incident hip fractures and clinical fractures and, in a subset of women, with bone mineral density. METHODS: In this observational study, we analyzed data from 93,676 postmenopausal women participating in the Women's Health Initiative Observational Study and all bone density data from the subset of participants who underwent bone density testing at three clinical centers. At baseline, participants were aged 50-79 years. Using Cox proportional hazards regression analysis, we examined associations of fracture incidence and bone density with several aspects of parity (number of pregnancies, age at first pregnancy lasting 6 months or greater, and number of pregnancies lasting 6 months or greater) and breastfeeding (number of episodes of breastfeeding for at least 1 month, number of children breastfed, age when first breastfed, age when last breastfed, total number of months breastfed). RESULTS: The mean baseline age (standard deviation) of participants was 64 (±7.4) years (mean follow-up 7.9 years). During follow-up, the incident rate of hip fracture was 1.27%. Ten percent of participants were nulligravid. In fully adjusted models, number of pregnancies, parity, age at first birth, number of children breastfed, age at first breastfeeding, age at last breastfeeding, and total duration of breastfeeding were not statistically significantly associated with hip fracture incidence. There were no consistent associations of parity or lactation characteristics with overall clinical fracture risk or bone density. However, compared with never breastfeeding, a history of breastfeeding for at least 1 month was associated with a decreased risk of hip fracture (yes compared with no, hazard ratio 0.84, 95% confidence interval 0.73-0.98). CONCLUSION: Patterns of parity and history of lactation were largely unrelated to fracture risk or bone density.

3 Article No Increase in Fractures After Stopping Hormone Therapy: Results From the Women's Health Initiative. 2017

Watts, Nelson B / Cauley, Jane A / Jackson, Rebecca D / LaCroix, Andrea Z / Lewis, Cora E / Manson, JoAnn E / Neuner, Joan M / Phillips, Lawrence S / Stefanick, Marcia L / Wactawski-Wende, Jean / Crandall, Carolyn / Anonymous240980. ·Mercy Health Osteoporosis and Bone Health Services, Cincinnati, Ohio 45236. · Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania 15261. · Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, Columbus, Ohio 43210. · Women's Health Center of Excellence, Family Medicine and Public Health, University of California, San Diego, La Jolla, California 92093. · Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35294. · Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115. · Medical College of Wisconsin Cancer Center Population Science, Division of General Internal Medicine and Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, Wisconsin 53226. · Atlanta VA Medical Center, Decatur, Georgia 30033. · Division of Endocrinology and Metabolism, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30322. · Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California 94305. · Department of Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, New York 14214; and. · Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90095. ·J Clin Endocrinol Metab · Pubmed #27820659.

ABSTRACT: Context: The Women's Health Initiative (WHI) hormone therapy (HT) trials showed protection against hip and total fractures, but a later observational report suggested loss of benefit and a rebound increased risk after cessation of HT. Objective: The purpose of this study was to examine fractures after discontinuation of HT. Design and Setting: Two placebo-controlled randomized trials served as the study setting. Patients: Study patients included WHI participants (N = 15,187) who continued active HT or placebo through the intervention period and who did not take HT in the postintervention period. Interventions: Trial interventions included conjugated equine estrogen (CEE) plus medroxyprogesterone acetate (MPA) in naturally menopausal women and CEE alone in women with prior hysterectomy. Main Outcome Measures: Total fractures and hip fractures through 5 years after discontinuation of HT were recorded. Results: Hip fractures were infrequent (∼2.5 per 1000 person-years); this finding was similar between trials and in former HT and placebo groups. There was no difference in total fractures in the CEE + MPA trial for former HT vs former placebo users (28.9 per 1000 person-years and 29.9 per 1000 person-years, respectively; hazard ratio [HR], 0.97; 95% confidence interval [CI], 0.87 to 1.09; P = 0.63); however, in the CEE-alone trial, total fractures were higher in former placebo users (36.9 per 1000 person-years) compared with the former active group (31.1 per 1000 person-years), a finding that was suggestive of a residual benefit of CEE against total fractures (HR, 0.85; 95% CI, 0.73 to 0.98; P = 0.03). Conclusions: We found no evidence for increased fracture risk, either sustained or transient, for former HT users compared with former placebo users after stopping HT. There was residual benefit for total fractures in former HT users from the CEE-alone study.

4 Article Risk of Nonspine Fractures in Older Adults with Sarcopenia, Low Bone Mass, or Both. 2015

Chalhoub, Didier / Cawthon, Peggy M / Ensrud, Kristine E / Stefanick, Marcia L / Kado, Deborah M / Boudreau, Robert / Greenspan, Susan / Newman, Anne B / Zmuda, Joseph / Orwoll, Eric S / Cauley, Jane A / Anonymous5470840. ·Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. · California Pacific Medical Center, San Francisco, California. · Division of Epidemiology and Community Health, Department of Medicine, University of Minnesot aand Minneapolis VA Health Care System, Minneapolis, Minnesota. · School of Medicine, Stanford University, Stanford, California. · University of California at San Diego, La Jolla, California. · Oregon Health & Sciences University, Portland, Oregon. ·J Am Geriatr Soc · Pubmed #26310882.

ABSTRACT: OBJECTIVES: To test the hypothesis that men and women with low bone mineral density (BMD) and sarcopenia have a higher risk of fracture than those with only one or neither conditions. DESIGN: The Osteoporotic Fractures in Men Study and the Study of Osteoporotic Fractures in women are prospective observational studies with a mean follow up of 9 (2000-2012) and 8 years (1997-2009), respectively. SETTING: U.S. clinical centers. PARTICIPANTS: Men (n = 5,544; mean age 73.7) and women (n = 1,114; mean age 77.6) aged 65 and older, able to walk without assistance, and without bilateral hip replacement. MEASUREMENTS: Sarcopenia was defined as low appendicular lean mass plus slowness or weakness and low BMD according to the World Health Organization definition of a T-score less than -1.0. Participants were classified as having normal BMD and no sarcopenia (3,367 men, 308 women), sarcopenia only (79 men, 48 women), low BMD only (1,986 men, 626 women), and low BMD and sarcopenia (112 men, 132 women). RESULTS: Men with low BMD and sarcopenia (hazard ratio (HR)=3.79, 95% confidence interval (CI)=2.65-5.41) and men with low BMD only (HR=1.67, 95% CI=1.45-1.93) but not men with sarcopenia only (HR=1.14, 95% CI=0.62-2.09) had greater risk of fracture than men with normal BMD and no sarcopenia. Women with low BMD and sarcopenia (HR=2.27, 95% CI=1.37-3.76) and women with low BMD alone (HR=2.62, 95% CI=1.74-3.95), but not women with only sarcopenia, had greater risk of fracture than women with normal BMD and no sarcopenia. CONCLUSION: Men with low BMD and sarcopenia are at especially high risk of fracture. Sarcopenia alone did not increase fracture risk in either group.

5 Article Preference for wine is associated with lower hip fracture incidence in post-menopausal women. 2013

Kubo, Jessica T / Stefanick, Marcia L / Robbins, John / Wactawski-Wende, Jean / Cullen, Mark R / Freiberg, Matthew / Desai, Manisha. ·Quantitative Sciences Unit, Stanford University School of Medicine, 1070 Arastradero Road, Palo Alto, Stanford, CA 94304, USA. jkubo@stanford.edu. ·BMC Womens Health · Pubmed #24053784.

ABSTRACT: BACKGROUND: Past studies of relationships between alcohol and hip fracture have generally focused on total alcohol consumed and not type of alcohol. Different types of alcohol consist of varying components which may affect risk of hip fracture differentially. This study seeks to examine the relationship between alcohol consumption, with a focus on type of alcohol consumed (e.g. beer, wine, or hard liquor) and hip fracture risk in post-menopausal women. METHODS: The longitudinal cohort consisted of U.S. post-menopausal women aged 50-79 years enrolled between 1993-1998 in the Women's Health Initiative Clinical Trials and Observational Study (N=115,655). RESULTS: Women were categorized as non-drinkers, past drinkers, infrequent drinkers and drinkers by preference of alcohol type (i.e. those who preferred wine, beer, hard liquor, or who had no strong preference). Mean alcohol consumption among current drinkers was 3.3 servings per week; this was similar among those who preferred wine, beer and liquor. After adjustment for potential confounders, alcohol preference was strongly correlated with hip fracture risk (p = 0.0167); in particular, women who preferred wine were at lower risk than non-drinkers (OR=0.78; 95% CI 0.64-0.95), past drinkers (OR=0.85; 95% CI 0.72-1.00), infrequent drinkers (OR=0.73; 95% CI 0.61-0.88), hard liquor drinkers (OR=0.87; 95% CI 0.71-1.06), beer drinkers (OR=0.72; 95% CI 0.55-0.95) and those with no strong preference (OR=0.89; 95% CI 0.89; 95% CI 0.73-1.10). CONCLUSIONS: Preference of alcohol type was associated with hip fracture; women who preferentially consumed wine had a lower risk of hip fracture compared to non-drinkers, past drinkers, and those with other alcohol preferences.

6 Article Sex hormones and frailty in older men: the osteoporotic fractures in men (MrOS) study. 2009

Cawthon, Peggy M / Ensrud, Kristine E / Laughlin, Gail A / Cauley, Jane A / Dam, Thuy-Tien L / Barrett-Connor, Elizabeth / Fink, Howard A / Hoffman, Andrew R / Lau, Edith / Lane, Nancy E / Stefanick, Marcia L / Cummings, Steven R / Orwoll, Eric S / Anonymous5830637. ·Research Institute, California Pacific Medical Center, San Francisco, California 94107-1728, USA. pcawthon@sfcc-cpmc.net ·J Clin Endocrinol Metab · Pubmed #19737923.

ABSTRACT: CONTEXT: As men age, the prevalence of frailty increases whereas levels of androgens decline. Little is known about the relation between these factors. OBJECTIVE: The aim of this study was to assess cross-sectional and longitudinal associations of estradiol, bioavailable estradiol, testosterone, bioavailable testosterone (bioT), and SHBG with frailty status. DESIGN AND SETTING: The Osteoporotic Fractures in Men (MrOS) study was conducted at six U.S. clinical centers. PARTICIPANTS: A total of 1469 community-dwelling men at least 65 yr old with baseline data participated; 1245 men had frailty status reassessed 4.1 yr later. MAIN OUTCOME MEASURE: Proportional odds models estimated the likelihood of greater frailty status. Frail men had at least three of the following: weakness, slowness, low activity, exhaustion, and shrinking/sarcopenia; intermediate men had one or two criteria; and robust men had none. At follow-up, death was included as an additional ordinal outcome. Sex hormones were assayed by spectrometry/chromatographic methods. RESULTS: In cross-sectional analyses, men in the lowest quartile of bioT had 1.39-fold (95% confidence interval, 1.02, 1.91) increased odds of greater frailty status compared to men in the highest quartile after adjustment for covariates including age, body size, health status, and medical conditions. In age-adjusted longitudinal analyses, men in the lowest quartile of bioT had 1.51-fold (95% confidence interval, 1.10, 2.07) increased odds of greater frailty status 4.1 yr later. This association was largely attenuated by adjustment for covariates. No other hormones were associated in a cross-sectional or longitudinal manner with frailty status after adjustment. CONCLUSIONS: Low levels of bioT were independently associated with worse baseline frailty status. Frailty status should be considered as an outcome in trials of testosterone supplementation.