Osteoporosis can be caused by many miscellaneous factors. These factors include medical, lifestyle and socioeconomic variables, the latest being not well studied and defined in international bibliography. From these there are the factors regarding the working environment (house or office) and the living environment (urban or countryside). Our hypothesis is based on the fact that women living in an urban environment or working in an office environment should have lower Bone Mineral Density (BMD) and thus, greater fracture possibility because of their lower level of physical activity, greater alcohol/coffee consumption and increased smoking frequency compared to women living in the countryside or women housekeeping. In order to find whether this hypothesis is true, a population based observational retrospective study has been performed. The fracture rate of 4616 post-menopausal osteoporotic women (PMOW) (mean age=64,1±9,3 years) from 160 centers all over Greece has been compared with the two aforementioned possible risk factors. Descriptive statistics like the mean±SD and frequencies were used to present the data. In order to assess for relationships between categorical variables the chi-square (χ2) test was performed. Statistical analysis was conducted using the software SAS, version 9.1 and statistical significance was established as 5%. The results are as follow:
16,2% of these PMOW had a history of fracture and for 80,3% of them was a hip fracture. 84,1% of PMOW lived in urban environment and had lower fracture rate than women living in the countryside (p<
0,05). 47,2% of the PMOW worked at home and had lower fracture rate than women working for more than 20 years in an office environment (p<
0,0001). It can be concluded that more fracture-susceptible PMOW are those working in an office environment and also living in the countryside. It can be assumed that the first is related with lower BMD and the second with the more ‘fall-prone’ nature of the country environment.
Recent epidemiological studies have demonstrated that more than half of postmenopausal women with osteoporosis (PWOP) treated with an antiresorptive drug plus calcium (Ca) and vitamin D, have serum levels of 25(OH)D3<
30ng/ml. Chronic low levels of vitamin D can contribute to the inefficiency of main antiresorptive treatment. A possible explanation for this phenomenon is the non-compliance with the daily supplementation of Ca and vitamin D. A fixed combination of Alendronate Once Weekly (OW) 70mg plus 2800 UI of cholecalciferol (AL+D) made its appearance in the market two years ago as a solution to this problem. The current study was designed to assess the efficacy of AL+D versus the old scheme of Alendronate 70 OW plus daily Ca 500mg + 400 UI of vitamin D (AL+S) on serum levels of 25(OH)D3. 100 randomly assigned PWOP treated already for 1 to 5 years with AL+S have changed their treatment to AL+D for one year. Serum levels of 25(OH)D3 (Biomedica.co.at/vitamind) has been measured before and after 12 months and also their BMD (Hologic Delphi), PTH, TSH, serum chemistry and hematology has been recorded for safety reasons. At the end of the study only 83 PWOP (MA=59,9±6,6 yrs) appeared for comparison. Our results are as follow:
The mean plasma level of 25(OH)D3 under AL+S treatment and before taking AL+D is 24,3±8,4 ng/mL and The plasma levels of 25(OH)D3 after 12 months of treatment with AL+D are 33,3±9 ng/mL. The paired t-test has been used to compare the levels of 25(OH)D3 between treatment groups. There is a highly important statistical difference (t=−8.989, df=82, p<
0,0001) between treatment groups. From the above data it can be concluded that fixed combination of AL+D can improve the 25(OH)D3 status over 12 months versus AL+S probably because it assures a better compliance of vitamin D.
