Nagaraj, Nayana
(2017)
The role of reproductive health in musculoskeletal aging: A life-course approach.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
In the United States, older individuals (≥65 years), account for about 34% of healthcare expenditures with women accounting for 22% greater expenditure than men. Musculoskeletal disease and disability alone costs nearly $950 billion/year. Over 40% of older women (≥70 years) live with disability and/or functional limitations. These gender differences suggest the role of gender specific factors. In addition to greater lifetime risk of chronic diseases like arthritis, depression and osteoporosis, women are more likely to accumulate greater allostatic load from physiological insults and dysregulation across the reproductive life course. Together, these factors could increase the risk of functional limitations and disability in older women. However, our current understanding of the effect of women’s reproductive health (menarche, parity, breastfeeding, menopause, hysterectomy and oophorectomy) on age related structural and functional changes is limited. Understanding these associations could have significant public health implications on disability prevention in later life.
Through this dissertation, we assessed the associations of reproductive factors across the life course, with physical function decline, risk of hip osteoarthritis (OA) and changes in hip geometry in later life. We found that women with early life reproductive factors like later age at menarche, greater parity and breastfeeding were more likely to maintain their grip strength in later life. These findings are likely due to lifestyle factors associated with child rearing. In contrast, same cohort of women demonstrated associations between greater parity and breastfeeding with lower risk of radiographic hip OA. These findings maybe attributable to pregnancy related changes at the hip joint. In a cohort of midlife women, early life reproductive factors including older age at first birth, and breastfeeding with associated with unfavorable levels and accelerated change in hip geometry measure during the menopausal transition (MT). Changes in Follicle Stimulating Hormone (FSH) and Sex Hormone Binding Globulin (SHBG) were associated with poorer hip geometry levels and accelerated its change during the MT. Put together, the 3 studies demonstrated associations between early life reproductive health and musculoskeletal structure and function in later life. Future understanding of underlying mechanisms could help design targeted interventions to prevent disability in later life.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
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| Date: |
5 December 2017 |
| Date Type: |
Submission |
| Defense Date: |
13 November 2017 |
| Approval Date: |
30 January 2018 |
| Submission Date: |
5 December 2017 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
139 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
reproductive health, women's health, hip geometry, aging, life course approach, musculoskeletal aging |
| Date Deposited: |
30 Jan 2018 22:46 |
| Last Modified: |
01 Jan 2020 06:15 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/33428 |
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