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Tuzun S, Akarirmak U, Kulaksiz B, Keles A, Okutan D, Karsli P, Kurtoglu SS, Aygun E, Palamar D. The association of FRAX with predictors of falls in the assessment of postmenopausal osteoporosis in Turkey: the fracture study of Turkey (FRACT study). Arch Osteoporos 2024; 19:29. [PMID: 38642281 PMCID: PMC11032283 DOI: 10.1007/s11657-024-01387-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/09/2024] [Indexed: 04/22/2024]
Abstract
Although FRAX is used for fracture risk evaluation, this tool does not include balance and fall risk. The association between the predictors of falls and high FRAX scores we found in this study suggests that risk indicators for falls may add substantial value to FRAX by improving fracture risk prediction. PURPOSE This observational, descriptive, and cross-sectional study aimed to assess the fall risk predictors and explore their association with FRAX in Turkish patients with postmenopausal osteoporosis. METHODS Two hundred and nine (209) women with postmenopausal osteoporosis referred to the Fracture Liaison Service (FLS) at Istanbul University-Cerrahpaşa were enrolled in the FRACT study (The Fracture Study of Turkey). Clinical risk factors were assessed using the FRAX tool. Tandem stance, Tandem walking, Timed up and go (TUG), and Chair stand tests were performed to assess balance and fall risk. RESULTS Among patients with a mean age of 67.6 (± 9.7) years, 66 patients (31.6%) had osteoporosis without fractures and 143 patients (68.4%) had fragility fractures. The proportion of patients with poor performance of fall prediction tests was significantly higher in patients with a fragility fracture than those with osteoporosis alone. There was an inverse relationship between dynamic balance tests and the reported number of prior falls in the past year. FRAX score was higher in patients with impaired Tandem stance, Tandem walking, and TUG tests (p = 0.008, p = 0.035, p = 0.001, respectively). CONCLUSION Assessment of fall risk predictors should be one of the major pillars in the physical evaluation of osteoporotic patients in the FLS setting. FRAX is a useful tool to determine the fracture risk of patients with both static and dynamic balance impairments. Combining balance assessment with FRAX may be an important step to optimize osteoporosis risk assessment.
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Affiliation(s)
- Sansin Tuzun
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey.
| | - Ulku Akarirmak
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Bilal Kulaksiz
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Aslinur Keles
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Dilara Okutan
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Pinar Karsli
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Sevgi Selin Kurtoglu
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Eren Aygun
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
| | - Deniz Palamar
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Fatih, Istanbul, Turkey
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Nishikura T, Kitamura K, Watanabe Y, Kabasawa K, Saito T, Takahashi A, Takachi R, Kobayashi R, Oshiki R, Tsugane S, Watanabe K, Nakamura K. Low plasma 25-hydroxyvitamin D levels are not associated with a high risk of recurrent falls in community-dwelling Japanese adults: the Murakami cohort study. Arch Osteoporos 2024; 19:25. [PMID: 38568437 DOI: 10.1007/s11657-024-01381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 03/19/2024] [Indexed: 04/05/2024]
Abstract
Reports on the association between vitamin D levels and fall risk have been mixed, and long-term follow-up studies are lacking. This 5-year cohort study of 5,343 community-dwelling Japanese people aged 40-74 years found that low vitamin D levels are not associated with a high risk of recurrent falls. PURPOSE Findings of cohort studies on the association between plasma 25-hydoxyvitamin D (25[OH]D) levels and fall risk have been mixed, and long-term follow-up studies are lacking. The present study investigated whether low plasma 25(OH)D levels are longitudinally associated with a high risk of recurrent falls in adults. METHODS This 5-year cohort study included 5,343 community-dwelling Japanese people aged 40-74 years. Baseline blood collection and a questionnaire survey were conducted in 2011-2013. Plasma 25(OH)D levels were determined and divided into quintiles after stratification by season, sex, and age group. Information on recurrent falls occurring in the year before the survey 5 years later was obtained, and participants with two or more falls were considered to have experienced recurrent falls. Covariates were sex, age, marital status, education, occupation, BMI, total physical activity levels, calcium intake, vitamin K intake, smoking, drinking, and disease history. RESULTS Mean age and 25(OH)D levels were 60.9 years and 50.9 nmol/L, respectively. In the follow-up survey, 209 recurrent falls were reported. Plasma 25(OH)D levels were not significantly associated with the occurrence of recurrent falls in men, women, or men/women-combined (adjusted P for trend = 0.1198, 0.8383, and 0.2355, respectively). In men and men/women-combined, adjusted ORs for recurrent falls in the lowest quintile were significantly lower (adjusted OR = 0.42 and 0.59, respectively) than the middle quintile (reference). CONCLUSION Low plasma 25(OH)D levels are not associated with a high risk of recurrent falls in middle-aged and older people. Further longitudinal studies will be needed to confirm our findings in other populations.
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Affiliation(s)
- Toshi Nishikura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata, 951-8510, Japan
- Department of Rehabilitation, Niigata University of Rehabilitation, 2-16 Kaminoyama, Murakami, Niigata, 958-0053, Japan
| | - Kaori Kitamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata, 951-8510, Japan
| | - Yumi Watanabe
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata, 951-8510, Japan
| | - Keiko Kabasawa
- Department of Health Promotion Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata, 951-8510, Japan
| | - Toshiko Saito
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata, 951-8510, Japan
| | - Akemi Takahashi
- Department of Rehabilitation, Niigata University of Rehabilitation, 2-16 Kaminoyama, Murakami, Niigata, 958-0053, Japan
| | - Ribeka Takachi
- Department of Food Science and Nutrition, Nara Women's University Graduate School of Humanities and Sciences, Kitauoya-Higashimachi, Nara, 630-8506, Japan
| | - Ryosaku Kobayashi
- Department of Rehabilitation, Niigata University of Rehabilitation, 2-16 Kaminoyama, Murakami, Niigata, 958-0053, Japan
| | - Rieko Oshiki
- Department of Rehabilitation, Niigata University of Rehabilitation, 2-16 Kaminoyama, Murakami, Niigata, 958-0053, Japan
| | - Shoichiro Tsugane
- International University of Health and Welfare Graduate School of Public Health, 4-1-26 Akasaka, Minato-Ku, Tokyo, 107-8402, Japan
| | - Kei Watanabe
- Department of Orthopaedic Surgery, Niigata University Medical and Dental Hospital, 754 Asahimachi-Dori, Niigata, 951-8520, Japan
| | - Kazutoshi Nakamura
- Division of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Niigata, 951-8510, Japan.
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Neale RE, Lucas RM, Byrne SN, Hollestein L, Rhodes LE, Yazar S, Young AR, Berwick M, Ireland RA, Olsen CM. The effects of exposure to solar radiation on human health. Photochem Photobiol Sci 2023:10.1007/s43630-023-00375-8. [PMID: 36856971 PMCID: PMC9976694 DOI: 10.1007/s43630-023-00375-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
This assessment by the Environmental Effects Assessment Panel (EEAP) of the Montreal Protocol under the United Nations Environment Programme (UNEP) evaluates the effects of ultraviolet (UV) radiation on human health within the context of the Montreal Protocol and its Amendments. We assess work published since our last comprehensive assessment in 2018. Over the last four years gains have been made in knowledge of the links between sun exposure and health outcomes, mechanisms, and estimates of disease burden, including economic impacts. Of particular note, there is new information about the way in which exposure to UV radiation modulates the immune system, causing both harms and benefits for health. The burden of skin cancer remains high, with many lives lost to melanoma and many more people treated for keratinocyte cancer, but it has been estimated that the Montreal Protocol will prevent 11 million cases of melanoma and 432 million cases of keratinocyte cancer that would otherwise have occurred in the United States in people born between 1890 and 2100. While the incidence of skin cancer continues to rise, rates have stabilised in younger populations in some countries. Mortality has also plateaued, partly due to the use of systemic therapies for advanced disease. However, these therapies are very expensive, contributing to the extremely high economic burden of skin cancer, and emphasising the importance and comparative cost-effectiveness of prevention. Photodermatoses, inflammatory skin conditions induced by exposure to UV radiation, can have a marked detrimental impact on the quality of life of sufferers. More information is emerging about their potential link with commonly used drugs, particularly anti-hypertensives. The eyes are also harmed by over-exposure to UV radiation. The incidence of cataract and pterygium is continuing to rise, and there is now evidence of a link between intraocular melanoma and sun exposure. It has been estimated that the Montreal Protocol will prevent 63 million cases of cataract that would otherwise have occurred in the United States in people born between 1890 and 2100. Despite the clearly established harms, exposure to UV radiation also has benefits for human health. While the best recognised benefit is production of vitamin D, beneficial effects mediated by factors other than vitamin D are emerging. For both sun exposure and vitamin D, there is increasingly convincing evidence of a positive role in diseases related to immune function, including both autoimmune diseases and infection. With its influence on the intensity of UV radiation and global warming, the Montreal Protocol has, and will have, both direct and indirect effects on human health, potentially changing the balance of the risks and benefits of spending time outdoors.
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Affiliation(s)
- R. E. Neale
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia ,School of Public Health, University of Queensland, Brisbane, QLD Australia
| | - R. M. Lucas
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT Australia
| | - S. N. Byrne
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - L. Hollestein
- Erasmus MC Cancer Institute, Rotterdam, The Netherlands ,Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - L. E. Rhodes
- Dermatology Research Centre, School of Biological Sciences, University of Manchester, Salford Royal Hospital, Northern Care Alliance NHS Trust, Manchester, UK
| | - S. Yazar
- Garvan Medical Research Institute, Sydney, NSW Australia
| | | | - M. Berwick
- University of New Mexico Comprehensive Cancer Center, Albuquerque, USA
| | - R. A. Ireland
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - C. M. Olsen
- Population Health Program, QIMR Berghofer Medical Research Institute, Brisbane, QLD Australia ,Frazer Institute, University of Queensland, Brisbane, QLD Australia
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Murthy LS, de França NAG, Duval GT, Vogrin S, Annweiler C, Duque G. Higher Concentrations of Parathyroid Hormone (PTH) are Associated with Reduced Gait Velocity in Adults: A Systematic Review. Arch Gerontol Geriatr 2022; 99:104579. [DOI: 10.1016/j.archger.2021.104579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 11/02/2022]
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Hospitalisations for falls and hip fractures attributable to vitamin D deficiency in older Australians. Br J Nutr 2021; 126:1682-1686. [PMID: 33509323 DOI: 10.1017/s0007114521000416] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Vitamin D deficiency is associated with an increased risk of falls and fractures. Assuming this association is causal, we aimed to identify the number and proportion of hospitalisations for falls and hip fractures attributable to vitamin D deficiency (25 hydroxy D (25(OH)D) <50 nmol/l) in Australians aged ≥65 years. We used 25(OH)D data from the 2011/12 Australian Health Survey and relative risks from published meta-analyses to calculate population-attributable fractions for falls and hip fracture. We applied these to data published by the Australian Institute of Health and Welfare to calculate the number of events each year attributable to vitamin D deficiency. In men and women combined, 8·3 % of hospitalisations for falls (7991 events) and almost 8 % of hospitalisations for hip fractures (1315 events) were attributable to vitamin D deficiency. These findings suggest that, even in a sunny country such as Australia, vitamin D deficiency contributes to a considerable number of hospitalisations as a consequence of falls and for treatment of hip fracture in older Australians; in countries where the prevalence of vitamin D deficiency is higher, the impact will be even greater. It is important to mitigate vitamin D deficiency, but whether this should occur through supplementation or increased sun exposure needs consideration of the benefits, harms, practicalities and costs of both approaches.
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Pellegrino L, Marangoni F, Muscogiuri G, D’Incecco P, Duval GT, Annweiler C, Colao A. Vitamin D Fortification of Consumption Cow's Milk: Health, Nutritional and Technological Aspects. A Multidisciplinary Lecture of the Recent Scientific Evidence. Molecules 2021; 26:5289. [PMID: 34500722 PMCID: PMC8434398 DOI: 10.3390/molecules26175289] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/24/2021] [Accepted: 08/28/2021] [Indexed: 01/24/2023] Open
Abstract
Vitamin D is essential in assuring bone health at all stages of life, but its non-skeletal effects are also essential: This vitamin impacts the physiology of the immune system, skeletal muscles and adipose tissue, glucose metabolism, skin, cardiovascular and reproductive systems, neuro-cognitive functions and cell division. The incidence of vitamin D deficiency is widespread worldwide, at any age, in young and healthy subjects, as well as in pregnant women and the elderly population, due to several factors, including inadequate sunlight exposure, skin pigmentation and coverage, adiposity, lifestyle and low dietary intakes. To overcome this problem, the fortification of foods that are consumed on a daily basis, such as milk, is strongly advisable. This opinion paper aims to discuss, in a multidisciplinary way, the current evidence supporting the importance of vitamin D in health and disease and the role of milk as an optimal carrier of this vitamin, to promote adequate intakes, highlighting its unique physico-chemical characteristics linked to both fat globule membrane and casein micelle structure. Moreover, it addresses the impact of industrial processing and storage of consumption milk on the stability of these structures, thus in determining vitamin D bioavailability and the achievement of adequate intakes.
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Affiliation(s)
- Luisa Pellegrino
- Department of Food, Environmental and Nutritional Sciences, University of Milan, Via G. Celoria 2, 20133 Milan, Italy;
| | - Franca Marangoni
- NFI—Nutrition Foundation of Italy, Viale Tunisia 38, 20124 Milan, Italy;
| | - Giovanna Muscogiuri
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy; (G.M.); (A.C.)
- UNESCO Chair for Health Education and Sustainable Development, Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Paolo D’Incecco
- Department of Food, Environmental and Nutritional Sciences, University of Milan, Via G. Celoria 2, 20133 Milan, Italy;
| | - Guillaume T. Duval
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, 49035 Angers, France; (G.T.D.); (C.A.)
| | - Cedric Annweiler
- Department of Geriatric Medicine and Memory Clinic, Research Center on Autonomy and Longevity, University Hospital, 49035 Angers, France; (G.T.D.); (C.A.)
- Department of Medical Biophysics, Robarts Research Institute, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON N5X 4L2, Canada
| | - Annamaria Colao
- Department of Clinical Medicine and Surgery, Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy; (G.M.); (A.C.)
- UNESCO Chair for Health Education and Sustainable Development, Federico II University of Naples, Via S. Pansini 5, 80131 Naples, Italy
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Wilson LF, Xu Z, Mishra GD, Dobson AJ, Doust J. Did changes to recommended testing criteria affect the rate of vitamin D testing among Australian women. Arch Osteoporos 2020; 15:162. [PMID: 33067691 DOI: 10.1007/s11657-020-00840-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 10/01/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED We examine whether new government criteria designed to reduce overuse of vitamin D testing changed testing rates in Australian women. Although testing initially declined, the reduction was not sustained. Women who had more doctor visits and who had been tested previously were more likely to have vitamin D testing. PURPOSE Vitamin D testing increased substantially in the 2000s in many countries, particularly in women. Because of concerns about potential over-testing, in 2014, the Australian criteria for subsidised testing were restricted to those at high risk of vitamin D deficiency. We aimed to describe vitamin D testing trends in Australian women (1996 to 2019) and investigate sociodemographic and health factors associated with testing under the new criteria. METHODS We used joinpoint regression to assess changes in national testing trends in Australian women (aged 15+ years) using universal health insurance system data. Additionally, we investigated the factors associated with vitamin D testing through Poisson regression with robust error variance using survey and linked insurance system data from participants born 1946-51 in the Australian Longitudinal Study on Women's Health (ALSWH). RESULTS Between 1996 and 2013, vitamin D testing rates increased in all age groups. Rates declined between 2013 and 2016, but increased again between 2016 and 2019. In the ALSWH cohort, a higher likelihood of testing under the new criteria was associated with 12 or more doctor visits per year compared to two or fewer visits per year (relative risk (RR) 1.85; 95% CI 1.61-2.12), and women who had two or more vitamin D tests between 2012 and 2014 compared to no test (RR 1.55; 95% CI 1.48-1.62). CONCLUSION The introduction of new criteria has not led to sustained declines in testing. High testing rates and repeated testing suggest that over-testing for vitamin D deficiency in Australian women is still occurring.
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Affiliation(s)
- Louise Forsyth Wilson
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia.
| | - Zhiwei Xu
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
| | - Gita Devi Mishra
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
| | - Annette Jane Dobson
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
| | - Jenny Doust
- NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CREWaND), School of Public Health, The University of Queensland, Herston Road, Herston, QLD, 4006, Australia
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Walker P, Kifley A, Kurrle S, Cameron ID. Increasing the uptake of vitamin D supplement use in Australian residential aged care facilities: results from the vitamin D implementation (ViDAus) study. BMC Geriatr 2020; 20:383. [PMID: 33023492 PMCID: PMC7542101 DOI: 10.1186/s12877-020-01784-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 09/21/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Adequate (≥800 IU/day) vitamin D supplement use in Australian residential aged care facilities (RACFs) is variable and non-optimal. The vitamin D implementation (ViDAus) study aimed to employ a range of strategies to support the uptake of this best practice in participating facilities. The aim of this paper is to report on facility level prevalence outcomes and factors associated with vitamin D supplement use. METHODS This trial followed a stepped wedge cluster, non-randomised design with 41 individual facilities serving as clusters pragmatically allocated into two wedges that commenced the intervention six months apart. This multifaceted, interdisciplinary knowledge translation intervention was led by a project officer, who worked with nominated champions at participating facilities to provide education and undertake quality improvement (QI) planning. Local barriers and responsive strategies were identified to engage stakeholders and promote widespread uptake of vitamin D supplement use. RESULTS This study found no significant difference in the change of vitamin D supplement use between the intervention (17 facilities with approx. 1500 residents) and control group (24 facilities with approx. 1900 residents) at six months (difference in prevalence change between groups was 1.10, 95% CI - 3.8 to 6.0, p = 0.6). The average overall facility change in adequate (≥800 IU/day) vitamin D supplement use over 12 months was 3.86% (95% CI 0.6 to 7.2, p = 0.02), which achieved a facility level average prevalence of 59.6%. The variation in uptake at 12 months ranged from 25 to 88% of residents at each facility. In terms of the types of strategies employed for implementation, there were no statistical differences between facilities that achieved a clinically meaningful improvement (≥10%) or a desired prevalence of vitamin D supplement use (80% of residents) compared to those that did not. CONCLUSIONS This work confirms the complex nature of implementation of best practice in the RACF setting and indicates that more needs to be done to ensure best practice is translated into action. Whilst some strategies appeared to be associated with better outcomes, the statistical insignificance of these findings and the overall limited impact of the intervention suggests that the role of broader organisational and governmental support for implementation should be investigated further. TRIAL REGISTRATION Retrospectively registered (ANZCTR ID: ACTRN12616000782437 ).
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Affiliation(s)
- Pippy Walker
- Menzies Centre for Health Policy, University of Sydney, Charles Perkins Centre D17, Camperdown, NSW, 2006, Australia. .,John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Health Service, Hornsby, NSW, 2077, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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Zhuang H, Wang P, Li Y, Lin J, Yao X, Xu H. Analysis of Related Factors of Brittle Hip Fracture in Postmenopausal Women with Osteoporosis. Orthop Surg 2020; 12:194-198. [PMID: 31943831 PMCID: PMC7031597 DOI: 10.1111/os.12605] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/23/2019] [Accepted: 12/08/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To investigate the effects of age, body mass index (BMI), bone mineral density (BMD), and levels of serum 25-hydroxyvitamin D (25OHD) on hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. METHODS A total of 252 postmenopausal women patients, whose bone density had reached the threshold of osteoporosis and age ≥50 years (50-98 years), collected from the Second Affiliated Hospital of Fujian Medical University from January 2015 to December 2018, were performed by retrospective analysis. According to whether or not they had a hip fracture, including femoral neck fracture or intertrochanteric fracture, the patients were divided into two groups, including 117 cases (50-84 years old) in the non-hip fracture group and 135 cases (57-98 years old) in the hip fracture group. BMD was measured by Hologic Discovery A DXA bone mineral densitometer. Levels of serum 25OHD were detected by ROCHE detection instrument. Comparisons of age, BMI, bone density of femoral neck, and levels of serum 25OHD between the two groups were performed by using the Student's t-test. Furthermore, the statistically significant factors were analyzed by multiple regression analysis to investigate the independent risk factors of hip fracture. RESULTS The group without hip fracture: 117 cases; average age: 67.4 ± 8.5 years; BMI: 22.3 ± 3.2 kg/m2 ; bone density of femoral neck: (0.504 ± 0.067) g/cm2 ; T-value of femoral neck: -3.1 ± 0.6; levels of serum 25OHD: (24.9 ± 8.5) ng/mL. The group with brittle hip fracture: 135 cases; average age: 80.7 ± 7.6 years; BMI: 20.3 ± 3.5 kg/m2 ; bone density of femoral neck: (0.426 ± 0.077) g/cm2 ; T-value of femoral neck: -3.8 ± 0.7; levels of serum 25OHD: (15.9 ± 8.9) ng/mL. Age, BMI, bone density of femoral neck, and 25OHD level of the group without hip fracture were markedly lower than hip fracture group (P < 0.05). The results of logistic regression analysis suggested that age, bone density of femoral neck, and levels of serum 25OHD were independent risk factors for fragile hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis. CONCLUSION Higher age, lower levels of bone density and 25OHD are the main risk factors of hip fracture on the condition of the bone density of femoral neck having reached the threshold of osteoporosis.
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Affiliation(s)
- Hua‐feng Zhuang
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Pei‐wen Wang
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Yi‐zhong Li
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Jin‐kuang Lin
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Xue‐dong Yao
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Hao Xu
- Department of OrthopaedicsThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
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Pérez-López FR, Chedraui P, Pilz S. Vitamin D supplementation after the menopause. Ther Adv Endocrinol Metab 2020; 11:2042018820931291. [PMID: 32551035 PMCID: PMC7278294 DOI: 10.1177/2042018820931291] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022] Open
Abstract
The purpose of this review was to assess recent evidence regarding the effects of low vitamin D levels on some highly prevalent clinical conditions of postmenopausal women. We reviewed and selected recent literature regarding menopause-related conditions associated with vitamin D deficiency and interventions to manage them. Low circulating 25-hydroxyvitamin D (25(OH)D) levels related to menopause are linked to diet, lifestyle, changes in body composition, insulin sensitivity, and reduced physical activity. Vitamin D supplementation increases serum 25(OH)D levels while normalizing parathyroid hormone and bone markers, and in women with serum 25(OH)D levels below 10 ng/ml supplementation may improve bone mineral density. Low vitamin D status has been associated with the metabolic syndrome, high triglyceride levels, and low high-density lipoprotein cholesterol levels. When compared with placebo, vitamin D supplementation may lower the risk of the metabolic syndrome, hypertriglyceridemia, and hyperglycemia. There is an inverse relationship between fat mass and serum 25(OH)D levels and, therefore, the dosage of supplementation should be adjusted according to the body mass index. Although vitamin D supplementation may improve glucose metabolism in prediabetic subjects, data regarding muscle strength are conflictive. There is evidence that vitamin D over-treatment, to reach extremely high circulating 25(OH)D levels, does not result in better clinical outcomes. The identification and treatment of vitamin D deficiency in postmenopausal women may improve their general health and health outcomes. Vitamin D supplementation should preferably be based on the use of either cholecalciferol or calcifediol.
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Affiliation(s)
| | - Peter Chedraui
- Instituto de Investigación e Innovación en Salud Integral, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador, and Facultad de Ciencias de la Salud, Universidad Católica Nuestra Señora de la Asunción, Asunción, Paraguay
| | - Stefan Pilz
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Cavalier E, Bruyère O. Vitamin D for the older patient: from hype to hope? Curr Opin Clin Nutr Metab Care 2020; 23:4-7. [PMID: 31714264 DOI: 10.1097/mco.0000000000000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The review critically appraises the most recent and important meta-analyses that have assessed the effect of vitamin D supplementation on bone health in the older population. RECENT FINDINGS Vitamin D status is generally lower in study participants with bone wasting. However, studies on the effects of vitamin D supplementation on bone health, summarized in different meta-analyses, have provided conflicting results, likely because of the heterogeneity between studies. Interventional studies performed using more physiological doses of vitamin D (i.e. avoiding very large, nonphysiological doses) or in study participants with low vitamin D status have provided more beneficial effects on bone health. SUMMARY Meta-analyses assessing the impact of vitamin D in the treatment of osteoporosis are heterogeneous in their conception or their results and sometimes have included inappropriate studies to answer the useful research question for the clinician, making the interpretation and the clinical use of these conflicting meta-analyses quite difficult.
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Affiliation(s)
- Etienne Cavalier
- Department of Clinical Chemistry Division of Public Health, Epidemiology and Health Economics, University of Liège WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, Liège, Belgium
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Harbison AJ, Prabhu S. Causation and Treatment Algorithms for Elderly Patients who have Fallen in the Twin Tiers. Cureus 2019; 11:e6513. [PMID: 32025432 PMCID: PMC6988720 DOI: 10.7759/cureus.6513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction One-third of people aged 65 years of age and older fall annually. Vitamin D is key in maintaining muscle mass and bone structure. The purpose of this quality improvement project is to evaluate the current treatment of elderly patients who experience falls, educate providers on the importance of vitamin D, and measure the changes. Methods We obtained baseline data from the electronic medical records (EMR) of patients who had experienced falls from over a two-year period. We also surveyed providers from the departments of internal medicine (IM) and family medicine (FM) to evaluate fall treatment, educated providers on new protocols, reviewed EMRs of patients that had fallen and surveyed FM and IM providers after education. Results We found that vitamin D supplementation and home health (HH) referral were marginally improved after education and that significant improvement was found in patients being referred to physical therapy (PT). Conclusion Establishing a fall treatment protocol leads to more consistent care among FM and IM providers. Reviewing and updating of the protocol based on outcomes and subsequent research is recommended for improvement in patient care.
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Affiliation(s)
| | - Sheela Prabhu
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
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13
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Sex-specific differences in the association of vitamin D with low lean mass and frailty: Results from the Berlin Aging Study II. Nutrition 2019; 62:1-6. [DOI: 10.1016/j.nut.2018.11.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 10/04/2018] [Accepted: 11/17/2018] [Indexed: 01/04/2023]
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Bird ML, El Haber N, Batchelor F, Hill K, Wark JD. Vitamin D and parathyroid hormone are associated with gait instability and poor balance performance in mid-age to older aged women. Gait Posture 2018; 59:71-75. [PMID: 29017107 DOI: 10.1016/j.gaitpost.2017.09.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/04/2017] [Accepted: 09/27/2017] [Indexed: 02/02/2023]
Abstract
CONTEXT Vitamin D status and parathyroid hormone (PTH) levels influence the risk of accidental falls in older people, but the mechanisms underlying this effect remain unclear. OBJECTIVE Investigate the relationship between circulating PTH and 25 hydroxyvitamin D (25-OHD) levels and clinical tests of gait stability and balance as physical fall risk factors. We hypothesized that high levels of PTH and low 25-OHD levels would be significantly associated with gait stability and decreased balance performance. DESIGN Observational cohort study. SETTING Australian community. PARTICIPANTS 119 healthy, ambulatory female twin adults aged 47-80 years residing in Victoria, Australia. OUTCOME MEASURES Serum PTH and 25-OHD levels with clinical tests of gait stability [double support duration (DSD)] and dynamic balance (Step Test). Associations were investigated by regression analysis and by comparing groups divided by tertiles of PTH (<3.5, 3.5-4.9, >4.9pmol/L) and 25-OHD (<53, 53-75, >75 nmol/L) using analysis of variance. RESULTS Serum PTH was associated positively with DSD, with an increase of 10.6-15.7% when the mid and highest PTH tertiles were compared to the lowest tertile (p <0.025) when 25-OHD was included in the regression analysis. 25-OHD was significantly associated with DSD (greater by 10.6-11.1% when lowest and mid-tertiles compared with the highest 25-OHD tertile) (p <0.025) and dynamic balance (better performance by 12.6% in the highest compared with the lowest 25OHD tertile) (p <0.025). CONCLUSION These findings reveal an important new relationship between parathyroid hormone and gait stability parameters and add to understanding of the role of 25-OHD in motor control of gait and dynamic balance in community-dwelling women across a wide age span.
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Affiliation(s)
- Marie-Louise Bird
- The University of Tasmania, Tasmania, Australia; The University of British Columbia, Canada
| | | | | | - Keith Hill
- School of Physiotherapy and Exercise Science, Curtin University, Western Australia, Australia
| | - John D Wark
- Department of Medicine, Royal Melbourne Hospital, Parkville, Victoria 3050, Australia.
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Annweiler C, Henni S, Walrand S, Montero-Odasso M, Duque G, Duval GT. Vitamin D and walking speed in older adults: Systematic review and meta-analysis. Maturitas 2017; 106:8-25. [DOI: 10.1016/j.maturitas.2017.07.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/28/2017] [Indexed: 01/03/2023]
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Suetani S, Saha S, Eyles DW, Scott JG, McGrath JJ. Prevalence and correlates of suboptimal vitamin D status in people living with psychotic disorders: Data from the Australian Survey of High Impact Psychosis. Aust N Z J Psychiatry 2017; 51:921-929. [PMID: 28829181 DOI: 10.1177/0004867416681853] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Having sufficient sera concentrations of 25-hydroxyvitamin D is important for a range of health outcomes including cardiometabolic diseases. Clinical studies in people with psychotic disorders suggest that a sizable proportion has suboptimal vitamin D status (i.e. vitamin D deficiency or insufficiency). Individuals with psychosis also have many of the risk factors associated with suboptimal vitamin D status such as smoking, obesity, and reduced physical activity. The aim of this study was to examine the prevalence and socio-demographic and clinical correlates of vitamin D status using a large, population-based sample of adults with psychotic disorders. METHODS Data were collected as part of the Survey of High Impact Psychosis, a population-based survey of Australians aged 18-64 years with a psychotic disorder. 25-Hydroxyvitamin D concentration was measured in 463 participants. 25-Hydroxyvitamin D concentration was dichotomised into optimal (above 50 nmol/L) and suboptimal (below 50 nmol/L). The influence of a range of socio-demographic and clinical variables on vitamin D status was examined using logistic regression. RESULTS Nearly half (43.6%) of the participants had suboptimal vitamin D status. Those with (a) increased physical activity or (b) positive symptoms had significantly reduced odds of having suboptimal vitamin D status. However, there were no significant associations between suboptimal vitamin D status and other psychiatric symptom measures or cardiometabolic risk factors. CONCLUSION Many people with psychotic disorders have suboptimal vitamin D status. As part of the routine assessment of physical health status, clinicians should remain mindful of vitamin D status in this vulnerable population and encourage the use of appropriate vitamin D supplements.
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Affiliation(s)
- Shuichi Suetani
- 1 Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,2 Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Sukanta Saha
- 1 Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,2 Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - Darryl W Eyles
- 1 Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,2 Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
| | - James G Scott
- 1 Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,3 University of Queensland Centre for Clinical Research, University of Queensland, Herston, QLD, Australia.,4 Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - John J McGrath
- 1 Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,2 Queensland Brain Institute, University of Queensland, St Lucia, QLD, Australia
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Walker P, Miller Amberber A, Kurrle S, Kifley A, Cameron ID. Prevalence of vitamin D supplement use in Australian residential aged care facilities in November 2014. BMC Res Notes 2017; 10:385. [PMID: 28797304 PMCID: PMC5553921 DOI: 10.1186/s13104-017-2721-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/29/2017] [Indexed: 12/03/2022] Open
Abstract
Objective We sought to establish the prevalence and predictors of adequate vitamin D supplement use, as per current falls prevention guidelines in Australian aged care homes. De-identified medication chart data from November 2014 were collected from pharmacists. The proportion of residents prescribed vitamin D and associations between adequate vitamin D supplementation and state, calcium use and osteoporosis medication use were assessed. Results The prevalence of adequate vitamin D supplement use (≥800 IU) was 47.1% of residents (95% CI 41.4, 52.8%). There was no significant difference between states (p = 0.3), however there was large variation between individual facilities (15.9–85.0%). Residents were more likely to be prescribed an adequate dose of vitamin D if they were prescribed a calcium supplement (p = 0.0001) or an osteoporosis medication (p = 0.03).
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Affiliation(s)
- Pippy Walker
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Amanda Miller Amberber
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Susan Kurrle
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Health Service, Hornsby, NSW, 2077, Australia
| | - Annette Kifley
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
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Annweiler C. Vitamin D in dementia prevention. Ann N Y Acad Sci 2017; 1367:57-63. [PMID: 27116242 DOI: 10.1111/nyas.13058] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 03/06/2016] [Accepted: 03/09/2016] [Indexed: 12/25/2022]
Abstract
Beyond effects on bone health, vitamin D exerts effects on a variety of target organs, including the brain. The discussion herein presents the state of the art in research on the neurological role of vitamin D and clinical implications among older adults, including implications for dementia onset and progression. Some of the neurosteroid actions of vitamin D include regulation of calcium homeostasis, clearance of amyloid-β peptide, antioxidant and anti-inflammatory effects, and possible protection against the neurodegenerative mechanisms associated with Alzheimer's disease (AD). The correction of age-related hypovitaminosis D and cognitive decline has been reported by various cross-sectional and longitudinal studies reporting associations of lower vitamin D concentrations with brain changes and poorer cognition, specifically with respect to executive dysfunction. Epidemiological studies have consistently shown an association between inadequate dietary intake of vitamin D and cognitive disorders, including greater AD risk. Although there have not been any randomized placebo-controlled trials conducted to examine the effectiveness of vitamin D supplementation to prevent AD, several nonrandomized controlled studies have found that older adults experienced cognitive improvements after 1-15 months of vitamin D supplementation. Therefore, it appears crucial to maintain vitamin D concentrations at sufficiently high levels in order to slow, prevent, or improve neurocognitive decline.
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Affiliation(s)
- Cédric Annweiler
- Division of Geriatric Medicine, Department of Neuroscience, University Memory Center, Angers University Hospital, Angers, France.,UPRES EA 4638, University of Angers, L'UNAM, Angers, France.,Robarts Research Institute, Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Duval GT, Paré PY, Gautier J, Walrand S, Dinomais M, Annweiler C. Vitamin D and the Mechanisms, Circumstances and Consequences of Falls in Older Adults: A Case-Control Study. J Nutr Health Aging 2017; 21:1307-1313. [PMID: 29188894 DOI: 10.1007/s12603-016-0857-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine i) whether cases of elderly fallers had lower serum 25-hydroxyvitamin D (25OHD) concentration than controls without history of falls; and ii) whether serum 25OHD concentration was associated with specific mechanisms, circumstances and consequences of falls. DESIGN Case-control study with a 1:2 ratio. SETTING Geriatric ward of the University Hospital of Angers, France, between February 2012 and March 2014. PARTICIPANTS 216 inpatients (72 cases and 144 age- and gender-matched controls). MEASUREMENT Falls were defined as involuntary events causing the person to the ground or other lower level. The main mechanisms, circumstances and consequences of falls were identified using standardized questionnaires. Vitamin D deficiency was defined as serum 25OHD concentration ≤25nmol/L. Age, gender, body mass index, polypharmacy, use antihypertensive drugs, use psychoactive drugs, disability, cognitive performance, serum concentrations of parathyroid hormone, creatinine and albumin, and season of evaluation were used as potential confounders. RESULTS 216 participants (72 cases and 144 controls) were included in the study. There was no between-group difference in the prevalence of vitamin D deficiency (P=0.176). After adjusting for confounding factors, vitamin D deficiency was positively associated with falls (OR=4.03, P=0.014). Finally, the fallers with vitamin D deficiency exhibited more often orthostatic hypotension (68.8% against 33.3%, P=0.039) and a history of recurrent falls (85% against 50%, P=0.002) than those without vitamin D deficiency. CONCLUSION This case-control study reported that vitamin D deficiency was associated with falls in older inpatients. There was a greater prevalence of orthostatic hypotension and of the reccurrence of falls among fallers with vitamin D deficiency, suggesting that vitamin D may influence the conditions predisposing to falls rather than the fall by itself.
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Affiliation(s)
- G T Duval
- Cédric Annweiler, MD, PhD, Division of Geriatric Medicine, Angers University Hospital, F-49933 Angers Cedex 9, France; E-mail: ; Phone: ++33 2 41 35 54 86; Fax: ++33 2 41 35 48 94
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Prevalence of Vitamin D Deficiency in Spring and Summer Months in Central Pennsylvania Neuromuscular Clinic: A Study Complementary to the Pilot Study Published in Journal of Clinical Neuromuscular Disease in June 2015 for Fall and Winter Months. J Clin Neuromuscul Dis 2016; 17:223-5. [PMID: 27224439 DOI: 10.1097/cnd.0000000000000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Formosa MM, Xuereb-Anastasi A. Biochemical Predictors of Low Bone Mineral Density and Fracture Susceptibility in Maltese Postmenopausal Women. Calcif Tissue Int 2016; 98:28-41. [PMID: 26400554 DOI: 10.1007/s00223-015-0060-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 09/09/2015] [Indexed: 01/11/2023]
Abstract
Osteoporosis and fractures are complex conditions influenced by an interplay of genetic and environmental factors. The aim of the study was to investigate three biochemical parameters including total serum calcium, total serum alkaline phosphatase (sALP) and albumin in relation to bone mineral density (BMD) at the lumbar spine and femoral neck (FN), and with all-type of low-trauma fractures in Maltese postmenopausal women. Levels were also correlated with age and physical activity. A case-control study of 1045 women was performed. Women who suffered a fracture were classified as cases whereas women without a fracture history were included as controls subdivided into normal, osteopenic, or osteoporotic according to their BMD measurements. Blood specimens were collected following good standard practice and testing was performed by spectrophotometry. Calcium and sALP levels were weakly correlated with FN BMD levels (calcium: r = -0.111, p = 0.002; sALP: r = 0.089, p = 0.013). Fracture cases had the lowest serum levels of calcium, sALP and albumin relative to all other control groups, which decreased with increasing age, possibly increasing fracture risk. Biochemical levels were lowest in women who sustained a hip fracture and more than one fracture. Biochemical parameters decreased with reduced physical activity; however, this was most evident for fracture cases. Reduced physical activity was associated with lower BMD levels at the hip, and to a lower extent at the spine. In conclusion, results suggest that levels of serum calcium and albumin could be indicative of fracture risk, whereas calcium levels and to lower extent sALP levels could be indicators of hip BMD.
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Affiliation(s)
- Melissa M Formosa
- Department of Applied Biomedical Science, Faculty of Health Sciences, Block A, Level 1, Mater Dei Hospital, University of Malta, Msida, MSD 2080, Malta.
| | - Angela Xuereb-Anastasi
- Department of Applied Biomedical Science, Faculty of Health Sciences, Block A, Level 1, Mater Dei Hospital, University of Malta, Msida, MSD 2080, Malta
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Abstract
Alzheimer's disease (AD) is an age-related progressive dementia, which is increasing in prevalence world-wide. Typically affecting short-term memory at onset, this devastating illness advances to impair all aspects of cognition, as well as non-cognitive domains. Although much effort has been made in recent years to develop disease-modifying treatments, medications which provided promising results in pre-clinical research have so far faltered in human clinical trials. Attention has recently shifted into trying to identify preventative measures that may delay the onset of the illness. Preventative factors include physical activity, proper diet, cognitive stimulation and the management of conditions such as hypertension, diabetes and obesity. However, it remains imperative to identify approaches that may help patients already diagnosed with the illness. Alongside pharmacological research, much work has been done on uncovering strategies which may slow down the progression of AD. This review aims to summarize evidence supporting or refuting methods impacting on the progression of the disease. AD remains a chronic and serious condition, therefore any intervention delaying the onset of moderate/severe symptoms will have a significant impact on patients and their families.
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Montali F, Campaniello G, Benatti M, Rastelli G, Pedrazzoni M, Cervellin G. Impact of different drug classes on clinical severity of falls in an elderly population: Epidemiological survey in a trauma center. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jcgg.2015.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Machado KLLL, Domiciano DS, Machado LG, Lopes JB, Figueiredo CP, Takayama L, Oliveira RM, Menezes PR, Pereira RMR. Persistent hypovitaminosis D and loss of hip bone mineral density over time as additional risk factors for recurrent falls in a population-based prospective cohort of elderly persons living in the community. The São Paulo Ageing & Health (SPAH) Study. Osteoporos Int 2015; 26:1535-42. [PMID: 25600475 DOI: 10.1007/s00198-014-3024-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/26/2014] [Indexed: 01/06/2023]
Abstract
UNLABELLED We performed concomitant evaluation of clinical, laboratory, and bone mineral density (BMD) parameters as potential risk factors for falls in a population-based prospective cohort of older adults, since previous studies have focused mostly in clinical risk factors. Loss of hip BMD and persistent hypovitaminosis D were associated with recurrent falls in community-dwelling elderly. INTRODUCTION Few studies have performed a concomitant evaluation of clinical data, laboratory bone parameters, and bone mineral density (BMD) to determine more accurately the contribution of each of these variables to risk of falls in elderly persons. We investigated the association between bone parameters and recurrent falls in a population-based prospective cohort of community-dwelling older adults. METHODS A total of 705 elderly individuals (448 women, 257 men) were evaluated with clinical data, BMD, and laboratory bone tests at baseline and after a mean follow-up of 4.3 ± 0.8 years. Individuals with recurrent falls (≥2 falls in the previous year from the date of the second evaluation) were considered chronic fallers. Logistic regression models were used to identify independent risk factors for recurrent falls. RESULTS The frequency of chronic fallers was 16.5%. In multivariate analyses, risk factors for recurrent falls were visual impairment (odds ratio (OR) = 2.49, 95% confidence interval (CI) 1.30-4.74, p = 0.006), use of psychotropic drugs (OR = 2.47, 95% CI 1.37-4.49, p = 0.003), clinical fracture (OR = 2.78, 95% CI 1.48-5.20, p = 0.001), persistently low 25-hydroxyvitamin D (25OHD) (<20 ng/mL) (OR = 1.71, 95% CI 1.10-2.64, p = 0.016), and loss of total hip BMD during the study (OR = 1.21, 95% CI 1.17-1.25, p = 0.035 for each 4% decrease). CONCLUSIONS In addition to traditional clinical risk factors for falls, loss of hip BMD and hypovitaminosis D were associated with recurrent falls in community-dwelling elderly persons. Thus, recognizing these factors is essential to preventing falls and improving the outcomes of this population.
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Affiliation(s)
- K L L L Machado
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo, 455, 3° andar, sala 3193, São Paulo, SP, 01246-903, Brazil
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Annweiler C, Bartha R, Karras SN, Gautier J, Roche F, Beauchet O. Vitamin D and white matter abnormalities in older adults: A quantitative volumetric analysis of brain MRI. Exp Gerontol 2015; 63:41-7. [DOI: 10.1016/j.exger.2015.01.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/05/2015] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
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Beauchet O, Launay CP, Fantino B, Annweiler C, Allali G. Motor imagery of gait in non-demented older community-dwellers: performance depends on serum 25-hydroxyvitamin D concentrations. AGE (DORDRECHT, NETHERLANDS) 2015; 37:18. [PMID: 25701394 PMCID: PMC4336298 DOI: 10.1007/s11357-015-9755-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 02/05/2015] [Indexed: 06/04/2023]
Abstract
Hypovitaminosis D has been associated with poorer physical and cognitive performances in older adults. The objectives of this study were (1) to measure and compare the time to perform (pTUG) and to imagine (iTUG) the Timed "Up & Go" test (TUG) test, and the time difference between these two performances (i.e., TUG delta time) in non-demented community-dwelling older adults with and without lower serum 25-hydroxyvitamin D (25OHD) concentrations and (2) to examine the association between the TUG delta time and serum 25OHD concentrations. Durations of pTUG, iTUG and TUG delta time, and serum 25OHD concentrations (severe insufficiency <10 ng/mL; moderate insufficiency: 10-30 ng/mL; normal status >30 ng/mL) were measured in 359 non-demented participants (mean age 70.4 ± 4.8 years; 40.7 % women). Participants with severe 25OHD insufficiency (15.6 %) had higher TUG delta time compared to those with moderate insufficiency (P = 0.010) and normal status (P = 0.048). TUG delta time was negatively associated with serum 25OHD concentrations (P < 0.010). Accurate motor imagery of gait was explained in part by serum 25OHD concentrations, increased discrepancy between pTUG and iTUG being associated with lower serum 25OHD concentrations.
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Affiliation(s)
- Olivier Beauchet
- Department of Neuroscience, Division of Geriatric Medicine, UPRES EA 4638, UNAM, Angers University Hospital, Angers, Cedex 9, France,
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Grant WB. Using findings from observational studies to guide vitamin D randomized controlled trials. J Intern Med 2015; 277:83-6. [PMID: 24734896 DOI: 10.1111/joim.12260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- W B Grant
- Sunlight, Nutrition, and Health Research Center, San Francisco, CA, USA
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Abstract
The number of individuals aged 65 and older is expected to more than double from 2012 to 2060. The role of vitamin D in the prevention and treatment of diseases associated with aging has not been well studied. Traditionally, the role of vitamin D focused on the maintenance of skeletal health in the older adult. With the discovery of vitamin D receptors in the nervous, cardiovascular and endocrine systems, the role of vitamin D and its impact on these systems has become an important area of research. Older adults are at risk for lower levels of vitamin D as a result of decreased cutaneous synthesis and dietary intake of vitamin D. Epidemiologic evidence indicates an association between low levels of vitamin D and diseases associated with aging such as cognitive decline, depression, osteoporosis, cardiovascular disease, hypertension, type 2 diabetes, and cancer. Clinical trials to determine the benefit of vitamin D supplementation in preventing and treating such diseases are in progress. This paper highlights current evidence regarding the role that vitamin D may play in diseases associated with aging and addresses the need for well-designed randomized trials to examine its benefit on health outcomes in the older adult.
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Affiliation(s)
- Meghan Meehan
- School of Nursing, Loyola University Chicago, IL., USA
| | - Sue Penckofer
- School of Nursing, Loyola University Chicago, IL., USA
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