Comparison of muscle and fat parameters measured by ultrasonography and dual-energy x-ray absorptiometry between older palliative care patients with and without type 2 diabetes mellitus

BACKGROUND AND AIMS

There are limited data on the comparison of body compositions between diabetic and non-diabetic patients. We aimed to compare the muscle mass and fat parameters measured by ultrasonography (USG) and dual-energy x-ray absorptiometry (DXA) between older palliative care patients with and without type 2 diabetes mellitus (DM).

METHODS

We conducted a prospective, cross-sectional study. We recorded the demographics, comorbidities, blood pressures, microvascular complications, pressure injuries, ambulation and nutritional status, and laboratory parameters. We measured the handgrip strength with a hand dynamometer and anthropometric parameters. We analyzed the subcutaneous fat thickness, muscle thickness (MT), and cross-sectional area (CSA) of the rectus femoris (RF) and biceps brachii muscles by USG and the total and regional muscle mass and fat parameters by DXA. We performed a regression analysis to examine the independently associated factors of DM.

RESULTS

We included 55 patients (mean age: 79.0 ± 8.0 years, 56.4%: female). 43.6% had type 2 DM. The patients with DM had significantly higher glucose and HbA1c levels and lower RFMT and RFCSA values than the patients without DM (p < 0.01, for all). The RFMT was independently associated with DM after adjusting age, sex, and body mass index (Odds ratio = 0.735, 95% confidence interval = 0.565-0.956, p = 0.022).

CONCLUSION

Our study demonstrated that the RFMT might be associated with type 2 DM. This was the first study comparing the body compositions measured by USG and DXA between older diabetic and non-diabetic palliative patients with a wide range of laboratory evaluations. Longitudinal, multi-center studies are warranted to understand the underlying mechanisms.

Ultrasonographically Measured Rectus Femoris Cross-sectional Area might Predict Osteosarcopenia

AIM

We have aimed to investigate the role of ultrasonographic muscle parameters (UMP) in predicting osteosarcopenia in bedridden patients in a palliative care center.

BACKGROUND

The role of ultrasound has not been evaluated in predicting osteosarcopenia.

OBJECTIVE

Reduced muscle thickness (MT) and cross-sectional area (CSA) have often been observed in individuals with sarcopenia, reflecting muscle loss and atrophy. Meanwhile, the potential role of muscle ultrasound has not been evaluated in predicting osteosarcopenia.

METHODS

We have conducted a prospective, observational study between January 2021 and 2022. We have recorded the demographics, comorbidities, and nutritional status by using the mini nutritional assessment-short form. We measured handgrip strength with a hand dynamometer and the muscle mass with dual X-ray absorptiometry. Sarcopenia was defined by the European Working Group on Sarcopenia in Older People 2 criteria. Osteoporosis was diagnosed according to the World Health Organization criteria. We have categorized the body phenotypes into four groups: "non-sarcopenic non-osteoporotic," "sarcopenic alone," "osteoporotic alone," and "sarcopenic osteoporotic." We have measured the subcutaneous fat thickness (SFT), MT, and CSA of the rectus femoris (RF) and biceps brachii (BB) via ultrasonography. A multivariate regression analysis was performed and area under curve (AUC) values were used to evaluate the accuracy of UMPs.

RESULTS

We included 31 patients (mean age: 74.6±12.1 years, 54.8%: male). The prevalences of sarcopenia, osteoporosis, and sarcopenic osteoporosis were 71%, 48.4%, and 41.9%, respectively. Only the "sarcopenic osteoporotic" phenotype was negatively correlated with all UMPs. In the regression analysis, only the "sarcopenic osteoporotic" phenotype was independently associated with RFCSA (ß=-0.456, p= 0.024). The AUC for all patients was >0.700.

CONCLUSION

RFCSA measurement might be useful in the screening for osteosarcopenia. This has been the first study investigating the relationship between UMPs and body phenotypes. Multi-center and large-scale studies are, however, needed.

Peripheral Vascular Disease is Associated with Impaired Activities of Daily Living in the Elderly with Dementia: A Prospective Study

BACKGROUND

Although distinct disorders, peripheral vascular disease (PVD) and dementia are both associated with a progressive decline in activities of daily living in elderly patients.

OBJECTIVE

This study aimed to compare the functional performance scores between elderly patients with and without dementia and with or without PVD.

METHODS

Patients with Alzheimer's disease, vascular dementia, and mixed type dementia and controls were prospectively enrolled. Functional performance scores for basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were evaluated using the Barthel scale and Lawton scale, respectively. PVD was diagnosed using the ankle brachial index (ABI).

RESULTS

Controls without PVD were age- and sex-matched with 57 patients with both dementia and PVD and with 69 patients without dementia. The patients with PVD in both groups had lower mean BALD scores. Adjusting for age, clinical dementia rating, and depression, PVD was associated with a higher likelihood of being in the quartiles of lower BADL scores in those with dementia (p=0.020). Adjusting for age, sex, Mini-Mental State Examination (MMSE) score, depression, and comorbidity and drug counts among the patients without dementia, a significant association was observed with PVD and a higher likelihood of being in the quartiles of lower BADL scores (p=0.044). PVD was related to a higher likelihood of being in the quartiles of lower IADL scores in the non-dementia subjects (p=0.001) after adjusting for age, depression, MMSE, education, and comorbidity count.

CONCLUSION

PVD presence determined the poorer status of BADL in demented individuals but not of the level of IADL. It is still unclear whether modifying PVD health risks and undergoing ABI screening may help demented people become more independent.

Low bone density and osteoporosis among older adults with Alzheimer's disease, vascular dementia, and mixed dementia: A Cross-sectional Study With Prospective Enrollment

OBJECTIVES

This study aims to examine bone mineral density (BMD) and osteoporosis in older adults with dementia compared to those with a normal cognitive status and to evaluate the type, severity, and duration of dementia.

PATIENTS AND METHODS

Between May 2013 and May 2017, a total of 363 participants aged ≥65 years (136 males, 227 females; mean age 78.4±5.4 years; range 66 to 99 years) with and without Alzheimer's disease (AD), vascular dementia (VaD), or mixed dementia (AD-VaD) were included in this single-center, prospective, cross-sectional study. The dementia group included 93 patients with dementia and the control group included 270 age- and sex-matched healthy individuals. We used dual-energy X-ray absorptiometry (DXA) to measure BMD of the lumbar spine, total hip, and femoral neck.

RESULTS

Controlled for age and sex, demented and non-demented participants had a similar BMD (g/cm2) at lumbar spine [F (1, 358):0.83, p=363], but lower BMD values of total hip [F (1, 359):10.26, p=0.001] and femoral neck [F (1, 359):15.21, p<0.001] in the patients with dementia. Adjusted percentage of osteoporosis and low bone mass based on total hip and femoral neck T-scores were also significantly higher in the patient group. The mean BMD values, frequency of osteoporosis, and low bone mass did not significantly differ according to the subtype of dementia, sex, and disease duration or severity.

CONCLUSION

Our study results show that demented elders have a lower BMD and higher frequency of osteoporosis at the hip, but not at the lumbar spine, irrespective of sex and type of dementia. Based on these results, we can speculate that not only AD, but also VaD and AD-VaD may be associated with bone loss at the hip.

Age at First Osteoporosis Screening Among Older Women and Men: Is Bone Mineral Density Measurement Ordered Timely?

BACKGROUND

US National Osteoporosis Foundation has specified age cut-offs for osteoporosis screening in older women and men.

OBJECTIVE

In this study, we investigated whether Turkish seniors undergo their first ever osteoporosis screening early, on time or late.

METHODS

We determined the age of older women and men at their first-time Bone Mass Densitometry (BMD) testing using the medical records of a geriatric outpatient unit. The timing of the BMD test was considered ''late'' when performed after the age of 65 and 70 in women and men, respectively. An "early" screening was defined as having a BMD measurement before these age cut-offs.

RESULTS

We included 481 individuals in the study (mean age: 74.5±6.5 years, women: 62%). On admission, around 18% of the sample could give no definite information and another 35% had never been assessed for osteoporosis. Among those with a past screening, 64.8% reported comorbid osteoporosis and 33% reported no osteoporosis. Mean age of the first-time BMD measurement was 67.4±7.7 years. The first-time BMD measurement was on time in 9.7%, early in 37.4% and late in 52.9% of the subjects. Half of the individuals with a self-reported osteoporosis diagnosis were non-osteoporotic on a new BMD ordered following the geriatric assessment. Multimorbidity (≥3), parental hip fracture, and smoking were the independent predictors of being early screened.

CONCLUSION

We found two-thirds of women and men unscreened for osteoporosis despite being indicated by age. Early and late screening were both prevalent. Self-reported osteoporosis diagnosis was mostly inconsistent with BMD testing in our sample.

The Association of Sarcopenia and Bone Mineral Densitometry in a Small Population of Turkish Elderly (P21-048-19)

Objectives

Mortality rate of hip fracture is 18%-33% in following year. Epidemiological studies showed that sarcopenia is associated with mortality, morbidity and functional loss. Little is known about sarcopenia diagnostic criteria (ESPEN 2009) and bone mineral densitometry (BMD) scores in Turkish Elderly Population.

Methods

In this single centered observational study, elderly patients without cognitive impairment underwent assessment. Demographic features, mini nutrition assessment- sort form (MNA-sf) score, BMD, hand grip strength, 5 meter walking speed, skeletal muscle mass(SMM) and skeletal muscle mass index (SMM/Height 2) were recorded. We assessed sarcopenia criteria and BMD score relation.

Results

Forty-seven patients were fulfills inclusion criteria and underwent assessment. Mean age was 75.7661.03 and 63.8% were female. Three of all were sarcopenic according to ESPEN 2009 guidelines. 83% were normal and 17% were at malnutrition risk according to MNA-sf score. Hand grip straight (r¼0.286, p¼0.05) and SMM (r¼0.38, p¼0.011) were significantly positive correlates with femur total T score but there were no correlations between SMM index and 5 meters walking speed.

Conclusions

This preliminary study showed relations between skeletal muscle mass, hand grip strength and femur total BMD score in a small Turkish Elderly Patients Population. Sarcopenia and osteoporosis relation in Turkish Population should be assessed in multicentre large population-based study.

Funding Sources

Conflict of Interest: No conflict of interest, Fund: None.

Multiple Antihyperglycemic Drug Use is Associated with Undernutrition Among Older Adults with Type 2 Diabetes Mellitus: A Cross-Sectional Study

INTRODUCTION

Undernutrition is prevalent in older age. Current management of type 2 diabetes mellitus (T2DM) requires modified diet patterns; however, older adults with diabetes may also be at the risk of undernutrition due to age, disease, and medication-related factors. Our objectives in this study were to examine the proportion and associations of undernutrition among community-dwelling older adults with T2DM.

METHODS

This prospective, cross-sectional study involved older outpatient adults (≥ 65 years) with and without T2DM. We assessed the nutritional status using the Mini Nutritional Assessment-Short Form. Undernutrition referred to being either at risk of malnutrition or malnourished. Variables independently associated with undernutrition were evaluated by logistic regression analysis.

RESULTS

Five hundred forty-six older adults [n = 215 with T2DM and n = 331 control; mean (SD) age, 74.9 (6.3) years; 388 (71.1%) female] were included in the study. The frequency of undernutrition was 31.1%, which was higher in patients with T2DM than in those without (36.7% vs. 27.5%, p < 0.05). However, the difference was no longer significant after adjustment for covariates (gender, lower education, lower body mass index, cardiovascular disease, multimorbidity, cognitive performance, functional performance, depressive symptoms, and polypharmacy). In the T2DM group, the ratio of multiple antihyperglycemic drug use (≥ 2) was higher in those with undernutrition compared with normal nutritional status (78.5% vs. 59.6%, p = 0.005). On multivariable analysis, decreased functional performance, depressive symptoms, and use of multiple antihyperglycemic drugs were associated with undernutrition in patients with T2DM.

CONCLUSIONS

Undernutrition was more common among older adults with T2DM compared with the control group. Undernutrition was further dependent on chronic conditions and diabetes management.

Assessment of geriatric predictors of adherence to Zoledronic acid treatment for osteoporosis: a prospective follow-up study

Objectives Discontinuation of bisphosphonate treatment remains high even with the long acting parenteral options. Whether there are some unidentified causes of noncompliance more specific to aged individuals is unknown. The aim of this study was to investigate baseline predictors of adherence to Zoledronic acid (ZOL) infusions among non-demented older adults with osteoporosis. Methods Patients aged ≥ 65 years who received a first ever ZOL infusion for osteoporosis were prospectively enrolled. Risk factors for osteoporosis and fractures, comorbidities, geriatric assessment measures, including depression, and anticholinergic burden were determined at baseline. Adherence was defined as taking the next ZOL infusion at 12 months. Results A total of 187 participants were included (mean age: 75.7 ± 6.3 years, female: 77.5%). Adherence to the next ZOL infusion was 66.8% (n = 125). Non-adherent participants (n = 62, 33.2%) had significantly higher frequency of historical height decrease and depression at baseline. Poor adherence was associated with height decrease, presence of depression, and higher anticholinergic burden in univariate analysis. After adjustment for relevant confounders, fragility fracture history (OR: 0.38, 95%CI: 0.17-0.86, p = 0.020), depression (OR: 0.32, 95%CI: 0.12-0.82, p = 0.018), and higher anticholinergic burden (OR: 0.67, 95%CI: 0.49-0.93, p = 0.017) were the predictors of lower adherence to ZOL infusion. Conclusions The rate of adherence to the next ZOL infusion was still suboptimal among older women and men in this study. Past osteoporotic fractures, depression, and higher anticholinergic drug burden predicted poor ZOL adherence. It was a novel finding that drug-related anticholinergic side effects adversely influenced adherence to another medication without anticholinergic properties.

Mismatch between ADA and AGS recommendations for glycated hemoglobin targets for older adults

In recent years, modified glycemic targets have been defined for older adults with diabetes mellitus. In a sample of elderly patients, we have identified several inconsistencies between the real life applicability of glycated hemoglobin goals recommended by the American Diabetes Association and the American Geriatrics Society.

Undetected Peripheral Arterial Disease Among Older Adults With Alzheimer's Disease and Other Dementias

BACKGROUND

Peripheral arterial disease (PAD) was reported to increase the risk of dementia(s) even more than stroke. We assessed the prevalence of PAD in a group with definite diagnosis of dementia.

METHODS

Patients aged 65 years or older with Alzheimer's disease (AD), vascular dementia (VaD), or AD-VaD were enrolled (n = 162, mean age: 78.87 [6.05] years). An age- and gender-matched control group was also included (n = 190). Peripheral arterial disease was diagnosed by the ankle-brachial index.

RESULTS

Frequency of PAD among patients with and without dementia was 35.2% and 16.3%, respectively ( P < .001), being similar among different types of dementia. After adjustment for covariates, dementia (odds ratio: 2.41, 95% confidence interval: 1.34-4.32; P = .003) was among the predictors of PAD diagnosis along with older age, female gender, and diabetes.

CONCLUSIONS

The prevalence of PAD was more than double in patients with dementia, with no difference among AD, VaD, and AD-VaD types.

Effects of Bisphosphonates and Calcium plus Vitamin-D Supplements on Cognitive Function in Postmenopausal Osteoporosis§

BACKGROUND

Postmenopausal osteoporosis has been linked to accelerated cognitive decline; however, little is known about the effects of medical treatment on cognitive functions.

MATERIAL AND METHODS

In this prospective study, we evaluated the effects of bisphosphonate treatment and calcium plus vitamin D supplementation on cognitive functions in 45 women with postmenopausal osteoporosis who were started on medical treatment. The medications included alendronate, zoledronic acid, risedronate, or ibandronic acid along with a low or high dose of calcium plus vitamin D supplements. The cognitive function was assessed by the mini-mental state examination (MMSE) test. All subjects underwent bone mineral density (BMD) measurement via dual-energy X-ray absorptiometry at baseline and at study completion.

RESULTS

The mean T-score improved significantly at 1 year, except for neck of the femur area. The mean MMSE score did not change significantly at 12 months (26.40 ± 2.07 vs. 26.48 ± 2.07; p = 0.513), with no difference among bisphosphonates combined with calcium plus vitamin D. Higher dose (1200 mg/800 U/day) of calcium plus vitamin D supplementation tended to have a greater improvement as compared with lower dose (600 mg/400 U/day) (Δ MMSE: 0.11 ± 0.72 vs. -0.14 ± 0.69).

CONCLUSIONS

Cognitive functions in the women remained unaltered, whereas bone BMD T-scores were significantly improved at the 12(th) month after the administration of bisphosphonates and calcium plus vitamin D supplements. Higher doses of calcium plus vitamin D supplements were likely to have better cognitive effects as compared with lower doses.