Estrogen is the key regulator of bone metabolism in both men and women. Menopause and the accompanying loss of ovarian estrogens are associated with declines in bone mineral density (BMD): 10-year ...cumulative loss was 9.1% at the femoral neck and 10.6%, lumbar spine. Estradiol concentrations also predict fractures. Total estradiol levels, <5pg/ml were associated with a 2.5-fold increase in hip and vertebral fractures in older women, an association that was independent of age and body weight. Similar associations were found in men. Despite the lower BMD and higher fracture risk in hypogonadal men, there is little association between circulating testosterone, fracture and bone loss. Nevertheless, the combination of any low sex steroid hormone and 25-hydroxyvitamin D was associated with an increased fracture risk. Menopausal hormone therapy has been shown to reduce hip and all fractures in the Women’s Health Initiative with little difference between the estrogen-alone and the estrogen plus progestin trials. The risk reductions were attenuated in both trials post intervention; however, a significant hip fracture benefit persisted over 13years for women assigned to the combination therapy.
Clinical trials of testosterone replacement in older men give tantalizing but inconclusive results. The results suggest that testosterone treatment probably improves BMD, but the results are less conclusive in older versus younger men. The Testosterone Trial is designed to test the hypothesis that testosterone treatment of men with unequivocally low serum testosterone (<275ng/dL) will increase volumetric BMD (vBMD) of the spine. Results of the Testosterone Trials are expected in 2015.
Public health impact of osteoporosis Cauley, Jane A
The journals of gerontology. Series A, Biological sciences and medical sciences,
10/2013, Volume:
68, Issue:
10
Journal Article
Peer reviewed
Open access
To describe the public health impact of osteoporosis including the magnitude of the problem and important consequences of osteoporotic fractures.
Literature review of key references selected by ...author.
Current demographic trends leading to an increased number of individuals surviving past age 65 will result in an increased number of osteoporotic fractures. Important consequences of osteoporotic fractures include an increased mortality that for hip fractures extends to 10 years after the fracture. Increased mortality risk also extends to major and minor fractures, especially, in those over 75 years. Hip and vertebral fractures have important functional consequences and reductions in quality of life. The economic impact of osteoporotic fractures is large and growing. Significant health care resources are required for all fractures.
To alleviate the public and private burden of osteoporosis related fractures, assessment of risk and reduction of individual risk is critical.
PURPOSE OF REVIEWThe purpose of this review is to provide an update on osteoporosis epidemiology. The focus is on fractures because fractures are the most important clinical consequence of ...osteoporosis. Studies published over the past 18 months are identified and reviewed. Finally, the clinical impact of these new findings is discussed.
RECENT FINDINGSImportant research in 2015–2016 include analyses of screening and rescreening in younger women and older men, risk factors for hip fractures in older men, obesity and weight loss/gain, and risk of fracture. Several dietary factors, including adherence to a Mediterranean diet and a diet rich in protein, fruits, and vegetables and maintenance of physical function with increasing age represent modifiable nonpharmacologic risk factors that improve bone health. Sarcopenia may have a more important role in fracture in men than women. Important biomarkers for fracture include low 25-hydroxyvitamin D and hemoglobin A1c.
SUMMARYUpdated literature on fracture epidemiology have identified important risk factors for fracture.
Background
Osteoporotic fractures are a major public health issue. The literature suggests there are variations in occurrence of fractures by ethnicity and race.
Questions/purposes
My purpose is to ...review current literature related to the influence of ethnicity and race on the (1) epidemiology of fracture; (2) prevalence of osteoporosis by bone mineral density; (3) consequences of osteoporotic hip fracture; (4) differences in risk fracture for fracture; and (5) disparities in screening, diagnosis, and treatment of osteoporosis.
Methods
Current literature was selectively reviewed related to osteoporosis, ethnicity, and race.
Results
Ethnicity and race, like sex, influence the epidemiology of fractures, with highest fracture rates in white women. Bone mineral density is higher in African Americans; however, these women are more likely to die after hip fracture, have longer hospital stays, and are less likely to be ambulatory at discharge. Consistent risk factors for fracture across ethnicity include older age, lower bone mineral density, previous history of fracture, and history of two or more falls. Ethnic and racial disparities exist in the screening, diagnosis, and treatment of osteoporosis.
Conclusions
Across ethnic and racial groups, more women experience fractures than the combined number of women who experience breast cancer, myocardial infarction, and coronary death in 1 year. Prevention efforts should target all women, irrespective of their race/ethnicity, especially if they have multiple risk factors.
Sarcopenic obesity (SO) refers to the copresence of sarcopenia and obesity. In this condition, a disproportion exists between the amount of lean mass relative to fat mass. Research on SO is important ...because the presence of both sarcopenia and obesity may have important health consequences. However, SO research has been hampered by the disparate number of definitions of SO. Various definitions of sarcopenia include ratios of appendicular mass to height(2) or body weight, measures of muscle strength, or physical function. More recent definitions incorporate all 3. Obesity is usually defined by high body mass index, but some studies have relied on percent body fat or visceral fat. Depending on the definition, the prevalence of SO ranges from 0% to 41% in older populations. The loss of lean mass and increase in fat mass with advancing age may share common etiologic pathways. Declines in physical activity can lead to poor muscle strength, lower muscle mass, and increased fat infiltration; all of which could lead to increases in fat mass. The increases in fat mass and accompanying increases in adipokines and inflammation may further adversely affect muscle quality. SO has been related to an increased risk of mobility disability, above and beyond sarcopenia, or obesity alone. Additional research is needed to further our understanding of the pathophysiology of SO and its consequences. Interventions aimed at reducing SO may improve physical function as well as reduce disability and death.
Summary No systematic review of epidemiological evidence has examined risk factors for sleep disturbances among older adults. We searched the PubMed database combining search terms targeting the ...following domains 1) prospective, 2) sleep, and 3) aging, and identified 21 relevant population-based studies with prospective sleep outcome data. Only two studies utilized objective measures of sleep disturbance, while six used the Pittsburgh sleep quality index (PSQI) and thirteen used insomnia symptoms or other sleep complaints as the outcome measure. Female gender, depressed mood, and physical illness were most consistently identified as risks for future sleep disturbances. Less robust evidence implicated the following as potentially relevant predictors: lower physical activity levels, African-American race, lower economic status, previous manual occupation, widowhood, marital quality, loneliness and perceived stress, preclinical dementia, long-term benzodiazepine and sedative use, low testosterone levels, and inflammatory markers. Chronological age was not identified as a consistent, independent predictor of future sleep disturbances. In conclusion, prospective studies have identified female gender, depressed mood, and physical illness as general risk factors for future sleep disturbances in later life, although specific physiological pathways have not yet been established. Research is needed to determine the precise mechanisms through which these factors influence sleep over time.
OBJECTIVES
To develop an evidence‐based definition of sarcopenia that can facilitate identification of older adults at risk for clinically relevant outcomes (eg, self‐reported mobility limitation, ...falls, fractures, and mortality), the Sarcopenia Definition and Outcomes Consortium (SDOC) crafted a set of position statements informed by a literature review and SDOC's analyses of eight epidemiologic studies, six randomized clinical trials, four cohort studies of special populations, and two nationally representative population‐based studies.
METHODS
Thirteen position statements related to the putative components of a sarcopenia definition, informed by the SDOC analyses and literature synthesis, were reviewed by an independent international expert panel (panel) iteratively and voted on by the panel during the Sarcopenia Position Statement Conference. Four position statements related to grip strength, three to lean mass derived from dual‐energy x‐ray absorptiometry (DXA), and four to gait speed; two were summary statements.
RESULTS
The SDOC analyses identified grip strength, either absolute or scaled to measures of body size, as an important discriminator of slowness. Both low grip strength and low usual gait speed independently predicted falls, self‐reported mobility limitation, hip fractures, and mortality in community‐dwelling older adults. Lean mass measured by DXA was not associated with incident adverse health‐related outcomes in community‐dwelling older adults with or without adjustment for body size.
CONCLUSION
The panel agreed that both weakness defined by low grip strength and slowness defined by low usual gait speed should be included in the definition of sarcopenia. These position statements offer a rational basis for an evidence‐based definition of sarcopenia. The analyses that informed these position statements are summarized in this article and discussed in accompanying articles in this issue of the journal. J Am Geriatr Soc 68:1410‐1418, 2020.
See related editorial by Cesari et al in this issue
The Gerontological Society of America joined the Fragility Fracture Network's (FFN) global call to action on fragility fractures in Sep 2018. The call posits to improve the care of people with ...osteoporotic fractures, implementing services to treat, rehabilitate, and prevent subsequent fractures. The FFN's call to action was preceded by several other scientific organizations including the American Society for Bone and Mineral Research (ASBMR), and the International Osteoporosis Foundation.
Screening for Osteoporosis Cauley, Jane A
JAMA : the journal of the American Medical Association,
06/2018, Volume:
319, Issue:
24
Journal Article
Peer reviewed
The article discusses the findings of a study to evaluate and update the 2011 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for osteoporosis which revealed that the USPSTF ...recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older.
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