From US News, December 24, 2019
A SMALL CRACK IN THE bone that results from repetitive force (rather than trauma), stress fractures are common in athletes, like runners. The injuries also often occur in older people whose bones aren’t as strong or have been weakened by conditions like osteoporosis, which reduce bone density.
Vitamin D has been back in the news again recently. Is it necessary? Is it useful?
A forthcoming article in JBMRPlus by an international team of endocrinologists clears up some of the confusion.
Vitamin D is essential to prevent rickets or osteomalacia. All guidelines conclude that very poor vitamin D (defined as serum 25OHD below 12 ng/ml) should be avoided. There is however a lively debate on the role of vitamin D for skeletal and extra‐skeletal health of adults and elderly subjects with some calling it “futile” and other claiming that very high serum 25OHD such as found in African tribes are needed. Based on a careful evaluation of all existing data, we suggest that vitamin D is not a panacea for all possible diseases of mankind. Vitamin D is, however, important for bone health throughout life. We encourage vitamin D supplementation in moderate doses for all who need it, especially the very young, pregnant women, immigrants with dark skin living in moderate climates, and (frail) older persons. Some people take more vitamin D than needed but far too many are continue to live with an in adequate vitamin D and or calcium nutritional status.
Please cite this article as doi: 10.1002/jbm4.10232.
The annual Falls Prevention Awareness Day (FPAD) — September 23, 2019 — raises awareness about how to prevent fall-related injuries among older adults. National, state, and local partners collaborate to educate others about the impact of falls, share fall prevention strategies, and advocate for the expansion of evidence-based community fall prevention programs. National and state efforts are published in NCOA’s annual FPAD Impact Report. If you would like to learn more about fall prevention efforts in your state, please contact your State Falls Prevention Coalition lead.
Visit the National Council on Aging website for more resources to engage in FPAD!
Fact Sheet: Osteoporosis, Falls and Broken Bones
Take action to prevent osteoporosis, falls, and broken bones. Download and share this one-page handout on the link between fall-related injuries and osteoporosis. Created by the NCOA Falls Free® Coalition and the National Association of Chronic Disease Directors.
A large cohort study has revealed a common osteoporosis drug significantly decreases premature mortality risk, likely related to a reduction in bone loss.
Date: August 12, 2019
Source: Garvan Institute of Medical Research
Two studies led by the Garvan Institute of Medical Research have revealed that nitrogen-bisphosphonates, drugs commonly prescribed for osteoporosis, reduced the risk of premature mortality by 34% in a cohort of over 6,000 individuals. This reduction in early mortality risk was significantly associated with a reduction in bone loss compared with no treatment.
The findings present new advice of the significant benefits of taking approved osteoporosis medicine for those at risk of osteoporosis, and their health care professional.
After the age of 50, 40% of women and 25% of men will sustain an osteoporotic fragility fracture in their life, an injury that puts them at risk of further fractures. However, currently fewer than 30% of women and 20% of men with fragility fractures are taking approved treatments for osteoporosis.
“It’s a common misconception that osteoporosis affects only women, and many people choose to not take recommended treatments,” says Professor Jacqueline Center, who heads the Clinical Studies and Epidemiology laboratory at the Garvan Institute and is an Endocrinologist at St Vincent’s Hospital, who led the studies. “But osteoporotic fractures are not benign. Osteoporosis medication not only decreases the risk of further fractures — but it appears that this same medication also decreases mortality rates over the subsequent 15 years.”
Reduction in mortality risk
Osteoporosis affects around 200 million people worldwide, and is a progressive disease in which bones become more porous and fragile, often without symptoms until the first fracture occurs.
A Garvan-led team of international researchers analysed data from a cohort of 6,120 participants aged over 50, who took part in the observational Canadian Multicentre Osteoporosis Study.
The analysis showed that individuals treated with nitrogen-bisphosphonates (alendronate or risedronate) had a 34% reduction in mortality risk over the subsequent 15 years, compared to non-treated individuals. The study was published in the April issue of the journal Osteoporosis International(1).
In a second follow-up study, published in the Journal of Bone and Mineral Research, the team analysed data from a cohort of 1,735 women, from the same study. The analysis revealed that 39% of the reduction in premature mortality risk was mediated through a reduction in the rate of bone loss.
The researchers also directly compared the nitrogen-bisphosphonates (alendronate or risedronate) with a weaker, non-nitrogen bisphosphonate and found a similar reduction in mortality risk benefit with the nitrogen-bisphosphonates.
The study provides additional evidence that nitrogen-bisphosphonate treatment can provide significant benefits for those with osteoporosis and is the first to examine potential mechanisms.
“For many individuals with osteoporosis, bone health isn’t front-of-mind,” says first author of both studies, Garvan’s Dr Dana Bliuc, Research Officer in the Clinical Studies and Epidemiology laboratory. “We hope our study results will encourage people with osteoporosis or at risk of a fracture to seek treatment — and commit to taking it.”
Materials provided by Garvan Institute of Medical Research.
Garvan Institute of Medical Research. “Osteoporosis drugs linked to reduced risk of premature death.” ScienceDaily. ScienceDaily, 12 August 2019. <www.sciencedaily.com/releases/2019/08/190812155456.htm>.
- Dana Bliuc, Thach Tran, Tineke Geel, Jonathan D Adachi, Claudie Berger, Joop den Bergh, John A Eisman, Piet Geusens, David Goltzman, David A Hanley, Robert Josse, Stephanie Kaiser, Christopher S Kovacs, Lisa Langsetmo, Jerilynn C Prior, Tuan V Nguyen, Jacqueline R Center. Reduced Bone Loss Is Associated With Reduced Mortality Risk in Subjects Exposed to Nitrogen Bisphosphonates: A Mediation Analysis. Journal of Bone and Mineral Research, 2019; DOI: 10.1002/jbmr.3816
Last week an NPR story included information on tai chi as a fall prevention exercise. I was intrigued because I have recently started teaching Tai Chi for Arthritis and Fall Prevention developed the Tai Chi for Health Institute.
Here are the relevant parts of the story and a link to the full story.
What are some of the interventions you’ve used that can help seniors?
You can do so many things. First of all, I tell everybody you’ve got to do some balance training. Tai chi is probably the best exercise to prevent falls, but whatever works for you. And, interestingly, just walking does not reduce your risk for falling. So a lot of doctors will say, “Just get out and walk 20 minutes every day, and that’ll keep you safe. That’ll help you stay healthy.” Walking is great for your heart; it’s great for your brain; it’s great for lots of it. But in order to really reduce your risk for falls, you’ve got to do something specific to balance.
What makes tai chi a good exercise to prevent falls? And why isn’t walking a good alternative?
Walking is kind of just keeping you in one plane moving forward, and it’s not doing any kind of postural training. What tai chi does is it gives you an increased area of postural stability, [which is] kind of your being able to remain upright in space. When you do tai chi, you do stepping moves to the front, to the side; you move your arms out, you reach, you bend. And basically that increases the size of your postural stability so that you can catch yourself and not have the fall. You can be a little bit off kilter and right yourself.
I just bought Terry Roth Schaff’s new book, Medical Yoga Therapy A Practical Guide for the Yoga & Medical Community (2018) and I’ve already found modifications I can use in next week’s classes.
Based on extensive clinical experience with patients, Terry trains yoga and medical professionals to use yoga to treat such widespread ailments as osteoporosis, arthritis, herniated discs and stenosis.
I was already a big fan of Terry’s previous book, Yoga for a Healthy Spine (2012), which has been the foundation for several classes I’ve taught over the last six years.
Terry’s work has been featured in the medical journal, Topics On Geriatric Rehabilitation and in Yoga Therapy Today. Her recent book is receiving high praise from leading doctors at teaching hospitals.