Bone Loss In Older Women Research Articles

One-year supplementation with Lactobacillus reuteri ATCC PTA 6475 counteracts a degradation of gut microbiota in older women with low bone mineral density

Recent studies have shown that probiotic supplementation has beneficial effects on bone metabolism. In a randomized controlled trial (RCT) we demonstrated that supplementation of Lactobacillus reuteri ATCC PTA 6475 reduced bone loss in older women with low bone mineral density. To investigate the mechanisms underlying the effect of L. reuteri ATCC PTA 6475 on bone metabolism, 20 women with the highest changes (good responders) and the lowest changes (poor responders) in tibia total volumetric BMD after one-year supplementation were selected from our previous RCT. In the current study we characterized the gut microbiome composition and function as well as serum metabolome in good responders and poor responders to the probiotic treatment as a secondary analysis. Although there were no significant differences in the microbial composition at high taxonomic levels, gene richness of the gut microbiota was significantly higher (P < 0.01 by the Wilcoxon rank-sum test) and inflammatory state was improved (P < 0.05 by the Wilcoxon signed-rank test) in the good responders at the end of the 12-month daily supplementation. Moreover, detrimental changes including the enrichment of E. coli (adjusted P < 0.05 by DESeq2) and its biofilm formation (P < 0.05 by GSA) observed in the poor responders were alleviated in the good responders by the treatment. Our results indicate that L. reuteri ATCC PTA 6475 supplementation has the potential to prevent a deterioration of the gut microbiota and inflammatory status in elderly women with low bone mineral density, which might have beneficial effects on bone metabolism.

Metabolic Alterations in Older Women With Low Bone Mineral Density Supplemented With Lactobacillus reuteri.

ABSTRACTOsteoporosis and its associated fractures are highly prevalent in older women. Recent studies have shown that gut microbiota play important roles in regulating bone metabolism. A previous randomized controlled trial (RCT) found that supplementation with Lactobacillus reuteri ATCC PTA 6475 (L.reuteri) led to substantially reduced bone loss in older women with low BMD. However, the total metabolic effects of L. reuteri supplementation on older women are still not clear. In this study, a post hoc analysis (not predefined) of serum metabolomic profiles of older women from the previous RCT was performed to investigate the metabolic dynamics over 1 year and to evaluate the effects of L. reuteri supplementation on human metabolism. Distinct segregation of the L. reuteri and placebo groups in response to the treatment was revealed by partial least squares‐discriminant analysis. Although no individual metabolite was differentially and significantly associated with treatment after correction for multiple testing, 97 metabolites responded differentially at any one time point between L. reuteri and placebo groups (variable importance in projection score >1 and p value <0.05). These metabolites were involved in multiple processes, including amino acid, peptide, and lipid metabolism. Butyrylcarnitine was particularly increased at all investigated time points in the L. reuteri group compared with placebo, indicating that the effects of L. reuteri on bone loss are mediated through butyrate signaling. Furthermore, the metabolomic profiles in a case (low BMD) and control population (high BMD) of elderly women were analyzed to confirm the associations between BMD and the identified metabolites regulated by L. reuteri supplementation. The amino acids, especially branched‐chain amino acids, showed association with L. reuteri treatment and with low BMD in older women, and may serve as potential therapeutic targets. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Greater Bone Marrow Adiposity Predicts Bone Loss in Older Women.

Bone marrow adiposity (BMA) is associated with aging and osteoporosis, but whether BMA can predict bone loss and fractures remains unknown. Using data from the Age Gene/Environment Susceptibility (AGES)-Reykjavik study, we investigated the associations between 1 H-MRS-based measures of vertebral bone marrow adipose tissue (BMAT), annualized change in bone density/strength by quantitative computed tomography (QCT) and DXA, and secondarily, with incident clinical fractures and radiographic vertebral fractures among older adults. The associations between BMAT and annualized change in bone density/strength were evaluated using linear regression models, adjusted for age, body mass index (BMI), diabetes, estradiol, and testosterone. Cox proportional hazards models were used to evaluate the associations between baseline BMAT and incident clinical fractures, and logistic regression models for incident vertebral fractures. At baseline, mean ± SD age was 80.9 ± 4.2 and 82.6 ± 4.2 years in women (n = 148) and men (n = 150), respectively. Mean baseline BMAT was 55.4% ± 8.1% in women and 54.1% ± 8.2% in men. Incident clinical fractures occurred in 7.4% of women over 2.8 years and in 6.0% of men over 2.2 years. Incident vertebral fractures occurred in 12% of women over 3.3 years and in 17% of men over 2.7 years. Each 1 SD increase in baseline BMAT was associated with a 3.9 mg2 /cm4 /year greater loss of spine compressive strength index (p value = .003), a 0.9 mg/cm3 /year greater loss of spine trabecular BMD (p value = .02), and a 1.2 mg/cm3 /year greater loss of femoral neck trabecular BMD (p value = .02) in women. Among men, there were no associations between BMAT and changes in bone density/strength. There were no associations between BMAT and incident fractures in women or men. In conclusion, we found greater BMAT is associated with greater loss of trabecular bone at the spine and femoral neck, and greater loss of spine compressive strength, in older women. © 2019 American Society for Bone and Mineral Research.

Long-term effects of inhaled corticosteroids on bone mineral density in older women with asthma or COPD: a registry-based cohort study.

This study evaluated the impact of long-term ICS therapy on bone loss in older women with asthma or chronic obstructive pulmonary disease (COPD). We used a population-based bone densitometry registry linked with administrative health data covering the province of Manitoba, Canada (1999-2013), to identify women aged > 40years who had diagnosed asthma or COPD. ICS exposure was defined as cumulative dispensed days and medication possession ratio (MPR). Associations were examined both cross-sectionally and longitudinally, and results were covariate adjusted. Among 6561 women with asthma and/or COPD (mean age 65years [SD = 11]), compared to no ICS treatment, those in the highest tertile of prior ICS use (≥ 720days) had lower BMD at the femoral neck (- 0.09 T-score, 95% CI - 0.16, - 0.02) and total hip (- 0.14 T-score, 95% CI - 0.22, - 0.05), but not at the lumbar spine. Over a mean of 5years of follow-up, the highest tertile of ICS exposure (MPR > 0.5) was associated with a - 0.02 SD/year (95% CI - 0.04, - 0.01) greater decline in total hip BMD relative to non-users, with no significant effect at the femoral neck or lumbar spine. Middle and lower tertiles of ICS use were not associated with baseline or longitudinal change in BMD. The highest tertile of ICS use was associated with a slightly lower hip BMD at baseline and slightly greater reduction in total hip BMD over time in older women with asthma or COPD. No adverse effects on BMD were seen from low to moderate ICS exposure.

Lactobacillus reuteri reduces bone loss in older women with low bone mineral density: a randomized, placebo‐controlled, double‐blind, clinical trial

The importance of the gut microbiome for bone metabolism in mice has recently been demonstrated, but no studies are available in humans. Lactobacillus reuteri ATCCPTA 6475 (L. reuteri 6475) has been reported to increase bone mineral density (BMD) in mice but its effect on the human skeleton is unknown. The objective of this trial was to investigate if L. reuteri 6475 affects bone loss in older women with low BMD. In this double-blind, placebo-controlled study, women from the population who were 75 to 80 years old and had low BMD were randomized to orally receive 1010 colony-forming units of L. reuteri 6475 daily or placebo. The predefined primary end-point was relative change after 12 months in tibia total volumetric BMD (vBMD). Ninety women were included and 70 completed the study. L. reuteri 6475 reduced loss of total vBMD compared to placebo both in the intention-to-treat (ITT) analysis [-0.83% (95% confidence interval [CI], -1.47 to -0.19%) vs. -1.85% (95% CI, -2.64 to -1.07%); mean difference 1.02% (95% CI, 0.02-2.03)] and per protocol analysis [-0.93% (95% CI, -1.45 to -0.40) vs. -1.86% (95% CI, -2.35 to -1.36); mean difference 0.93% (95% CI, 0.21-1.65)]. In general, similar but smaller effects were observed in the secondary bone variable outcomes, but these differences did not reach statistical significance in the ITT population. Adverse events did not differ between groups. Supplementation with L. reuteri 6475 should be further explored as a novel approach to prevent age-associated bone loss and osteoporosis.

Soy Isoflavones and Osteoporotic Bone Loss: A Review with an Emphasis on Modulation of Bone Remodeling.

Osteoporosis is an age-related disorder that affects both women and men, although estrogen deficiency induced by menopause accelerates bone loss in older women. As the demographic shifts to a more aged population, a growing number of men and women will be afflicted with osteoporosis. Since the current drug therapies available have multiple side effects, including increased risk of developing certain types of cancer or complications, a search for potential nonpharmacologic alternative therapies for osteoporosis is of prime interest. Soy isoflavones (SI) have demonstrated potential bone-specific effects in a number of studies. This article provides a systematic review of studies on osteoporotic bone loss in relation to SI intake from diet or supplements to comprehensively explain how SI affect the modulation of bone remodeling. Evidence from epidemiologic studies supports that dietary SI attenuate menopause-induced osteoporotic bone loss by decreasing bone resorption and stimulating bone formation. Other studies have also illustrated that bone site-specific trophic and synergistic effects combined with exercise intervention might contribute to improve the bioavailability of SI or strengthen the bone-specific effects. To date, however, the effects of dietary SI on osteoporotic bone loss remain inconclusive, and study results vary from study to study. The current review will discuss the potential factors that result in the conflicting outcomes of these studies, including dosages, intervention materials, study duration, race, and genetic differences. Further well-designed studies are needed to fully understand the underlying mechanism and evaluate the effects of SI on osteoporosis in humans.

Intervals Between Bone Density Testing

There is a wide range of practices regarding times between bone density (BMD) measurements in osteopenic women. If decisions to treat osteoporosis are to be based on absolute fracture risk, then projections of fracture risk are a logical basis for determining appropriate intervals for BMD testing. Fracture risk depends mainly on age and BMD, and bone loss in older women is relatively constant at ∼1% annually, so it is possible to project fracture risk into the future and estimate when an individual's risk will approach the threshold for intervention. Modeling scenarios for a range of osteopenic baseline BMDs in 65-year-old women shows a remarkable consistency in the doubling time for Fracture Risk Assessment Tool (FRAX)-assessed fracture risk: 5 to 6 years. This estimate is of immediate relevance to clinical practice in that it can be used to determine how long to wait before reassessing BMD and fracture risk in women whose other risk factors are stable.

Collagen type I alpha 1 gene polymorphism in premature ovarian failure

Premature ovarian failure (POF) is characterized by amenorrhea, hypergonadotropism and hypoestrogenism in women bellow 40 years. Osteoporosis is one of the late complications of POF. To correlate collagen type I alpha1 (COLIA1) gene polymorphism with bone mineral density (BMD) in women with POF. We determined the COLIA1 genotypes SS, Ss, ss in 66 women with POF. Single nucleotide polymorphism (G toT substitution) within the Sp 1-binding site in the first intron of the COLIA1 gene was assessed by polymerase chain reaction (PCR) followed by single-stranded conformation polymorphism (SSCP) analysis. Bone mineral density (BMD) was measured at the lumbar spine region by dual X-ray absorptiometry. Kruskal-Wallis ANOVA, Chi-square test, Spearman correlation test. The relative distribution of COLIA1 genotype alleles was SS - 54.4%, Ss - 41.0% and ss - 4.5%. No significant differences were found between genotype groups in body mass index, age, duration of amenorrhea or BMD. A significant positive correlation was observed between BMI and parity. The COLIA1 gene is just one of many genes influencing bone characteristics. It may act as a marker for differences in bone quantity and quality, bone fragility and accelerated bone loss in older women. However, in young women with POF, COLIA1 cannot identify those at higher risk for osteoporosis.

Participation in Community-Based Exercise Predicts Quality of Life among Older Women

Better Bones & Balance (BBB) is a community-based exercise program shown to improve physical function and reduce bone loss in older women. The effect of participation on quality of life (QOL) has never been reported. PURPOSE: To determine whether participation in BBB predicts self reported QOL among older, postmenopausal women. METHODS: Women aged 55+ (n=69) participating in BBB for > 1 year, were recruited from 15 different BBB classes in the Willamette Valley and sedentary, age-matched controls (n=47) were recruited from the same region for comparison (total sample aged 69 + 7.9 years). QOL was measured using the Medical Outcomes Study Short Form (SF-36). The SF-36 examines physical and mental components related to QOL. The Physical Component Summary (PCS) includes 4 sub-scales; physical functioning, role-physical functioning, bodily pain, and general health. The Mental Component Summary (MCS) includes 4 sub-scales; vitality, social functioning, role emotional, and mental health. Height and weight were measured and all participants filled out a standard health history questionnaire and a general physical activity questionnaire. Stepwise regression was used to understand the relationships between age, health, medication use, and physical activity behaviors on PCS and MCS scores. ANCOVA (adjusted for medication use and disease status) was used to better understand between group differences on the specific MCS and PCS subscales. RESULTS: Variables predictive of PCS scores included # of prescription medications and participation in BBB (p<0.001); # of medications, participation in BBB and age were significant predictors of PCS scores. Women participating in BBB reported significantly better scores on all components of the PCS (p<0.007) as well as the vitality (p=0.037) and social functioning (p=0.001) sub-scales of the MCS. The BBB groups' scores on all of these variables were significantly higher than average when compared to an age-matched normative sample (p<0.001). CONCLUSIONS: Participation in Better Bones & Balance is associated with greater QOL in both physical and mental domains. As there were no differences in self reported physical activity outside of BBB, we can conclude that class participation and not physical activity alone is likely contributing to the observed effects.

Efeitos da natação e do treinamento resistido na densidade mineral óssea de mulheres idosas

Exercícios com impacto como caminhada, saltos, corridas e exercícios resistidos são muito utilizados para prevenção da perda óssea em idosas. No entanto, poucos são os estudos que relatam os efeitos da natação na manutenção da massa óssea em mulheres idosas. Portanto, o objetivo deste estudo foi comparar os efeitos da natação com o treinamento resistido na densidade mineral óssea (DMO) de mulheres idosas. Vinte e três mulheres com idade média de 63,9 ± 6,49 anos foram divididas em dois grupos: 1) grupo natação (NAT, n = 13, que) treinou em intensidade entre 60 e 90% da freqüência cardíaca de reserva; 2) grupo treinamento resistido (TR, n = 10), que treinou os principais grupamentos musculares com três séries a 80% de 1RM. Os dois grupos praticaram três vezes por semana com uma hora de duração para cada sessão, durante seis meses. A DMO do colo do fêmur e da coluna lombar (L2-L3-L4) foi mensurada através de DXA antes (T0) e após seis meses de treino (T6). Os resultados mostraram que as médias para a DMO lombar em T0 (0,9250 ± 0,1506g/cm²) e T6 (0,9303 ± 0,1269g/cm²) para o NAT e em T0 (0,9739 ± 0,1249g/cm²) e T6 (0,9737 ± 0,1317g/cm²) para o TR não foram diferentes quando comparadas intra ou intergrupos. De modo similar, não houve diferenças entre a DMO do colo do fêmur em T0 (0,7784 ± 0,1523g/cm²) e T6 (0,7905 ± 0,1610g/cm²) para o NAT e T0 (0,7546 ± 0,1360g/cm²) e T6 (0,7522 ± 0,1421g/cm²) para o TR. Os resultados deste estudo não demonstraram diferenças na DMO entre NAT e TR após seis meses de treino; e que tanto TR quanto NAT não produzem aumentos significativos na DMO de mulheres idosas nesse período.

Longitudinal changes in BMD and bone geometry in a population-based study.

We prospectively examined vBMD and structural bone parameters assessed by QCT among participants of the InCHIANTI study over a 6-yr follow-up. Periosteal apposition occurred both in men and women. Endocortical resorption causes bone loss in older women despite periosteal apposition. To address the hypothesis that age-related changes in BMD and bone geometry may be different in men and women, we prospectively examined volumetric BMD (vBMD) and structural bone parameters assessed by QCT among participants of the InCHIANTI study over a 6-yr follow-up. Three hundred forty-five men and 464 women 21-102 yr of age from the InCHIANTI study, a population-based study in Tuscany, Italy, were included. Tibial QCT bone parameters were measured at enrollment (1998-2000) and at 3- (2001-2003) and 6-yr (2004-2006) follow-ups. Periosteal apposition occurred both in men and women. The annual rate of bone periosteal apposition was higher in younger than in older men, whereas in women, the rate of apposition was homogenous across age groups. The age-related medullary expansion, expression of endocortical resorption, was significantly higher in women compared with men. In women, but not in men, accelerated endocortical resorption not sufficiently balanced by periosteal apposition caused accelerated loss in cortical bone mass. The cross-sectional moment of inertia decreased progressively over the life span in both sexes. Endocortical resorption causes bone loss in older women despite periosteal apposition. Obtaining a balance between endocortical resorption and periosteal apposition should be the target for interventions aimed to decrease bone loss and prevent osteoporosis in older women.

Effects of tibolone and raloxifene on bone mineral density in osteopenic postmenopausal women

A randomized trial was conducted in osteopenic postmenopausal women to compare the efficacy of tibolone versus raloxifene on BMD of the lumbar spine and hip. Tibolone increased lumbar spine and total hip BMD to a statistically significantly greater extent than raloxifene after two years of treatment. Both tibolone, a selective tissue estrogenic activity regulator (STEAR), and raloxifene, a selective estrogen receptor modulator (SERM), are known to prevent postmenopausal bone loss. However, no head-to-head studies to compare the efficacy on bone have been performed. A double-blind, randomized trial was conducted in osteopenic postmenopausal women aged 60-79 years to compare the effects of tibolone 1.25 mg/day to raloxifene 60 mg/day on bone mineral density (BMD). Serum osteocalcin and serum type I collagen C-telopeptides were measured as biochemical markers of bone metabolism. Three hundred and eight subjects were allocated to treatment. Both treatments significantly increased lumbar spine BMD, however the increase was significantly larger after tibolone treatment than after raloxifene treatment (at year 1: 2.2% versus 1.2%, p<0.01 and at year 2: 3.8% versus 2.1%, p<0.001). After 2 years of treatment, the increase in total hip BMD in the tibolone group was significantly larger than in the raloxifene group (p<0.05). Both treatments significantly reduced type I collagen C-telopeptides and osteocalcin levels when compared to baseline. Tibolone 1.25 mg/day for 2 years prevents postmenopausal bone loss in older women and results in a larger increase of BMD both at the lumbar spine and hip than raloxifene.

Effect of Weighted Exercises on Bone Mineral Density in Post Menopausal Women A Systematic Review

Osteoporosis is both preventable and treatable with exercise playing an important role in osteogenesis. The purpose of this systematic review was to determine which specific exercise programs utilizing weights were effective in maintaining or increasing bone mineral density (BMD) in postmenopausal women. A computerized search of the MEDLINE, CINAHL, EMBASE, PEDro, and Science Citation databases was conducted for the period 1990 through February 2005. The search was performed using English language-only keyword searches using MESH terms osteoporosis, postmenopausal, exercise, weight training, and bone mineral density. A total of 20 articles was critically evaluated for the quality of an intervention study using the criteria developed by MacDermid. An expert on the topic was asked to review the list of articles for omissions. The review revealed evidence to support the effectiveness of weight training exercises to increase BMD in postmenopausal women. The increases in BMD were site-specific and required high loading with a training intensity of 70% to 90% of 1 RM for 8 to 12 repetitions of 2 to 3 sets performed over one year duration. Weighted exercises can help in maintaining BMD in postmenopausal women and increasing BMD of the spine and hip in women with osteopenia and osteoporosis. The exercise program must be incorporated into a lifestyle change and be lifelong due to the chronic nature of bone loss in older women.

Use of Antidepressants and Rates of Hip Bone Loss in Older Women

Serotonin transporters have recently been described in bone, raising the possibility that medications that block serotonin reuptake could affect bone metabolism. We assessed current use of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) and obtained serial bone mineral density (BMD) measurements in a cohort of 2722 older women (mean age, 78.5 years) participating in the Study of Osteoporotic Fractures, a prospective cohort study of community-dwelling women. Hip BMD was measured at the sixth examination and an average of 4.9 years later at the eighth examination. We categorized women as nonusers (used no SSRIs or TCAs at either examination; n=2406), SSRI users (used SSRIs but no TCAs at either examination; n=198), or TCA users (used TCAs but no SSRIs at either examination; n=118). Depressive symptoms were identified using a cutoff score of at least 6 on the Geriatric Depression Scale. After adjustment for potential confounders, including the Geriatric Depression Scale score, mean total hip BMD decreased 0.47% per year in nonusers compared with 0.82% in SSRI users (P<.001) and 0.47% in TCA users (P=.99). Higher rates of bone loss were also observed at the 2 hip subregions for SSRI users. Results were not substantially altered when women who scored at least 6 on the Geriatric Depression Scale were excluded from the analysis. Use of SSRIs but not TCAs is associated with an increased rate of bone loss at the hip in this cohort of older women.

Thiazolidinedione Use and Bone Loss in Older Diabetic Adults

Activation of peroxisome proliferator-activated receptor-gamma by thiazolidinediones (TZDs) results in lower bone mass in mice. The objective of the study was to determine whether TZD use is associated with changes in bone mineral density (BMD) in older adults with type 2 diabetes. We analyzed 4-yr follow-up data from the Health, Aging, and Body Composition observational study. The study was conducted in a general community. White and black, physically able men and women, aged 70-79 yr at baseline with diabetes defined by self-report, use of hypoglycemic medication, elevated fasting glucose (>/=126 mg/dl), or elevated 2-h glucose tolerance test (>/=200 mg/dl) participated in the study. Whole-body, lumbar spine (derived from whole body), and hip BMD were measured by dual-energy x-ray absorptiometry at 2-yr intervals. Of 666 diabetic participants, 69 reported TZD use at an annual visit, including troglitazone (n = 22), pioglitazone (n = 30), and/or rosiglitazone (n = 31). Those with TZD use had higher baseline hemoglobin A(1c) and less weight loss over 4 yr but similar baseline BMD and weight than others with diabetes. In repeated-measures models adjusted for potential confounders associated with TZD use and BMD, each year of TZD use was associated with greater bone loss at the whole body [additional loss of -0.61% per year; 95% confidence interval (CI) -1.02, -0.21% per year], lumbar spine (-1.23% per year; 95% CI -2.06, -0.40% per year), and trochanter (-0.65% per year; 95% CI -1.18, -0.12% per year) in women, but not men, with diabetes. These observational results suggest that TZDs may cause bone loss in older women. These results need to be tested in a randomized trial.

THE EFFECT OF WEIGHTED EXERCISES ON BONE MINERAL DENSITY IN POST MENOPAUSAL WOMEN.

Purpose: Osteoporosis is both preventable and treatable with therapeutic exercise playing an important role along with adequate nutrition and medication if required. Physical therapy interventions for women with osteoporosis have generally emphasized postural awareness, aerobic conditioning, and balance training as preventative measures and have paid scant attention to weight training exercises to stimulate bone formation. The purpose of this systematic review was to determine if exercise programs utilizing weights are an effective method to maintain or increase the bone mineral density (BMD) in postmenopausal women to prevent or decrease the sequelae associated with osteoporosis. Description: A computerized search of the MEDLINE, PEDro, and Science Citation databases was conducted for the years 1990 through February 2005. The search was performed using English language-only keyword searches using MESH terms ‘osteoporosis’, ‘postmenopausal’, exercise’, weight training’, and bone mineral density’. Inclusion criteria consisted of 1) randomized controlled trials with more than 15 participants, 2) self-selected group trials, 3) less than a 35% drop out rate, 4) post-menopausal women between the ages of 40 to 80 years old, 5) DEXA scan as the method of determining bone mineral density, and 6) incorporation of weighted or resistive exercises as a therapeutic intervention to promote osteogenesis. A total of 20 articles were critically evaluated for the quality of an intervention study using the criteria developed by MacDermid.18 These twenty articles were identified and reviewed with respect to specific exercise programs including their duration, frequency, and intensity and their effect on the BMD at the lumbar spine, femoral neck, femoral trochanter, lumbar spine, and distal radius. The articles were critically evaluated. Summary of Use: Our review revealed evidence to support the effectiveness of weight training exercises to increase bone mineral density in post-menopausal women. The increases in BMD were site-specific and required high loading with a training intensity of 70% to 90% of 1 RM for 8-12 repetitions of 2 to 3 sets of over one year duration to promote osteogenic changes. Most of the studies indicated that exercises that were effective in maintaining or increasing BMD had a combination of weight training with ground force exercises such as the use of a weighted vest and jumping combined with resistive exercises. Importance to Members: Weighted exercises can help in maintaining bone mineral density in post-menopausal women and increasing bone density of the spine and hip in women with osteopenia and osteoporosis. The exercise program must be incorporated into a lifestyle change and be lifelong due to the chronic nature of bone loss in older women. Physical therapists need to challenge their patient's with postmenopausal osteopenia and osteoporosis to the point of osteogenesis. For these patients there should be a longer intervention with follow-up to review and modify the treatment program to stimulate bone formation.

Investigate Bone Loss in Older Women on AEDs

Investigate Bone Loss in Older Women on AEDs

Longitudinal study of periodontal disease and edentulism with rates of bone loss in older women.

Previous cross-sectional studies have suggested a link between periodontal disease and osteoporosis. The purpose of the present study is to evaluate the association between changes in bone mineral density (BMD) and clinical signs of periodontal tissue destruction and tooth loss over a 2-year period. A total of 398 women (mean age 75.5 years) were randomly selected for an ancillary study of periodontal disease; osteoporosis in association with the presence or absence of teeth was evaluated. Osteoporosis in association with periodontal disease was also evaluated. All subjects were participants at the Pittsburgh Clinical Center for the Study of Osteoporotic Fractures (SOF), a prospective cohort study of women 65 years of age or older designed to determine risk factors for fractures. Oral health examinations, including periodontal probing and attachment loss, were performed at the fourth clinical visit, an average of 6 years after baseline. BMD of the total hip and its subregions was measured using dual energy x-ray absorptiometry at the time of dental examination and 2 years later. Results are expressed as annual percentage change. A total of 145 (36.4%) women were edentulous and 163 (80.7%) of the dentate women (N = 253) had periodontal disease. Dentate women reported higher education (P <0.001) and a higher calcium intake (P= 0.002). Absolute BMD and percentage change in BMD were similar in dentate and edentulous women. We found no difference in BMD or in absolute or percentage change in BMD between women with or without periodontal disease. Little evidence exists for an association between edentulousness, periodontal disease, and longitudinal changes in BMD.

Physical activity and calcium consumption are important determinants of lower limb bone mass in older women.

A population-based study of 1363 older women showed that the 24% who achieved high physical activity and dietary calcium intakes had a 5.1% higher hip BMD than those who did not, supporting the concept that lifestyle factors play an important role in the maintenance of lower extremity bone mass in older women. Although there is general agreement that increased dietary calcium consumption and exercise can slow bone loss in older women, the amount required to have this effect in an older population remains uncertain. This study was devised to examine the effects of calcium consumption (CC) and physical activity (PA) (lifestyle management) on bone mass in an older female population. Using a cross-sectional study design, a population-based sample of older women (mean age, 75 +/- 3 years) had hip and heel bone mass measured using DXA (Hologic 4500A; n = 1076) and quantitative ultrasound (QUS, Lunar Achilles; n = 1363), respectively. CC and PA were measured by a validated habitual food frequency and activity questionnaire, respectively. Dose-response effects of PA and CC on bone mass were examined using ANOVA. Division of the PA and CC into tertiles best described the dose-response effects. After adjustment for CC, age, weight, alcohol consumption, and cigarette smoking, high PA compared with medium or low PA was associated with higher hip BMD and heel QUS (total hip BMD, 3.1%; p < 0.001; QUS stiffness, 2.7%; p = 0.002). After adjustment for PA and covariates, high or medium CC compared with low CC was associated with higher total hip BMD (1.8%; p = 0.027), with no effect at the QUS heel site. PA and CC were dichotomized at the cut-points for effects on BMD. The combination of high PA and CC, achieved by 24% of the population, was associated with a total hip BMD that was 5.1% higher (34% of SD) than those individuals in the low PA and CC group. Stiffness was 3.6% (23% of SD) higher in the high PA and CC group than in the low PA and CC group. If the whole population undertook and achieved a high PA and high CC lifestyle, the population risk of hip fractures may be expected to be reduced by about 17% in this age group as a result of beneficial effects on the musculoskeletal system.

Antiepileptic drug use increases rates of bone loss in older women: a prospective study.

To test the hypothesis that older women with antiepileptic drug (AED) use have increased rates of bone loss. AED use was ascertained and calcaneal and hip bone mineral density (BMD) measured in a cohort of 9,704 elderly community-dwelling women enrolled in the Study of Osteoporotic Fractures, and they were followed prospectively for changes in BMD. Current use of AED was assessed by interview, with verification of use from medication containers at baseline and follow-up examinations. Women were classified as continuous users, partial (intermittent) users, or nonusers. Rates of change in BMD were measured at the total hip and two subregions (average 4.4 years between examinations) and at the calcaneus (average 5.7 years between examinations). After adjustment for confounders, the average rate of decline in total hip BMD steadily increased from -0.70%/year in nonusers to -0.87%/year in partial AED users to -1.16%/year in continuous AED users (p value for trend = 0.015). Higher rates of bone loss were also observed among continuous AED users at subregions of the hip and at the calcaneus. In particular, continuous phenytoin users had an adjusted 1.8-fold greater mean rate of loss at the calcaneus compared with nonusers of AED (-2.68 vs -1.46%/year; p < 0.001) and an adjusted 1.7-fold greater mean rate of loss at the total hip compared with nonusers of AED (-1.16 vs -0.70%/year; p = 0.069). Continuous AED use in elderly women is associated with increased rates of bone loss at the calcaneus and hip. If unabated, the rate of hip bone loss among continuous AED users is sufficient to increase the risk of hip fracture by 29% over 5 years among women age 65 years and older.