A high body mass index protects against femoral neck osteoporosis in healthy elderly subjects

OBJECTIVE: In a large sample of elderly subjects, we assessed the possible protective effect of obesity on the development of osteoporosis. METHODS: Healthy subjects 70 y or older and of low socioeconomic level were studied. Bone mineral density was measured in the femoral neck by using a Lunar Prodigy double beam densitometer and compared measurements with appropriate standards. Osteoporosis was defined according to criteria of the World Health Organization (WHO). Body weight and height were recorded simultaneously, and body mass index (BMI) was calculated as weight (kg) divided by height (m2). Age-adjusted odds ratios for femoral osteoporosis were calculated for WHO-proposed BMI ranges in women and men, with an odds of one for a BMI below 25 kg/m2. RESULTS: Eight hundred forty-five subjects (615 women and 230 men; mean age, 75 +/- 4.4 y) were studied. Mean BMI was 28.1 +/- 4.7 kg/m2. Twenty five percent of women and 11% of men had osteoporosis (P < 0.001). Forward stepwise multiple regression analysis showed BMI to be the best independent predictor of bone mineral density in women and men. The age-adjusted odds ratios for femoral osteoporosis were 0.34 (95% confidence interval [CI], 0.21 to 0.55) and 0.13 (95% CI, 0.04 to 0.43) for women and men with a BMI between 25 and 30 kg/m2, respectively. The odds ratios for women and men with a BMI between 30 and 35 kg/m2 were 0.21 (95% CI, 0.11 to 0.39) and 0.09 (95% CI, 0.01 to 0.67), respectively CONCLUSIONS: This study confirms the protective effect of a high BMI on femoral neck bone mineral density among elderly subjects. The risk for osteoporosis among men and women with a BMI above 30 kg/m2 was approximately 33% compared with subjects with a normal BMI.     

Effect of protein intake on bone and muscle mass in the elderly

The aging process is frequently characterized by an involuntary loss of muscle (sarcopenia) and bone (osteoporosis) mass. Both chronic diseases are associated with decreased metabolic rate, increased risk of falls/fracture, and, as a result, increased morbidity and loss of independence in the elderly. The quality and quantity of protein intake affects bone and muscle mass in several ways and there is evidence that increased essential amino acid or protein availability can enhance muscle protein synthesis and anabolism, as well as improve bone homeostasis in older subjects. A thorough evaluation of renal function is important, since renal function decreases with age. Finally, protein and calcium intake should be considered in the prevention or treatment of the chronic diseases osteoporosis and sarcopenia.     

北京市老年人肌肉衰减综合征膳食因素分析

目的分析中国北方城市老年人肌肉衰减综合征(以下简称肌衰征)的膳食影响因素并提出防治建议。方法在北京选择具有一定代表性的两个社区,筛选出830名60岁以上无严重疾病的老年人并对其进行横断面调查:包括询问调查,膳食调查(半定量食物频率法),体格测量(身高、体重)和肌肉量和肌肉功能测定。结果肌衰征率为20.1%,其中男性17.1%,女性21.6%,男女之间无统计学差异;肌衰征率与年龄、每天进行的中及重度锻炼时间、体质指数均相关。以肉类摄入量将受访对象分为35、35~70、70 g/d三组,肌衰征率分别为24.5%、19.9%和15.3%(χ~2=6.02,P=0.0492),呈下降趋势(Z=2.45、P=0.0141);以蛋类摄入量将受访对象分为30、30~60、60 g/d三组,肌衰征率分别为25.8%、18.7%和11.3%(χ~2=6.50,P=0.0388),呈下降趋势(Z=2.55、P=0.0109);以能量摄入将受访对象分为1612、1612~2109、2109 kcal/d三组,肌衰征率分别为25.8%、19.5%和15.0%(χ~2=8.19,P=0.0158),呈下降趋势(Z=2.87、P=0.0042);以蛋白质摄入量将受访对象分为58.2、58.2~78.4、78.4 g/d三组,肌衰征率分别为25.3%、18.2%和16.7%(χ~2=5.97,P=0.0505),呈下降趋势(Z=2.28、P=0.0227)。在控制年龄、BMI、运动量和受教育程度等混杂因素后,肉类、蛋类摄入量与肌衰征率呈负相关,标准化偏回归系数(β)分别为-0.1703(P=0.0119)和-0.1545(P=0.0302);动物性蛋白摄入与肌衰征率呈负相关(β=-0.1805、P=0.0302)。结论肌衰征膳食影响因素为肉、蛋动物性食物摄入量,故对老年人在保证能量摄入充足情况下,可增加富含优质蛋白的动物性食物摄入量,以延缓肌衰征的发展。     

A prospective trial of the effect of vitamin D supplementation on metacarpal bone loss in elderly women

The effect on cortical bone loss of treating elderly women with 15,000 IU vitamin D2 weekly was evaluated by sequential radiographic morphometry of the metacarpals. One hundred nine randomly selected women aged 65-74 yr were studied for 2 yr. The women were randomly allocated to control or treated groups taking placebo or vitamin D2 capsules. Hand radiographs and blood samples were obtained at the beginning and end of the trial. Plasma 25-hydroxyvitamin D was measured by radio-competitive protein binding assay. Comparing the treated and control groups, vitamin D treatment significantly raised the plasma 25-hydroxyvitamin D levels (p less than 0.001) and reduced the rate of cortical bone loss (p less than 0.01). The placebo had no measurable effect on the plasma levels.     

Protein intake: effects on bone mineral density and the rate of bone loss in elderly women

BACKGROUND: The role of dietary protein in bone metabolism is controversial. OBJECTIVE: We investigated the associations of dietary protein intake with baseline bone mineral density (BMD) and the rate of bone loss over 3 y in postmenopausal elderly women. DESIGN: Women aged 65-77 y (n = 489) were enrolled in an osteoporosis intervention trial. We studied the associations of protein intake as a percentage of energy with baseline BMD and the rate of bone loss in 96 women in the placebo group (n = 96). We also examined the effect of the interaction of dietary calcium intake with protein intake on BMD. RESULTS: In the cross-sectional study, a higher intake of protein was associated with higher BMD. BMD was significantly higher (P < 0.05) in the spine (7%), midradius (6%), and total body (5%) in subjects in the highest quartile of protein intake than in those in the lower 2 quartiles. This positive association was seen in women with calcium intakes > 408 mg/d. There was no significant effect of protein intake on hip BMD. In the longitudinal study of the placebo group, there was no association between protein intake and the rate of bone loss. CONCLUSIONS: The highest quartile of protein intake (: 72 g/d) was associated with higher BMD in elderly women at baseline only when the calcium intake exceeded 408 mg/d. In the longitudinal study, no association was seen between protein intake and the rate of bone loss, perhaps because the sample size was too small or the follow-up period of 3 y was not long enough to detect changes.     

Effects of food groups and dietary nutrients on bone loss in elderly Chinese population

Objective  

To examine the effects of food groups and dietary nutrients on bone loss in elderly Chinese population.     

增龄性肌肉减少症对老年患者再住院率影响的研究

目的旨在研究增龄性肌肉减少症对老年患者再住院率的影响。方法以410名年龄≥65岁的老年男性为研究对象,采用欧洲老年肌少症工作组(EWGSOP)标准诊断肌少症,对肌少症及非肌少症组进行再住院的随访研究,并应用Cox比例风险模型进行回归分析。结果肌少症患病率为19.51%;且患病率随年龄增加而增高。肌少症组与非肌少症组相比,MNA-SF评分、CHAMPS值、ADL1及ADL2评分差异有统计学意义(P0.01)。Cox回归分析,肌少症、服药种类数和Charlson指数是患者再住院相对危险因素(P0.05);RR值分别为5.46、1.43和1.87,且肌少症患者因急性感染住院比例占同病因住院的82.61%。结论增龄性肌少症是老年患者再住院率的危险因素,RR值为5.46,95%CI为1.793~16.624。     

Effect of a nutritional supplementation on bone health in Chilean elderly subjects with femoral osteoporosis

OBJECTIVE: To study the effects of a special nutritional supplement on bone mineral density and bone turnover markers in Chilean elderly subjects with femoral osteoporosis. SETTING: Public primary health care clinics in Chile. SUBJECTS: Free living elderly subjects with femoral osteoporosis. INTERVENTIONS: Subjects were randomized to receive the usual nutritional supplement provided by the Chilean Ministry of Health or a special nutritional supplement providing, among other nutrients, 90 mg isoflavones, 800 mg calcium, 400 IU vitamin D, 60 ug vitamin K and 31 g proteins per day. MEASURES OF OUTCOME: At baseline, and after six and twelve months of supplementation, body composition, bone mineral density, serum 25 OH vitamin D, intact parathyroid hormone (iPTH), osteocalcin, decarboxylated osteocalcin, urinary aminoterminal telopeptide of type I collagen (NTX), deoxypyridoline cross links (Dpd) and equol were measured. Every month, urinary daidzein was measured in a morning urine sample. RESULTS: No differences between treatment groups were observed in body composition or bone mineral density changes. The group receiving the special supplement had a significant increase in serum 25 OH vitamin D and a significant decrease in serum iPTH and decarboxylated osteocalcin. No association between daidzein or equol excretion and changes in bone mineralization was observed. CONCLUSIONS: A special supplement delivered to elderly subjects with osteoporosis improved serum vitamin D and reduced serum iPTH and undercarboxylated osteocalcin levels but did not affect BMD.     

Nutritional frailty, sarcopenia and falls in the elderly

PURPOSE OF REVIEW: There is currently intense interest in understanding why certain elderly individuals become frail and disabled with age whereas others do not. Is frailty the result of an acceleration of normal aging processes or is it the result of chronic medical conditions that are superimposed on the conventional mechanisms of aging? The clinical problem of falls has long been recognized as a threat to some elderly individuals, but too often is not considered worthy of objective study. The factors underlying falls are now being investigated as part of the increasing attention being paid to the evolution of frailty in the elderly. RECENT FINDINGS: Frailty in the elderly has been given many names, but increasing efforts are now being made to define frailty in a standardized way that would allow more objective study. The frail elderly patient usually shows loss of both neurological and muscle function. Falls in the elderly are an example in which deterioration may be present in both functions. Methods are being developed to separate the loss of muscle capacity from the associated loss of central and peripheral neurological function involved in gait and balance. SUMMARY: The definition of frailty has been centered around the onset of accelerated weight loss with an associated decrease of mass and strength of skeletal muscle. New studies are discussed that extend this definition. Methods for a more detailed analysis of the physiological and metabolic deficits leading to falls in the elderly may provide a better understanding of frailty in general.     

中国社区老年人肌肉衰减症影响因素的Meta分析

目的 通过Meta分析明确我国社区老人肌肉衰减症的主要影响因素。方法 使用计算机检索万方数据库、中国知网、维普网、PubMed、The Cochrane Library、Web of Science、Embase数据库,自建库以来至2021年1月发表的相关研究,严格遵循纳入与排除标准进行文献筛选并提取资料,文献质量采用NOS量表评估,采用RevMan 5.3软件Meta分析。结果 共纳入18篇文献,涉及总样本量12205例,其中病例组1644例,对照组10561例,提取18项主要影响因素;Meta分析结果显示:年龄(MD=3.79,95%CI:2.65～4.93)、性别(OR=0.69,95%CI:0.54～0.87)、BMI(MD=-2.73,95%CI:-3.30～-2.16)、文化程度(OR=1.80,95%CI:1.45～2.23)、运动习惯(OR=0.48,95%CI:0.28～0.83)、骨骼肌质量(MD=-1.21,95%CI:-1.58～-0.84)、步速(MD=-0.16,95%CI:-0.28～-0.05)、营养状况(SMD=-0.56,95%CI:-0.94～-0.18)、MMSE得分(MD=-2.27,95%CI:-3.86～-0.68)及居住方式(OR=3.09,95%CI:1.87～5.10)10项因素与肌肉衰减症有关(Р<0.05),与自理能力(MD=-0.39,95%CI:-1.05～0.27)、体脂量(MD=-0.01,95%CI:-3.36～3.35)、吸烟史(OR=0.95,95%CI:0.69～1.30)、饮酒史(OR=0.95,95%CI:0.79～1.13)、高血压病(OR=0.72,95%CI:0.35～1.50)、糖尿病(OR=1.08,95%CI:0.69～1.69)、心脏病(OR=1.14,95%CI:0.88～1.48)、骨关节炎(OR=1.22,95%CI:0.90～1.65)8项无关(Р>0.05)。结论 高龄、女性、低BMI、文化程度低、缺乏运动锻炼、骨骼肌质量低、步速慢、营养状况较差、MMSE低者、独居老人更易患肌肉衰减症,其他因素有待进一步验证。     

Relationship between malnutrition and sarcopenia in elderly Turkish community-dwellers

ObjectivesSarcopenia is frequently seen at older ages, with primary sarcopenia being associated with mitochondrial dysfunction or age-related decreases in sex hormones while other explanations include endocrine and neurodegenerative diseases. This study was planned and conducted to determine the relationship between malnutrition and sarcopenia in elderly Turkish community-dwellers.Material and methodsIn total, 173 community-dwelling elderly individuals were recruited from the capital city of Turkey. A questionnaire form was applied via face-to-face method and the MNA-SF and Barthel Index were administered. In addition, some anthropometric measurements were taken.ResultsBody mass (P < 0.05) and body height (P < 0.05) were higher in non-sarcopenic elderly individuals. Age was lower in non-sarcopenic elderly (P < 0.05). In this study, while the prevalence of sarcopenia was 50.2% in the elderly, the prevalence of malnutrition risk was found to be 42.2%. MNA-score was found to be significantly lower in sarcopenic elderly individuals. There was a strong relationship between sarcopenia and malnutrition risk, but not with daily living activities.ConclusionThe prevalence of sarcopenia was much higher than prevalence of risk at malnutrition. In Turkey, there is no bioelectrical impedance analysis performed among such community-dwellers, so this is the first study not using BIA while screening for sarcopenia in elderly community-dwellers. This study suggests that current nutritional policies in Turkey should target elderly individuals living in communities to screen for nutritional status regularly and apply interventions quickly. In doing so, there is no need for expensive equipment.     

Validation of air-displacement plethysmography for estimation of body fat mass in healthy elderly subjects

Summary.Background: Air-displacement plethysmography (ADP) is a non-invasive method for body composition analysis that divides the body into fat-free mass (FFM) and fat mass (FM) (= 2 compartment model, 2C). It places low demands on subject performance and is therefore most convenient in the elderly.Objective: To validate ADP against dual energy X-ray absorptiometry (DEXA) and to compare it to a four-compartment model of body composition (4C; fat mass, total body water, bone mineral content and residual mass) in the elderly.Methods: Body composition was assessed by ADP, DEXA and bioelectrical impedance analysis (BIA) in 26 healthy elderly subjects (15 women, 11 men) aged 60–82 years.Results: Despite a high correlation of %FM assessed by ADP and DEXA we observed significant differences between the results of these methods for both sexes (2.5 ±3.4%; bias ± SD). Deviations of %FM_ADP from %FM_DEXA were dependent on bone mineral content (BMC_DEXA) fraction of FFM. A low BMC_DEXA was related to an overestimation of DEXA-derived %FM by ADP. There was a systematic bias between results from ADP and the 4C model. 76% of its variance was explained by the assumption of a fixed density of FFM. 96% of the variance in the density of FFM was explained by water content and only 4% by BMC_DEXA of FFM. When compared to a 4C model, overestimation of %FM_ADP increases with increasing water fraction of FFM.Conclusion: Although there is a tendency for overestimation of %FM_ADP,ADP is a valid method for body composition measurement in the elderly. The bias in %FM_ADP is mainly related to water content of FFM and indicates that a correction factor for TBW may improve the accuracy of the ADP measurements in the elderly.     

Thirst in elderly subjects

The hormonal changes associated with ageing, the occurrence of other medical condition and the use of medications increases the likelihood of conditions such as hyper- and hypo-natremia. Awareness of the homeostatic changes with age and the relations with disease and drugs will lead better management of fluid disorders in the elderly patient and hopefully a reduction in morbidity and mortality.     

Protective effect of myo-inositol hexaphosphate (phytate) on bone mass loss in postmenopausal women

Introduction

The objective of this paper was to evaluate the relationship between urinary concentrations of InsP6, bone mass loss and risk fracture in postmenopausal women.

Materials and methods

A total of 157 postmenopausal women were included in the study: 70 had low (≤0.76 μM), 42 intermediate (0.76–1.42 μM) and 45 high (≥1.42 μM) urinary phytate concentrations. Densitometry values for neck were measured at enrollment and after 12 months (lumbar spine and femoral neck), and 10-year risk fracture was calculated using the tool FRAX^®.

Results

Individuals with low InsP6 levels had significantly greater bone mass loss in the lumbar spine (3.08 ± 0.65 % vs. 0.43 ± 0.55 %) than did those with high phytate levels. Moreover, a significantly greater percentage of women with low than with high InsP6 levels showed more than 2 % of bone mass loss in the lumbar spine (55.6 vs. 20.7 %). The 10-year fracture probability was also significantly higher in the low-phytate group compared to the high-phytate group, both in hip (0.37 ± 0.06 % vs 0.18 ± 0.04 %) and major osteoporotic fracture (2.45 ± 0.24 % vs 1.83 ± 0.11 %).

Discussion

It can be concluded that high urinary phytate concentrations are correlated with reduced bone mass loss in lumbar spine over 12 months and with reduced 10-year probability of hip and major osteoporotic fracture, indicating that increased phytate consumption can prevent development of osteoporosis.