Mineral-rich water consumption as a non-pharmacological intervention for early menopausal bone mineral density preservation and reduction of long-term fracture risk: comment on Billington et al. Osteoporos Int. 2021;32(7):1313–20

Abstract Objectives Weight loss interventions for older adults often reduce bone mineral density (BMD), increasing risk of subsequent detrimental outcomes. This study explored the long-term impact of a higher protein diet plus exercise versus a diet plus exercise control treatment on body weight, bone mineral density at 3 sites, and fracture risk. Methods Obese (BMI 34.3 ± 4.7 kg/m2) older adults (n = 55; age = 70.0 ± 6.1 yrs) with Short Physical Performance Battery (SPPB) score = 9.2 ± 1.4 (out of 12) who completed a 6-month weight loss plus exercise trial were invited to return for assessment 12 months later. The original randomization was to either 0.8 g protein/kg body weight (Control) or 1.2 g protein/kg body weight, predominantly dairy (Protein). The 18-month assessment included BMD by DEXA (Hologic, Horizon model A) for femoral neck (FN), total hip (TH), and spine (lumbar vertebrae 1–4; LS), as well body weight and secondary outcomes for Fracture Risk Assessment Tool (FRAX). Results A total of 38 (69.1%) study completers were assessed at 18 mo. Body weight was lower than baseline for both Control and Protein (P < 0.01), with Control (−4.8%) trending towards better maintenance of weight loss vs Protein (−2.3%) (P = 0.06). BMD at 18 mo. was not different from baseline in both Control and Protein for LS (0.01 ± 0.05 g/cm2 and −0.0002 ± 0.05 g/cm2; P = 0.512), FN (−0.01 ± 0.07 g/cm2 and −.009 ± 0.04 g/cm2; P = 0.814) and TH (−0.012 ± 0.03 g/cm2 and −.008 ± 0.033 g/cm2; P = 0.685). Change in BMD at 18 mo. did not differ by group at any site; the previously reported Protein group increase in LS at 6 mo. was not sustained. For individual fracture risk, between 0 and 18 mo., 6 improved (5 osteopenia to normal, 1 osteoporosis to osteopenia) and 1 worsened (normal to osteopenia but FRAX score below total and hip fracture thresholds). Conclusions The finding that obese older adults can maintain a lower body weight for 12 months without a decline in BMD and no increase in fracture risk amplifies our previous findings of legacy benefits of a short term obesity intervention for older adults. Further study is needed to determine if the protein benefit to LS is sustained if the higher protein intake is continued long term. Funding Sources This study was funded by the National Dairy Council and the US Department of Veterans Affairs Rehabilitation Research and Development Program.

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Contemporary analysis of bone mineral density in men initiating androgen deprivation therapy for prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.27_suppl.38 ◽

2019 ◽

Vol 37 (27_suppl) ◽

pp. 38-38

Author(s):

Jason Hu ◽

Armen G. Aprikian ◽

Marie Vanhuyse ◽

Alice Dragomir

Keyword(s):

Prostate Cancer ◽

Bone Mineral Density ◽

Fracture Risk ◽

Androgen Deprivation Therapy ◽

Bone Mineral ◽

Androgen Deprivation ◽

Rural Residence ◽

Mineral Density ◽

Bmd Testing

38 Background: Androgen deprivation therapy (ADT) is a cornerstone of advanced prostate cancer (PCa) treatment, however several side-effects are associated with its long-term use. Notably, loss of bone mineral density (BMD) is accelerated which increases fracture risk. Guidelines recommend BMD testing when initiating ADT to properly assess baseline fracture risk. The objective was to examine the proportion of BMD testing in men initiating long-term ADT in Quebec. Methods: The cohort consists of men extracted from Quebec public healthcare insurance administrative databases who were diagnosed with PCa from 2001-2012 and treated by ADT for at least one continuous year. The primary study outcome was the receipt of baseline BMD testing (defined as a BMD test identified in the period from 6 months prior to and up to 12 months after ADT initiation). Multivariable generalized linear mixed with a logit link was performed to identify variables associated with baseline BMD testing accounting for physician clustering. Results: We identified 7,069 patients, of which 887 (12.6%) underwent baseline BMD testing. Baseline BMD testing varied by year of ADT initiation, from 7.7% in 2001-2003 to 12.3% in 2013-2012. Following multivariable analyses, later years of ADT initiation (2004-2006, 2007-2009, 2010-2012, 2013-2015) remained associated with higher odds of baseline BMD testing compared to the earlier years (2001-2003) (ORs ranging from 1.43-1.88; p < 0.001). Conversely, age > 80 (OR 0.73; 95% CI 0.57-0.94; p = 0.001), greater Charlson comorbidity score (OR 0.51; 95%CI 0.34-0.75; p = 0.001), and rural residence (OR 0.60; 95%CI 0.48-0.75; p < 0.001) were associated with lower odds of baseline BMD testing. Conclusions: In our study population, rates of baseline BMD testing in men initiating ADT are low, although the rates increased over the course of the study period. Potential gaps identified in baseline BMD testing include older, more comorbid patients, and rural residence. Additional efforts emphasizing the importance of BMD testing in PCa guidelines may be needed.

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