Fat Infiltration of Muscle, Diabetes, and Clinical Fracture Risk in Older Adults

ABSTRACTPurposeGaps in pharmacological treatment for osteoporosis can reduce effectiveness. This study aimed to estimate persistence rates for oral bisphosphonates and denosumab in older primary care patients and identify factors associated with discontinuation.MethodsOlder patients newly prescribed oral bisphosphonates or denosumab between 2012 and 2017 were identified from 44 general practices (GP) in Ireland. Persistence without a coverage gap of >90 days was calculated for both medications from therapy initiation. Factors associated with time to discontinuation were explored using Cox regression analysis. Exposures included age-group, osteoporosis diagnosis, fracture history, calcium/vitamin D prescription, number of other medications, health cover, dosing frequency (bisphosphonates) and previous bone-health medication (denosumab).ResultsOf 41,901 patients, n=1,569 newly initiated on oral bisphosphonates and n=1,615 on denosumab. Two-year persistence was 49.4% for oral bisphosphonates and 53.8% for denosumab and <10% were switched to other medication. Having state-funded health cover was associated with a lower hazard of discontinuation for both oral bisphosphonates (HR=0.49, 95%CI=0.36-0.66, p<0.01) and denosumab (HR=0.71, 95%CI=0.57-0.89, p<0.01). Older age-group, number of medications and calcium/vitamin D prescription were also associated with better bisphosphonate persistence while having osteoporosis diagnosed was associated with better denosumab persistence.ConclusionPersistence for osteoporosis medications is sub-optimal. Of concern, few patients are switched to other bone-health treatments when denosumab is stopped which could increase fracture risk. Free access to GP services and medications may have resulted in better medication persistence in this cohort. Future research should explore prescribing choices in primary-care osteoporosis management and evaluate cost-effectiveness of interventions for improving persistence.SUMMARYGaps in pharmacological treatment for osteoporosis can reduce its effectiveness. This study found approximately half of older adults in primary care newly initiated on bisphosphonates or denosumab were still taking these after 2 years. Abrupt discontinuation of denosumab without switching to an alternative is concerning due to increased fracture risk.

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Association between post-traumatic stress disorder symptoms and bone fractures after the Great East Japan Earthquake in older adults: a prospective cohort study from the Fukushima Health Management Survey

BMC Geriatrics ◽

10.1186/s12877-020-01934-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fumikazu Hayashi ◽

◽

Tetsuya Ohira ◽

Hironori Nakano ◽

Masanori Nagao ◽

...

Keyword(s):

Older Adults ◽

Fracture Risk ◽

Health Management ◽

Bone Fractures ◽

Ptsd Symptoms ◽

Post Traumatic Stress ◽

Cox Proportional Hazard ◽

History Of ◽

Cox Proportional Hazard Models ◽

Post Traumatic

Abstract Background It has been reported that psychological stress affects bone metabolism and increases the risk of fracture. However, the relationship between bone fractures and post-traumatic stress disorder (PTSD) is unclear. This study aimed to evaluate the effects of disaster-induced PTSD symptoms on fracture risk in older adults. Methods This study evaluated responses from 17,474 individuals aged ≥ 65 years without a history of fractures during the Great East Japan Earthquake who answered the Mental Health and Lifestyle Survey component of the Fukushima Health Management Survey conducted in 2011. The obtained data could determine the presence or absence of fractures until 2016. Age, sex, physical factors, social factors, psychological factors, and lifestyle factors were subsequently analyzed. Survival analysis was then performed to determine the relationship between the fractures and each factor. Thereafter, univariate and multivariate Cox proportional hazard models were constructed to identify fracture risk factors. Results In total, 2,097 (12.0%) fractures were observed throughout the follow-up period. Accordingly, univariate and multivariate Cox proportional hazard models showed that PTSD symptoms (total PTSD checklists scoring ≥ 44) [hazard ratio (HR): 1.26; 95% confidence interval (CI): 1.10–1.44; P = 0.001], history of cancer (HR: 1.49; 95% CI: 1.24–1.79; P < 0.001), history of stroke (HR: 1.25; 95% CI: 1.03–1.52; P = 0.023), history of heart disease (HR: 1.30; 95% CI: 1.13–1.50; P < 0.001), history of diabetes (HR: 1.23; 95% CI: 1.09–1.39; P < 0.001), current smoking (HR: 1.29; 95% CI: 1.02–1.63; P = 0.036), and high dissatisfaction with sleep or no sleep at all (HR: 1.33; 95% CI: 1.02–1.74; P = 0.035) promoted a significant increase in fracture risk independent of age and sex. Conclusions The present study indicates that disaster-induced PTSD symptoms and insomnia contribute to increased fracture risk among older adults residing in evacuation areas within the Fukushima Prefecture.

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Soft tissue stiffness over the hip increases with age and its implication in hip fracture risk in older adults

Journal of Biomechanics ◽

10.1016/j.jbiomech.2019.06.002 ◽

2019 ◽

Vol 93 ◽

pp. 28-33 ◽

Cited By ~ 1

Author(s):

K.T. Lim ◽

W.J. Choi

Keyword(s):

Older Adults ◽

Hip Fracture ◽

Soft Tissue ◽

Fracture Risk ◽

Tissue Stiffness ◽

Hip Fracture Risk

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Plasma Metabolites Associated with Muscle Fat Infiltration in Community-Dwelling Older Adults from the Health ABC Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa040_022 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 22-22

Author(s):

Samaneh Farsijan ◽

Megan Marron ◽

Iva Miljkovic ◽

Mary Baugh ◽

Stephen Kritchevsky ◽

...

Keyword(s):

Older Adults ◽

Organic Acids ◽

African American Men ◽

Older Men ◽

Community Dwelling ◽

Metabolic Phenotype ◽

Plasma Metabolites ◽

Muscle Area ◽

Fat Infiltration ◽

Fat Depots

Abstract Objectives Age-related increase in muscle fat depots, i.e., myosteatosis, is a contributing factor to muscular dysfunction in older adults leading to frailty and disability. Myosteatosis is a complex condition that is associated with aging and diverse pathologies, including cancer and diabetes. We have previously shown that the relationship between muscle fat deposition and reduced physical function is moderated by muscle area and it is only observed in individuals with high muscle area. A further characterization of the metabolic phenotype associated with myoseatosis may shed light on the underlying biological mechanisms involved in its pathophysiology. Thus, we sought to further explore the heterogeneity of myosteatosis using a semi-targeted metabolomics approach to determine the plasma metabolites associated with myosteatosis in community-dwelling older men. Methods We performed a cross-sectional analysis of 314 African-American men (age: 69–79 years) from the Health ABC study at baseline. Mid-thigh inter-muscular fat (IMF) area by CT and 350 plasma metabolites by liquid-chromatography/mass spectrometry were measured. Partial correlation analysis was performed to determine metabolites associated with IMF. Results 161 metabolites were correlated with IMF (P < 0.05). After adjustment for age, weight, physical activity, medications and smoking, 36 metabolites remained significant with a false discovery rate of ≤0.25 to correct for multiple comparisons. Majority of IMF-associated metabolites were lipids/lipid-like molecules (26/36), followed by organic acids, including amino acids (5/36). Among these metabolites, only glutamine (from organic-acids) and mevalonic acid, (from fatty acids) were negatively correlated with IMF, while the remaining 34 metabolites were positively correlated. Notably, metabolic profiles of participants were distinctly different across different levels of myosteatosis, categorized by quartiles of IMF. Conclusions Dysregulated lipid and amino acid metabolism was a metabolomic hallmark of myosteatosis in this cohort of older men. Further exploration of metabolic heterogeneity of myosteatosis may help better understand the significance of fat infiltration on muscle health in aging. Funding Sources NIH/National Institute of Aging & NIA T32-AG0001810.

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