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Bi J, Zhang C, Lu C, Mo C, Zeng J, Yao M, Jia B, Liu Z, Yuan P, Xu S. Age-related bone diseases: Role of inflammaging. J Autoimmun 2024; 143:103169. [PMID: 38340675 DOI: 10.1016/j.jaut.2024.103169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024]
Abstract
Bone aging is characterized by an imbalance in the physiological and pathological processes of osteogenesis, osteoclastogenesis, adipogenesis, and chondrogenesis, resulting in exacerbated bone loss and the development of age-related bone diseases, including osteoporosis, osteoarthritis, rheumatoid arthritis, and periodontitis. Inflammaging, a novel concept in the field of aging research, pertains to the persistent and gradual escalation of pro-inflammatory reactions during the aging process. This phenomenon is distinguished by its low intensity, systemic nature, absence of symptoms, and potential for management. The mechanisms by which inflammaging contribute to age-related chronic diseases, particularly in the context of age-related bone diseases, remain unclear. The precise manner in which systemic inflammation induces bone aging and consequently contributes to the development of age-related bone diseases has yet to be fully elucidated. This article primarily examines the mechanisms underlying inflammaging and its association with age-related bone diseases, to elucidate the potential mechanisms of inflammaging in age-related bone diseases and offer insights for developing preventive and therapeutic strategies for such conditions.
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Affiliation(s)
- Jiaming Bi
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Caimei Zhang
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Caihong Lu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Chuzi Mo
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiawei Zeng
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Mingyan Yao
- Department of Endocrinology, The Third Hospital of Hebei Medical University, Shijiazhuang, China; Department of Endocrinology, Baoding No.1 Central Hospital, Baoding, China
| | - Bo Jia
- Department of Oral and Maxillofacial Surgery, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhongjun Liu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China
| | - Peiyan Yuan
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China.
| | - Shuaimei Xu
- Department of Endodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, Guangdong, China.
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Shen JX, Lu Y, Meng W, Yu L, Wang JK. Exploring causality between bone mineral density and frailty: A bidirectional Mendelian randomization study. PLoS One 2024; 19:e0296867. [PMID: 38271334 PMCID: PMC10810463 DOI: 10.1371/journal.pone.0296867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/23/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE The bidirectional correlation between low bone mineral density (BMD) and frailty, despite its extensive documentation, still lacks a conclusive understanding. The objective of this Mendelian randomization (MR) study is to investigate the bidirectional causal relationship between BMD and frailty. METHODS We utilized summary statistics data for BMD at different skeletal sites-including heel BMD (e-BMD, N = 40,613), forearm BMD (FA-BMD, N = 8,143), femoral neck BMD (FN-BMD, N = 32,735), and lumbar spine BMD (LS-BMD, N = 28,489), alongside frailty index (FI, N = 175,226) data in participants of European ancestry. MR analysis in our study was conducted using well-established analytical methods, including inverse variance weighted (IVW), weighted median (WM), and MR-Egger approaches. RESULTS We observed negative causal estimates between genetically predicted e-BMD (IVW β = - 0.020, 95% confidence interval (CI) = - 0.038, - 0.002, P = 0.029) and FA-BMD (IVW β = -0.035, 95% CI = -0.066, -0.004, P = 0.028) with FI. However, the results did not reach statistical significance after applying the Bonferroni correction, with a significance threshold set at P < 0.0125 (0.05/4). There was no causal effect of FN-BMD (IVW β = - 0.024, 95% CI = -0.052, 0.004, P = 0.088) and LS-BMD (IVW β = - 0.005, 95% CI = -0.034, 0.024, P = 0.749) on FI. In the reverse Mendelian randomization (MR) analysis, we observed no causal effect of FI on BMD at various skeletal sites. CONCLUSION Our study provides support for the hypothesis that low BMD may be a potential causal risk factor for frailty, but further research is needed to confirm this relationship. However, our findings did not confirm reverse causality.
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Affiliation(s)
- Jue-xin Shen
- Department of Orthopedics, Chongming Branch, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Lu
- Department of Orthopedics, Chongming Branch, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Meng
- Department of Orthopedics, Chongming Branch, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lei Yu
- Department of Orthopedics, Chongming Branch, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun-kai Wang
- Department of Orthopedics, Chongming Branch, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
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Wu S, Ma X, Liang Z, Jiang Y, Chen S, Sun G, Chen K, Liu R. Development and validation of a nomogram for predicting osteoporosis in prostate cancer patients: A cross-sectional study from China. Prostate 2023; 83:1537-1548. [PMID: 37589478 DOI: 10.1002/pros.24612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The specific risk factors contributing to the development of osteoporosis and the appropriate timing of treatment in Chinese prostate cancer (PCa) patients remain unclear. Our objective was to develop and validate a nomogram capable of predicting the occurrence of osteoporosis in PCa patients. METHODS We conducted a cross-sectional study with PCa patients attending the Second Hospital of Tianjin Medical University, collecting data from June 2021 to February 2023. The patients were divided into training and validation sets in a 7:3 ratio. The LASSO regression was used to identify the most relevant predictive variables, and the multivariable logistic regression was used to construct the nomogram. The nomogram's performance was validated through receiver operating characteristic (ROC) curves, C-index, calibration curves, and decision curve analysis (DCA) in both the training and validation sets. RESULTS We collected data from a total of 596 patients and then constructed the nomogram using age, body mass index, hemoglobin, vitamin D3, testosterone, and androgen deprivation therapy duration. The C-index of the nomogram was 0.923 in the training set and 0.859 in the validation set. The nomogram showed good consistency in both sets. DCA demonstrated the clinical benefit of the nomogram across various prediction thresholds. Furthermore, a separate nomogram was constructed to predict bone loss in patients undergoing ADT, exhibiting equally favorable diagnostic performance and clinical benefit. CONCLUSION This study constructed two reliable nomograms to predict osteoporosis and bone loss, integrating personal health information and PCa-specific treatment data. These nomograms offer an easy and individualized approach to predict the occurrence of osteoporosis and bone loss in PCa patients.
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Affiliation(s)
- Shangrong Wu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xudong Ma
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhengxin Liang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yuchen Jiang
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Shuaiqi Chen
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangyu Sun
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Kaifei Chen
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Ranlu Liu
- Department of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, China
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Mendoza-Pinto C, Etchegaray-Morales I, Munguía-Realpozo P, Méndez-Martínez S, Ayón-Aguilar J, Arellano-Avendaño F, Montel-Jarquín ÁJ, García-Carrasco M. SLICC-Frailty Index and Its Association with Low Bone Mineral Density and Vertebral Fractures in Women with Systemic Lupus Erythematosus. Calcif Tissue Int 2023; 113:475-480. [PMID: 37481761 PMCID: PMC10618373 DOI: 10.1007/s00223-023-01117-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023]
Abstract
The Systemic Lupus International Clinics (SLICC)-Frailty Index (FI) is associated with adverse outcomes in systemic lupus erythematosus (SLE). However, to our knowledge, its association with bone mineral density (BMD) and vertebral fractures (VF), has not been investigated using a standardized methods. Our aim was to evaluate the relationship between frailty assessed by SLICC-FI, and BMD and VF in Mestizo women with SLE. Adult women were included in this cross-sectional study. Information concerning the risk factors for VF and BMD in the lumbar spine and total hip was acquired. SLICC-FI was assessed at baseline. A semi-quantitative method was utilized to evaluate the prevalence of VF on lateral thoracolumbar radiographs. Univariate and multivariate regression analyses were performed adjusting for age, body mass index (BMI), SLE duration, cumulative glucocorticoid dose, bisphosphonate use, and BMD measurements. We included 202 women with SLE (mean age [SD] = 43.3 [13.6] years). The mean (SD) SLICC-FI value was 0.14 (0.09). Eleven (5.4%) patients were categorized as robust, 62 (30.7%) as relatively less fit, 84 (41.6%) as least fit, and 45 (22.3%) as frail. Both univariate and multivariate models showed associations between frailty (defined as SLICC-FI > 0.21) and prevalent VF in the entire population (OR 5.76, 95% CI 2.53-13.12; P < 0.001) and in the premenopausal group (OR 4.29, 95% CI; P = 0.047). We also found an association between the SLICC-FI and low BMD. In conclusion, frailty assessed by SLICC-FI might be associated with VF and low BMD in mestizo females with SLE.
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Affiliation(s)
- Claudia Mendoza-Pinto
- Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE- CIBIOR, Mexican Institute for Social Security, Puebla, Puebla, Mexico
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Ivet Etchegaray-Morales
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
| | - Pamela Munguía-Realpozo
- Systemic Autoimmune Diseases Research Unit, Specialties Hospital UMAE- CIBIOR, Mexican Institute for Social Security, Puebla, Puebla, Mexico.
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico.
| | | | - Jorge Ayón-Aguilar
- Health Research Medical Coordinator, Mexican Social Security Institute, Puebla Delegation, Puebla, Mexico
| | | | | | - Mario García-Carrasco
- Department of Rheumatology, Medicine School, Meritorious Autonomous University of Puebla, Puebla, Mexico
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Kravchenko G, Korycka-Bloch R, Stephenson SS, Kostka T, Sołtysik BK. Cardiometabolic Disorders Are Important Correlates of Vulnerability in Hospitalized Older Adults. Nutrients 2023; 15:3716. [PMID: 37686746 PMCID: PMC10490417 DOI: 10.3390/nu15173716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
With an increasingly aging population worldwide, the concept of multimorbidity has attracted growing interest over recent years, especially in terms of frailty, which leads to progressive multisystem decline and increased adverse clinical outcomes. The relative contribution of multiple disorders to overall frailty index in older populations has not been established so far. This study aimed to assess the association between the vulnerable elders survey-13 (VES-13) score, which is acknowledged to be one of the most widely used measures of frailty, and the most common accompanying diseases amongst hospitalized adults aged 60 years old and more. A total of 2860 participants with an average age of 83 years were included in this study. Multiple logistic regression with adjustment for age and nutritional status was used to assess the independent impact of every particular disease on vulnerability. Diabetes mellitus type 2, coronary artery disease, atrial fibrillation, heart failure, chronic kidney disease, osteoarthritis, fractures, eyes disorders, depression, dementia, pressure ulcers, and urinary incontinence were associated with higher scores of VES-13. Hospital admission of older subjects with those conditions should primarily draw attention to the risk of functional decline, especially while qualifying older patients for further treatment in surgery and oncology. At the same time, lipid disorders, gastrointestinal diseases, higher body mass index, and albumins level were related to a lower risk of being vulnerable, which may be attributed to a younger age and better nutritional status of those patients.
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Affiliation(s)
| | | | | | - Tomasz Kostka
- Department of Geriatrics, Healthy Aging Research Centre (HARC), Medical University of Lodz, Haller Sqr. No. 1, 90-647 Lodz, Poland; (G.K.); (R.K.-B.); (S.S.S.); (B.K.S.)
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Kozicka I, Guligowska A, Chrobak-Bień J, Czyżewska K, Doroba N, Ignaczak A, Machała A, Spałka E, Kostka T, Borowiak E. Factors Determining the Occurrence of Frailty Syndrome in Hospitalized Older Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12769. [PMID: 36232069 PMCID: PMC9564663 DOI: 10.3390/ijerph191912769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Frailty syndrome (FS) is a condition characterized by a decline in reserves, observed with aging. The most important consequences of the frailty syndrome include disability, hospitalization, fractures, institutionalization, and early mortality. The aim of this study was to identify the most important risk factors for FS in a group of older hospitalized patients in Poland. A total of one hundred and forty-one (78 women, 63 men) elderly patients from the Departments of Internal Medicine of the Medical University of Lodz (Poland) were recruited for this study. Frailty Instrument of the Survey of Health, Aging and Retirement in Europe (SHARE-FI), handgrip strength (HGS), depressive symptoms using the Geriatric Depression Scale (GDS), and functional ability (FA) using the Instrumental Activities of Daily Living (IADL) were assessed. According to SHARE-FI score, participants were divided into control group, frail, and pre-frail patients. Out of all 141 tested patients, FS was confirmed in 55 patients, and pre-frailty was observed in 52 patients. The occurrence of FS in the group of studied patients was related to age (p < 0.001), widowhood (p < 0.001), comorbidities (p < 0.001), heart diseases (p = 0.04), more medications taken (p < 0.001), lower FA (p < 0.001), weaker HGS, and depression (p < 0.001). The strongest positive correlations were between Share-FI score and the number of diseases (rS = 0.31), GDS (rS = 0.32), while negative correlations with IADL (rS = -0.47) and HGS (rS = -0.35). The study shows that FS is associated with age, comorbidities, number of medications taken, and widowhood. The present study has also demonstrated that FA, depression, and especially HGS are essential determinants of FS of elderly hospitalized people.
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Affiliation(s)
- Izabela Kozicka
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Agnieszka Guligowska
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Joanna Chrobak-Bień
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Katarzyna Czyżewska
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Natalia Doroba
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Anna Ignaczak
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Anna Machała
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Ewelina Spałka
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
| | - Tomasz Kostka
- Department of Geriatrics, Faculty of Health Sciences, Medical University of Lodz, Plac Hallera 1, 90-647 Lodz, Poland
| | - Ewa Borowiak
- Department of Conservative Nursing, Faculty of Health Sciences, Medical University of Lodz, Jaracza 63, 90-251 Lodz, Poland
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Xu X, Zhou X, Liu W, Ma Q, Deng X, Fang R. Evaluation of the correlation between frailty and sleep quality among elderly patients with osteoporosis: a cross-sectional study. BMC Geriatr 2022; 22:599. [PMID: 35854210 PMCID: PMC9295528 DOI: 10.1186/s12877-022-03285-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/11/2022] [Indexed: 02/08/2023] Open
Abstract
Background The incidence of osteoporosis increases with age. Frailty is a distinct characteristic seen in older osteoporosis patients. Poor sleep quality is common in elderly individuals. However, there are few studies on the correlation between frailty and sleep quality in elderly patients with osteoporosis in China. Methods This cross-sectional study was conducted from December 8, 2020, to April 30, 2021. A total of 247 patients who met the inclusion and exclusion criteria were recruited in outpatient departments at West China Hospital. A self-designed demographic data questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Frailty Phenotype scale were used to evaluate the sleep quality and frailty of the participants. Multivariate logistic regression was performed to evaluate the factors affecting frailty and sleep quality in osteoporosis patients. Results A total of 231 valid questionnaires were statistically analysed. The mean frailty score was 3.2 ± 1.6 and a total of 152 (65.8%) were frailty. The mean PSQI score was 11.9 ± 4.5 and a total of 183 (79.2%) patients had poor sleep quality (PSQI > 7). Multiple logistic regression showed that female, pain, polypharmacy, activities of daily living status (ADLs), and sleep quality were independent influencing factors for frailty, while comorbidity, ADLs and frailty status were independent influencing factors for sleep quality. Conclusion We found that frailty and sleep quality were prevalent and that frailty was positively correlated with the PSQI score in elderly patients with osteoporosis in China. The higher the frailty score is, the worse the sleep quality. It means the frailer old patients were, the worse their sleep quality, and poor sleep quality may increase the risk of frailty in elderly patients with osteoporosis. To manage elderly patients with osteoporosis effectively, medical staff should pay attention to frailty, sleep quality and its influencing factors.
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Affiliation(s)
- Xiaoru Xu
- West China School of Nursing/Department of International Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaoping Zhou
- West China School of Nursing/Department of International Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Wenjing Liu
- West China School of Nursing/Department of International Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Ma
- West China School of Nursing/Department of International Medical Center, West China Hospital, Sichuan University, Chengdu, China
| | - Xuexue Deng
- West China School of Nursing/Department of International Medical Center, West China Hospital, Sichuan University, Chengdu, China.
| | - Ronghua Fang
- West China School of Nursing/Department of International Medical Center, West China Hospital, Sichuan University, Chengdu, China.
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Kang JH, Hong SW. Risk Factors of Frailty in Patients with Distal Radius Fractures. Geriatr Orthop Surg Rehabil 2022; 13:21514593221094736. [PMID: 35450302 PMCID: PMC9016613 DOI: 10.1177/21514593221094736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/30/2022] [Indexed: 12/01/2022] Open
Abstract
Aim The aim of this study was to determine risk factors for the incidence of
frailty in patients with distal radius fractures (DRFs). Methods In total, 116 patients (mean age, 66.3 ± 7.7 years) with DRFs were recruited.
The participants were categorized into two groups, “frail” and “non-frail,”
according to the presence or absence of frailty, respectively. The areal
bone mineral densities (aBMDs) of the total hip, femoral neck, and lumbar
spine were measured using dual-energy x-ray absorptiometry. The
participants’ levels of resilience, depression, anxiety, nutritional intake,
oral health-related quality of life, and social support were evaluated by
self-reported questionnaires. The participants’ grip strength, gait speed,
number of teeth present in their oral cavities, circumference of their upper
arms and calves, and serum levels of vitamin D were also assessed. Results The participants in the “frail” group seemed to have lower aBMDs and muscle
function and mass than those in the “non-frail” group. There were
significant differences in grip strength, calf circumference, gait speed,
and aBMD of the total hip, femoral neck, and lumbar spine between the
groups. There were also significant differences in the levels of resilience
and depression between the groups. A multivariate logistic regression
analyses demonstrated that levels of sarcopenia, malnutritional status, and
aBMDs of the total hip and femoral neck had significant relationships with
the development of frailty in patients with DRFs. Conclusions An interdisciplinary approach involving the management of osteoporosis,
sarcopenia, oral health, social relationships, and psychological support
would be required for the proper management of DRF patients in preventing
frailty.
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Affiliation(s)
- Jeong-Hyun Kang
- Clinic of Oral Medicine and Orofacial Pain, Institute of Oral Health Science, Ajou University School of Medicine, Suwon, Korea
| | - Seok Woo Hong
- Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Wong RMY, Zu Y, Chau WW, Tso CY, Liu WH, Ng RWK, Chow SKH, Cheung WH, Tang N, Ho KKW. High Charlson Comorbidity Index Score is associated with early fracture-related complication for internal fixation of neck of femur fractures. Sci Rep 2022; 12:4749. [PMID: 35306533 PMCID: PMC8934361 DOI: 10.1038/s41598-022-08855-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 03/14/2022] [Indexed: 12/19/2022] Open
Abstract
The incidence of geriatric hip fractures continues to rise in our aging population and has become a major public health concern globally. The primary outcome of this study was to determine whether Age-adjusted Charlson Comorbidity Index (ACCI) is associated with increased fracture-related complications in neck of femur fractures treated by internal fixation. This was a cohort study between January 2014 to June 2018. All patients ≥ 50 years old with an acute neck of femur fracture after low-energy trauma fixed with cannulated hip screws were included and followed-up for 1 year at a tertiary centre. Primary outcome was to determine whether ACCI was associated with increased fracture-related complications. Secondary outcomes were revision rate, mortality, and function after surgery. Further analysis were performed within a “younger” group (age 50–65) and “elder” group (age > 65), as displaced fractures (Garden Type III/IV) were in “younger” group. 233 hip fractures (68 males; 165 females) with a mean age of 73.04 ± 12.89 were included in the study. Surgical outcomes showed that the complication rate of hip screw fixation for all patients was 21.5% (50 patients) at 1 year. ACCI was significantly higher in all patients with complications (p = 0.000). Analysis within “younger” (p = 0.000) and “elder” groups (p = 0.006) both showed significance. Stepwise logistic regression modelling showed ACCI had positive correlation with complications with ACCI = 6 (OR 4.27, p = 0.02). R2 values were comparatively better after controlled by Garden Type III/IV at ACCI = 4 (OR 6.42 (1.70, 24.25), p = 0.01). The authors recommend that for patients with a Garden Type I/II and ACCI ≥ 6 or a Garden Type III/IV and ACCI ≥ 4, a direct arthroplasty surgery should be considered.
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Ruangsuriya J, Wongpoomchai R, Srichairatanakool S, Sirikul W, Buawangpong N, Siviroj P. Guava Fruit and Acacia pennata Vegetable Intake Association with Frailty of Older Adults in Northern Thailand. Nutrients 2022; 14:nu14061192. [PMID: 35334846 PMCID: PMC8954598 DOI: 10.3390/nu14061192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 12/04/2022] Open
Abstract
As Thailand moves toward an aging society, frailty has become a concern amongst northern Thai elderly. The causes of frailty are multifactorial and include genetic, environmental, and socio-economic factors; diet is of particular interest. A cross-sectional study was conducted from September to October 2017 to investigate what kind of diets normally consumed by 350 Thai elders were associated with frailty using a questionnaire and frailty determination by Fried’s phenotype followed by phytochemical analyses of the diets. The multivariable logistic regression analysis demonstrated a significant positive association between certain foods and lower frailty. Guava fruit and Acacia pennata vegetable consumption had lower odds of frailty, which were 0.52 times (95% CI 0.28−0.96, p = 0.037) and 0.42 times (95% CI 0.21−0.83, p = 0.012) when adjusted for the potential confounders. The phytochemical analyses of guava fruit showed a significantly higher amount of total flavonoids (p < 0.001), total phenolic compounds (p = 0.002), and antioxidant capacity, including DPPH (p < 0.001), ABTS (p < 0.001), and FRAP (p = 0.002) when compared to those of banana. Acacia pennata vegetable contained a significantly higher amount of total phenolic compounds (p = 0.012) when compared to those of lettuce. These findings may assist in health promotion programs of frailty prevention by encouraging an increase in consumption of either guava fruit or Acacia pennata vegetable among Thai elderly.
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Affiliation(s)
- Jetsada Ruangsuriya
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (J.R.); (R.W.); (S.S.)
- Functional Food Research Center for Well-Being, Science and Technology Research Institute, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Rawiwan Wongpoomchai
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (J.R.); (R.W.); (S.S.)
- Functional Food Research Center for Well-Being, Science and Technology Research Institute, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Somdet Srichairatanakool
- Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; (J.R.); (R.W.); (S.S.)
| | - Wachiranun Sirikul
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Center of Data Analytics and Knowledge Synthesis for Health Care, Chiang Mai University, Chiang Mai 50200, Thailand
| | - Nida Buawangpong
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Penprapa Siviroj
- Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand;
- Correspondence:
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Zak M, Sikorski T, Wasik M, Courteix D, Dutheil F, Brola W. Frailty Syndrome-Fall Risk and Rehabilitation Management Aided by Virtual Reality (VR) Technology Solutions: A Narrative Review of the Current Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2985. [PMID: 35270677 PMCID: PMC8910391 DOI: 10.3390/ijerph19052985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/27/2022] [Accepted: 02/28/2022] [Indexed: 02/06/2023]
Abstract
Frailty, a physiological syndrome (FS) affecting primarily the older adults, manifests itself through significantly depleted bodily reserves, and appreciably higher (up to over threefold) individual exposure to fall risk. Concomitant medical conditions such as balance impairment, reduced visual acuity, limited mobility, and significantly diminished daily functional performance further exacerbate the patients' condition. Their resultant susceptibility to frequent hospitalisations makes their prognosis even worse. This narrative review aimed to provide an overview of published studies focused on rehabilitation management approaches aided by virtual reality (VR) technology in frail older adults. The authors had it also augmented with their own, evidence-based body of experience in rehabilitation. Making use of technologically advanced exercise machinery, specially adapted for rehabilitating frail older adults, combined with a structured exercise regimen, further aided by the application of select virtual reality (VR) technology solutions, clearly proved effective. Consequently, the patients were helped to move back from the frail to the pre-frail stage, as well as had their motor and cognitive functions appreciably enhanced. The application of modern technology in rehabilitating older adults over 65, affected by FS, when specifically aided by the select VR technology solutions, was also proven to complement successfully the conventional rehabilitation management. The overall versatility of the VR technology solutions, e.g., adaptation for home use allowing remote supervision, also makes this novel approach to rehabilitation far more appealing to the patients. They find it both very attractive and far more mentally engaging. Its considerable potential lies mostly in being appreciably more effective in bringing in desirable therapeutic outcomes.
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Affiliation(s)
- Marek Zak
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland;
| | - Tomasz Sikorski
- Doctoral School, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland; (T.S.); (M.W.)
| | - Magdalena Wasik
- Doctoral School, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland; (T.S.); (M.W.)
| | - Daniel Courteix
- Laboratory of the Metabolic Adaptations to Exercise under Physiological and Pathological Conditions (AME2P), Université Clermont Auvergne, 63000 Clermont-Ferrand, France;
| | - Frederic Dutheil
- Occupational and Environmental Medicine, CHU, 63000 Clermont-Ferrand, France;
- CNRS, LaPSCo, Physiological and Psychosocial Stress, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Waldemar Brola
- Institute of Health Sciences, Collegium Medicum, The Jan Kochanowski University of Kielce, Zeromskiego 5, 25-369 Kielce, Poland;
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12
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Symvoulakis EK, Kamekis A, Drakonaki E, Mastrodemou S, Ryerson CJ, Antoniou K. Frailty and chronic respiratory disease: the need for a multidisciplinary care model. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2021; 38:e2021031. [PMID: 34744425 PMCID: PMC8552571 DOI: 10.36141/svdld.v38i3.11599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022]
Abstract
Background. Frailty is a state of increased vulnerability to various health stressors but little information is summarized about frailty in patients with specific chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and asthma. Objective. We aimed to describe the burden of frailty on patients with chronic respiratory disorders and to discuss the need for multidisciplinary care services. Methods. PubMed and Cochrane Central databases were systematically reviewed for studies reporting outcomes associated with frailty in COPD, IPF, and asthma. Electronic databases were searched for relevant articles published in English from 2010 up to July 2020. Appraisal was carried out based on the Hierarchy of Evidence Rating System and the GRADE guidelines. Results. A total of 31 articles met all inclusion criteria with 24 of them at level IV, 1 at level V, and 6 at level VI. Frailty is likely to negatively affect quality of life and to increase the risk of mortality, especially in elderly with COPD, IPF and asthma. Each disease has a particular effect on the balance between health status, respiratory impairment and frailty. A greater understanding of frailty phenotype across different ages, as well as in a range of long-term conditions, is of great necessity in both clinical and research settings. Limited conformity was observed between different methodologies and nature of chronic diseases studied, leading to a further difficulty to extract homogeneous information. Conclusion. Literature shows that frailty is prevalent in COPD, IPF, and asthma, after adjusting for shared risk factors. Our findings suggest that frailty should be approached as an entity per se’, in order to assess real mortality risk, alongside respiratory disease severity and the presence of comorbidities. Health care professionals need knowledge, skills and multidisciplinary collaboration to buffer the impact of frailty on everyday practice.
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Affiliation(s)
- Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | | | | | - Semeli Mastrodemou
- Molecular & Cellular Pneumonology Laboratory, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Christopher J Ryerson
- Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Katerina Antoniou
- Molecular & Cellular Pneumonology Laboratory, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
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13
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Tembo MC, Mohebbi M, Holloway-Kew KL, Gaston J, Sui SX, Brennan-Olsen SL, Williams LJ, Kotowicz MA, Pasco JA. The contribution of musculoskeletal factors to physical frailty: a cross-sectional study. BMC Musculoskelet Disord 2021; 22:921. [PMID: 34724934 PMCID: PMC8561908 DOI: 10.1186/s12891-021-04795-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background Musculoskeletal conditions and physical frailty have overlapping constructs. We aimed to quantify individual contributions of musculoskeletal factors to frailty. Methods Participants included 347 men and 360 women aged ≥60 yr (median ages; 70.8 (66.1–78.6) and 71.0 (65.2–77.5), respectively) from the Geelong Osteoporosis Study. Frailty was defined as ≥3, pre-frail 1–2, and robust 0, of the following; unintentional weight loss, weakness, low physical activity, exhaustion, and slowness. Measures were made of femoral neck BMD, appendicular lean mass index (ALMI, kg/m2) and whole-body fat mass index (FMI, kg/m2) by DXA (Lunar), SOS, BUA and SI at the calcaneus (Lunar Achilles Insight) and handgrip strength by dynamometers. Binary and ordinal logistic regression models and AUROC curves were used to quantify the contribution of musculoskeletal parameters to frailty. Potential confounders included anthropometry, smoking, alcohol, prior fracture, FMI, SES and comorbidities. Results Overall, 54(15.6%) men and 62(17.2%) women were frail. In adjusted-binary logistic models, SI, ALMI and HGS were associated with frailty in men (OR = 0.73, 95%CI 0.53–1.01; OR=0.48, 0.34–0.68; and OR = 0.11, 0.06–0.22; respectively). Muscle measures (ALMI and HGS) contributed more to this association than did bone (SI) (AUROCs 0.77, 0.85 vs 0.71, respectively). In women, only HGS was associated with frailty in adjusted models (OR = 0.30 95%CI 0.20–0.45, AUROC = 0.83). In adjusted ordinal models, similar results were observed in men; for women, HGS and ALMI were associated with frailty (ordered OR = 0.30 95%CI 0.20–0.45; OR = 0.56, 0.40–0.80, respectively). Conclusion Muscle deficits appeared to contribute more than bone deficits to frailty. This may have implications for identifying potential musculoskeletal targets for preventing or managing the progression of frailty. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04795-4.
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Affiliation(s)
- Monica C Tembo
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
| | - Mohammadreza Mohebbi
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, VIC, Australia
| | - Kara L Holloway-Kew
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
| | - James Gaston
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
| | - Sophia X Sui
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
| | - Sharon L Brennan-Olsen
- School of Health and Social Development, Deakin University, Waterfront Geelong Campus, Geelong, VIC, Australia.,Institute for Health Transformation, Deakin University, Waterfront Geelong Campus, Geelong, VIC, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, St Albans, VIC, Australia
| | - Lana J Williams
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia
| | - Mark A Kotowicz
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia.,Barwon Health, Geelong, VIC, Australia
| | - Julie A Pasco
- Epi-Centre for Healthy Ageing, IMPACT - The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.,Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia.,Barwon Health, Geelong, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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14
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Tembo MC, Mohebbi M, Holloway-Kew KL, Gaston J, Brennan-Olsen SL, Williams LJ, Kotowicz MA, Pasco JA. The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study. Calcif Tissue Int 2021; 109:525-533. [PMID: 34014355 DOI: 10.1007/s00223-021-00865-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 05/07/2021] [Indexed: 12/14/2022]
Abstract
We investigated and quantified the predictability of frailty associated with musculoskeletal parameters. This longitudinal study included 287 men aged ≥ 50 yr at baseline (2001-2006) from the Geelong Osteoporosis Study. Baseline musculoskeletal measures included femoral neck bone mineral density (BMD), appendicular lean mass index (ALMI, kg/m2) and whole-body fat mass index (FMI, kg/m2) and lower-limb strength. Frailty at the 15 yr-follow-up (2016-2019) was defined as ≥ 3 and non-frail as < 3, of the following: unintentional weight loss, weakness, low physical activity, exhaustion, and slowness. Binary regression models and AUROC curves quantified the attributable risk of musculoskeletal factors to frailty and their predictive ability. Potential confounders included anthropometry, smoking, alcohol, FMI, socioeconomic status and comorbidities. Forty-eight (16.7%) men were frail at 15 yr-follow-up. Musculoskeletal models were better predictors of frailty compared to the referent (confounders only) model (AUROC for musculoskeletal factors 0.74 vs 0.67 for the referent model). The model with the highest AUROC (0.74; 95% CI 0.66-0.82) included BMD, ALMI and muscle strength (hip abductors) and was better than the referent model that included only lifestyle factors (p = 0.046). Musculoskeletal parameters improved the predictability model as measured by AUROC for frailty after 15 years. In general, muscle models performed better compared to bone models. Musculoskeletal parameters improved the predictability of frailty of the referent model that included lifestyle factors. Muscle deficits accounted for a greater proportion of the risk for frailty than did bone deficits. Targeting musculoskeletal health could be a possible avenue of intervention in regards to frailty.
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Affiliation(s)
- Monica C Tembo
- School of Medicine, Epi-Centre for Healthy Ageing, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, PO Box 281 Barwon Health, Geelong, VIC, 3220, Australia.
| | - Mohammadreza Mohebbi
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, VIC, Australia
| | - Kara L Holloway-Kew
- School of Medicine, Epi-Centre for Healthy Ageing, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, PO Box 281 Barwon Health, Geelong, VIC, 3220, Australia
| | - James Gaston
- School of Medicine, Epi-Centre for Healthy Ageing, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, PO Box 281 Barwon Health, Geelong, VIC, 3220, Australia
| | - Sharon L Brennan-Olsen
- School of Health and Social Development, Deakin University, Waterfront Geelong Campus, Geelong, VIC, Australia
- Institute for Health Transformation, Deakin University, Waterfront Geelong Campus, Geelong, VIC, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, St Albans, VIC, Australia
| | - Lana J Williams
- School of Medicine, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, Australia
| | - Mark A Kotowicz
- School of Medicine, Epi-Centre for Healthy Ageing, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, PO Box 281 Barwon Health, Geelong, VIC, 3220, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
| | - Julie A Pasco
- School of Medicine, Epi-Centre for Healthy Ageing, IMPACT, The Institute for Mental and Physical Health and Clinical Translation, Deakin University, PO Box 281 Barwon Health, Geelong, VIC, 3220, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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15
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Relationship between Masticatory Function and Bone Mineral Density in Community-Dwelling Elderly: A Cross-Sectional Study. Healthcare (Basel) 2021; 9:healthcare9070845. [PMID: 34356223 PMCID: PMC8305999 DOI: 10.3390/healthcare9070845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/18/2021] [Accepted: 06/30/2021] [Indexed: 01/12/2023] Open
Abstract
The relationship between masticatory function and bone mineral density (BMD) is unclear. This cross-sectional study examined this relationship after adjusting for confounding factors. The subjects were 702 community-dwelling elderly adults (306 men, 396 women) who had been recruited for the Community-Based Healthcare Research and Education study in 2019. Objective masticatory function was assessed using the gummy jelly method. The median for each descriptive statistic was 69.0 years for age, 86.2% for the young adult mean, and 18.0 for masticatory function. Comparisons of the groups with good and poor masticatory function by sex revealed a significant difference in muscle mass and the tooth number for both sexes (p < 0.05). Men showed significant differences in age (p < 0.05) and salivary occult blood findings (p < 0.05). Multivariate analysis using propensity scores showed a significant association between masticatory function and BMD in both sexes (men: odds ratio 163.0, 95% confidence interval 1.36–19,610.55, p = 0.04; women: odds ratio 48.65, 95% confidence interval 1.52–1561.15, p = 0.03 in women). Masticatory function and BMD in the community-dwelling elderly may be related. However, other factors, including frailty and sarcopenia, may also be involved. Regular oral health care by dentists and dental hygienists may benefit this population.
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16
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Leung AYM, Sun Q, Kwan RYC, Lam SC, Deng R. Moderating effect of age on the relationships between pre-frailty and body measures. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:515-525. [PMID: 32746506 DOI: 10.1111/hsc.13114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/28/2020] [Accepted: 07/02/2020] [Indexed: 06/11/2023]
Abstract
This study aims to investigate the relationship between body measures and the presence of two frailty-related phenotypes, and the moderating effect of age on this relationship. This is a secondary data analysis of the baseline data of an interventional study. The participants were residents of seven districts in Hong Kong, aged 55 or older, able to ambulate independently and to function well cognitively. Pre-frailty refers to the presence of two frailty-related phenotypes: low physical activity or poor handgrip strength or both. Included in the study were 199 individuals with a mean age of 73.43 (SD 7.54). Regression models showed that body weight (OR = 0.95, 95% CI 0.92-0.99, p < .05) was significantly associated with pre-frailty, as was body height (OR = 0.88, 95% CI 0.83-0.94, p < .001). Age is a significant moderator of the relationship between pre-frailty and body weight and body height. The effect of body weight (beta = -0.044, p < .05) and height (beta = -0.16, p < .001) on pre-frailty was significant and negative in the younger age groups. The findings indicate that raw body measures (i.e. body weight, body height) are more predictive of pre-frailty than BMI in older Chinese people. However, in the old-old group, these measures are not significant predictors of pre-frailty in Chinese community-dwelling adults. Practitioners should consider adopting body measures as predictors of pre-frailty in the younger-old population.
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Affiliation(s)
- Angela Yee Man Leung
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Qian Sun
- Sau Po Centre on Ageing, Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
- Faculty of Social Security, School of Public Administration, Hebei University of Business and Economics, Shijiazhuang, China
| | - Rick Yiu Cho Kwan
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Simon Ching Lam
- Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Renli Deng
- Nursing Department, The 5th Affiliated Hospital of Zunyi Medical University, Zhuhai, China
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17
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Fu M, Tian Y, Zhang T, Zhan Q, Zhang L, Wang J. Comparative study of DHA-enriched phosphatidylcholine and EPA-enriched phosphatidylcholine on ameliorating high bone turnover via regulation of the osteogenesis-related Wnt/β-catenin pathway in ovariectomized mice. Food Funct 2020; 11:10094-10104. [PMID: 33140795 DOI: 10.1039/d0fo01563f] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Here, we compared the effects of marine DHA-enriched phosphatidylcholine (DHA-PC) and EPA-enriched phosphatidylcholine (EPA-PC) on high bone turnover in a model of osteoporosis induced by bilateral ovariectomy in vivo, and further investigated the possible protective mechanisms. Meanwhile, DHA-PC and EPA-PC clearly ameliorated the microstructure of the trabecular bone and accelerated bone mineral apposition rate, additionally increasing bone mineral density and biomechanical properties of the bone. Furthermore, gene and protein expression levels suggest that DHA-PC and EPA-PC inhibited overactive osteogenesis via down-regulation of the expression of the osteogenesis-related Wnt/β-catenin signaling pathway. In conclusion, DHA-PC and EPA-PC reduced excessive osteogenesis via normalization of Wnt/β-catenin expression. These results may contribute to the elucidation of the anti-osteoporotic properties of DHA-PC and EPA-PC and further develop their potential application value as a functional food.
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Affiliation(s)
- Meng Fu
- College of Food Science and Engineering, Ocean University of China, Qingdao, Shandong Province 266003, China.
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18
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Tembo MC, Holloway-Kew KL, Sui SX, Dunning T, Low ACH, Yong SJ, Ng BL, Brennan-Olsen SL, Williams LJ, Kotowicz MA, Pasco JA. Prevalence of Frailty in Older Men and Women: Cross-Sectional Data from the Geelong Osteoporosis Study. Calcif Tissue Int 2020; 107:220-229. [PMID: 32617612 DOI: 10.1007/s00223-020-00713-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 06/16/2020] [Indexed: 10/23/2022]
Abstract
Few studies have investigated the prevalence of frailty in the Australian general population. This study determined the prevalence of frailty in a population-based sample of older adults and examined the relationship between frailty and comorbid conditions. Men (n = 347) and women (n = 360) aged ≥ 60 year from the Geelong Osteoporosis Study (GOS) were assessed between 2016-2019 and 2011-2014, respectively. Frailty was identified using a modified Fried frailty phenotype. Prevalence estimates were standardised to the 2011 Australian population. Kruskal-Wallis test and χ2 test were used to analyse data. For women, mean standardised prevalence estimates were 18.3% (14.1-22.5) for frail, 54.1% (47.3-60.8) pre-frail and 22.9% (18.9-26.8) robust. Corresponding estimates for men were 13.1% (9.8-16.3) frail, 47.8% (42.0-53.6) pre-frail and 27.3% (22.7-31.8) robust. Women who were frail were older, shorter, tended to have a higher body mass index (BMI) and used more medications compared to other groups. Compared to robust women, those who were frail were more likely to have cardio-metabolic (OR 3.5 (0.7-20.0)), pulmonary (OR 3.5 (1.5-8.4)) and musculoskeletal (OR 10.1 (2.1-48.0)) conditions. Frail men were older, had a higher BMI and were more likely to have musculoskeletal conditions (OR 5.8 (2.8-12.3)) and tended to be from a lower SES. No further associations were observed. This study reported the prevalence of frail and pre-frail individuals in a population-based sample of Australian men and women. Frailty was associated with musculoskeletal conditions for both men and women; however, associations with cardio-metabolic and pulmonary comorbidities were evident in women only.
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Affiliation(s)
- Monica C Tembo
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia.
| | - Kara L Holloway-Kew
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Sophia X Sui
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Trisha Dunning
- Barwon Health, Geelong, VIC, Australia
- Quality and Patient Safety Research, Deakin University and Barwon Health, School of Nursing and Midwifery, Geelong, VIC, Australia
| | | | | | - Boon L Ng
- Barwon Health, Geelong, VIC, Australia
| | - Sharon L Brennan-Olsen
- Australian Institute for Musculoskeletal Science, University of Melbourne and Western Health, Melbourne, Australia
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Australia
- Institute for Health Transformation, Deakin University, Waterfront Campus, Geelong, VIC, Australia
- School of Health and Social Development, Deakin University, Waterfront Campus, Geelong, VIC, Australia
| | - Lana J Williams
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Mark A Kotowicz
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Australia
| | - Julie A Pasco
- Epi-Centre for Healthy Ageing, IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine , Deakin University (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine-Western Health, University of Melbourne, Melbourne, Australia
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
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19
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Tembo MC, Holloway-Kew KL, Mohebbi M, Sui SX, Hosking SM, Brennan-Olsen SL, Williams LJ, Kotowicz MA, Pasco JA. The association between a fracture risk tool and frailty: Geelong Osteoporosis Study. BMC Geriatr 2020; 20:196. [PMID: 32503454 PMCID: PMC7275607 DOI: 10.1186/s12877-020-01595-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Frailty is characterised by age-related declines in physical, psychological and social functioning. Features of frailty overlap with risk factors for fragility fractures. The aim of this study was to investigate the association between the fracture risk assessment tool (FRAX®) and frailty. METHODS In cross-sectional analysis, frailty status was determined for participants aged 60-90 yr at 15-year follow-up of the Geelong Osteoporosis Study, using a modified Fried frailty phenotype. Using the FRAX on-line tool, scores for hip and major osteoporotic fracture (MOF) were calculated with and without bone mineral density (BMD). Using the area under Receiver Operating Characteristic (AUROC) curves, and FRAX scores calculated at the baseline visit for these participants, we investigated the association of FRAX and frailty 15 years later. RESULTS Forty-seven of 303 women (15.5%) and 41 of 282 men (14.5%) were frail at the 15-year visit. There was a gradient of increasing median FRAX scores from robust to frail. For example, for women, median MOF-FRAX without BMD increased from 5.9 for the robust to 7.5 for the pre-frail and 14.0 for the frail (p < 0.001). In secondary analyses, an association was observed between FRAX and frailty over 15 years, with the highest AUROC for women being 0.72 for MOF-FRAX with BMD, and for men, 0.76 hip-FRAX without BMD. CONCLUSION An association was observed between FRAX and frailty where frail men and women had higher FRAX-scores compared to the other groups. Preliminary data suggest that FRAX, with or without BMD, may be useful in enhancing the information on frailty. Further research using larger datasets will be required to explore this.
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Affiliation(s)
- Monica C Tembo
- Epi-Centre for Healthy Ageing, Deakin University, PO Box 281, Geelong, Victoria, 3220, Australia.
| | - Kara L Holloway-Kew
- Epi-Centre for Healthy Ageing, Deakin University, PO Box 281, Geelong, Victoria, 3220, Australia
| | - Mohammadreza Mohebbi
- Faculty of Health, Biostatistics Unit, Deakin University, Geelong, VIC, Australia
| | - Sophia X Sui
- Epi-Centre for Healthy Ageing, Deakin University, PO Box 281, Geelong, Victoria, 3220, Australia
| | - Sarah M Hosking
- Epi-Centre for Healthy Ageing, Deakin University, PO Box 281, Geelong, Victoria, 3220, Australia.,Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Sharon L Brennan-Olsen
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne, St Albans, Australia.,Department of Medicine-Western Campus, The University of Melbourne, St Albans, Australia.,School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Lana J Williams
- Epi-Centre for Healthy Ageing, Deakin University, PO Box 281, Geelong, Victoria, 3220, Australia
| | - Mark A Kotowicz
- Epi-Centre for Healthy Ageing, Deakin University, PO Box 281, Geelong, Victoria, 3220, Australia.,Department of Medicine-Western Campus, The University of Melbourne, St Albans, Australia.,Barwon Health, Geelong, Australia
| | - Julie A Pasco
- Epi-Centre for Healthy Ageing, Deakin University, PO Box 281, Geelong, Victoria, 3220, Australia.,Department of Medicine-Western Campus, The University of Melbourne, St Albans, Australia.,Barwon Health, Geelong, Australia
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20
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Ambagtsheer RC, Thompson MQ, Archibald MM, Casey MG, Schultz TJ. Diagnostic test accuracy of self-reported screening instruments in identifying frailty in community-dwelling older people: A systematic review. Geriatr Gerontol Int 2019; 20:14-24. [PMID: 31729157 DOI: 10.1111/ggi.13810] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 10/09/2019] [Accepted: 10/15/2019] [Indexed: 12/28/2022]
Abstract
Against a backdrop of aging populations worldwide, it has become increasingly important to identify frailty screening instruments suitable for community settings. Self-reported and/or administered instruments might offer significant simplicity and efficiency advantages over clinician-administered instruments, but their comparative diagnostic test accuracy has yet to be systematically examined. The aim of this systematic review was to determine the diagnostic test accuracy of self-reported and/or self-administered frailty screening instruments against two widely accepted frailty reference standards (the frailty phenotype and the Frailty Index) within community-dwelling older adult populations. We carried out a systematic search of the Embase, CINAHL, MEDLINE, PubMed, Web of Science, PEDro, PsycINFO, ProQuest Dissertations, Open Grey and GreyLit databases up to April 2017 (with an updated search carried out over May-July 2018) to identify studies reporting comparison of self-reported and/or self-administered frailty screening instruments against an appropriate reference standard, with a minimum sensitivity threshold of 80% and specificity threshold of 60%. We identified 24 studies that met our selection criteria. Four self-reported screening instruments across three studies met minimum sensitivity and specificity thresholds. However, in most cases, study design considerations limited the reliability and generalizability of the results. Additionally, meta-analysis was not carried out, because no more than three studies were available for any of the unique combinations of index tests and reference standards. Although the present study has shown that a number of self-reported frailty screening instruments reported sensitivity and specificity within a desirable range for community application, additional diagnostic test accuracy studies are required. Geriatr Gerontol Int 2020; 20: 14-24.
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Affiliation(s)
- Rachel C Ambagtsheer
- National Health and Medical Research Council Center of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Aging, Adelaide, South Australia, Australia.,Torrens University Australia, Adelaide, South Australia, Australia
| | - Mark Q Thompson
- National Health and Medical Research Council Center of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Aging, Adelaide, South Australia, Australia
| | - Mandy M Archibald
- National Health and Medical Research Council Center of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Aging, Adelaide, South Australia, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | - Timothy J Schultz
- National Health and Medical Research Council Center of Research Excellence in Trans-Disciplinary Frailty Research to Achieve Healthy Aging, Adelaide, South Australia, Australia.,The Center for Evidence-based Practice South Australia (CEPSA): a Joanna Briggs Institute Center of Excellence, Adelaide, South Australia, Australia
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21
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Yoneki K, Kitagawa J, Hoshi K, Harada M, Watanabe T, Shimoda T, Matsuzawa R, Yoshida A, Matsunaga Y, Takeuchi Y, Kamiya K, Matsunaga A. Association between frailty and bone loss in patients undergoing maintenance hemodialysis. J Bone Miner Metab 2019; 37:81-89. [PMID: 29335796 DOI: 10.1007/s00774-017-0898-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 12/22/2017] [Indexed: 01/14/2023]
Abstract
Frailty is significantly associated with bone loss in the general population. However, it is unclear whether this association also exists in patients undergoing hemodialysis who have chronic kidney disease-mineral and bone disorder (CKD-MBD). This study aimed to assess the association between frailty and bone loss in patients undergoing hemodialysis. This cross-sectional study included 214 (90 women, 124 men) Japanese outpatients undergoing maintenance hemodialysis three times per week, with a mean age of 67.1 years (women) and 66.8 years (men). Frailty was defined based on criteria set forth by the Cardiovascular Health Study (CHS)-19 (21.1%) women and 47 (37.9%) men were robust, 41 (45.6%) women and 43 (34.7%) men were pre-frail, and 30 (33.3%) women and 34 (27.4%) men were frail. For bone mass, quantitative ultrasound (QUS) parameters (speed of sound, broadband ultrasound attenuation, stiffness index) of the calcaneus were measured. The association between frailty and QUS parameters was determined separately for women and men using multivariate analysis of covariance (ANCOVA), with adjustments for clinical characteristics including age, body mass index, hemodialysis vintage, diabetes, current smoking, serum albumin, phosphate, corrected calcium, intact parathyroid hormone, and medication for CKD-MBD (vitamin D receptor activator, calcimimetics). ANCOVA revealed that all QUS parameters declined significantly with increasing levels of frailty in both sexes (P < 0.05). In conclusion, frailty (as defined by CHS criteria) should be considered a risk factor for bone loss in patients undergoing hemodialysis.
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Affiliation(s)
- Kei Yoneki
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
- Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Sagamihara, Japan
| | - Jun Kitagawa
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Keika Hoshi
- Department of Hygiene, Kitasato University School of Medicine, Sagamihara, Japan
| | - Manae Harada
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
- Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Sagamihara, Japan
| | - Takaaki Watanabe
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
- Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Sagamihara, Japan
| | - Takahiro Shimoda
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
- Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Sagamihara, Japan
| | - Ryota Matsuzawa
- Department of Rehabilitation, Kitasato University Hospital, Sagamihara, Japan
| | - Atsushi Yoshida
- Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Sagamihara, Japan
| | - Yusuke Matsunaga
- Department of Hemodialysis Center, Sagami Circulatory Organ Clinic, Sagamihara, Japan
- Department of Sleep Medicine, Graduate School of Medical Sciences, Kitasato University, Sagamihara, Japan
| | - Yasuo Takeuchi
- Division of Nephrology, Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan
| | - Atsuhiko Matsunaga
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, 1-15-1 Kitasato, Sagamihara, Kanagawa, 252-0373, Japan.
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22
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Pillatt AP, Patias RS, Berlezi EM, Schneider RH. Which factors are associated with sarcopenia and frailty in elderly persons residing in the community? REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.180165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Abstract Objective: to broaden knowledge about the factors associated with sarcopenia and frailty in elderly persons residing in the community. Method: an integrative systematic review based on the PRISMA recommendations was carried out, using articles published from 2012 to March 2017 in the PubMED, SciELO, Virtual Health Library, CINAHL and Springer electronic databases with the following descriptors: frail elderly, sarcopenia and etiology and their synonyms. The articles identified by the initial search strategy were independently assessed by two researchers, according to the eligibility criteria, and the articles selected were evaluated for methodological quality. Results: the results of this survey show that frailty may be associated with sarcopenia, low serum vitamin D levels, anemia, subclinical hyperthyroidism in men, while the greatest evolution in women was for osteoporosis. An association between sarcopenia and advanced age was also observed, with worsening quality of life, physical-functional capacity, nutritional status and comorbidities, as well as an increased risk of death in sarcopenic elderly persons. Conclusion: this systematic review showed that low serum levels of vitamin D are associated with frailty and factors that predispose this condition. It is therefore important to monitor the serum levels of this vitamin in the elderly population, and it is suggested that new studies are carried out related to supplements of this vitamin in frail elderly persons.
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23
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Hayashi M, Abe K, Fujita M, Okai K, Takahashi A, Ohira H. Association between sarcopenia and osteoporosis in chronic liver disease. Hepatol Res 2018; 48:893-904. [PMID: 29734510 DOI: 10.1111/hepr.13192] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/13/2018] [Accepted: 05/01/2018] [Indexed: 12/13/2022]
Abstract
AIM Sarcopenia and osteoporosis are important complications in chronic liver disease (CLD). The aim of this study was to investigate the relationship between sarcopenia and osteoporosis in patients with CLD. METHODS We retrospectively investigated the relationship between sarcopenia and osteoporosis in 112 CLD patients (57 men and 55 women), including 40 cirrhotic patients (36%), by measuring the appendicular skeletal muscle mass index (ASMI) using bio-impedance analysis. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry. RESULTS The sarcopenia rate was 13% (14/112), and the osteoporosis and osteopenia rates were 17% (19/112) and 65% (73/112), respectively. The rate of osteoporosis was significant and high in patients with sarcopenia or cirrhosis. In linear regression analysis, sarcopenia was significantly associated with the BMD of the lumbar spine (coefficient = -0.149, P = 0.014) and the femur neck (coefficient = -0.110, P = 0.003). Cirrhosis was also significantly associated with low BMD of the lumbar spine (coefficient = -0.160, P < 0.001) and the femur neck (coefficient = -0.066, P = 0.015). In the logistic analysis, sarcopenia (odds ratio = 6.16, P = 0.039) and cirrhosis (odds ratio = 15.8, P = 0.002) were independent risk factors for osteoporosis. The ASMI cut-off values for osteoporosis were 7.33 kg/m2 in men and 5.71 kg/m2 in women. CONCLUSIONS Sarcopenia was closely associated with osteoporosis, and a low ASMI was a potential predictor of osteoporosis in CLD patients. Screening for BMD might be required to detect osteoporosis in cirrhotic patients.
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Affiliation(s)
- Manabu Hayashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Kazumichi Abe
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Masashi Fujita
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Ken Okai
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Atsushi Takahashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiromasa Ohira
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
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24
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Bartosch P, McGuigan FE, Akesson KE. Progression of frailty and prevalence of osteoporosis in a community cohort of older women-a 10-year longitudinal study. Osteoporos Int 2018; 29:2191-2199. [PMID: 29947868 PMCID: PMC6154042 DOI: 10.1007/s00198-018-4593-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 05/28/2018] [Indexed: 11/26/2022]
Abstract
UNLABELLED In community dwelling, 75-year-old women followed 10 years, a frailty index was created at each of three visits. Frailty score increased by ~ 6-7% annually. A higher frailty score was equivalent to being 5-10 years chronologically older. Frailty was associated with low bone density and higher risk of dying. INTRODUCTION To understand the distribution of frailty among a population-based sample of older community-dwelling women, progression over 10 years, and association with mortality and osteoporosis. METHODS The study is performed in a cohort designed to investigate osteoporosis. The OPRA cohort consists of 75-year-old women, n = 1044 at baseline, and follow-up at age 80 and 85. A frailty index (scored from 0.0-1.0) based on deficits in health across multiple domains was created at all time-points; outcomes were mortality up to 15 years and femoral neck bone density. RESULTS At baseline, the proportion least frail, i.e., most robust (FI 0.0-0.1) constituted 48%, dropping to 25 and 14% at age 80 and 85. On average, over 10 years, the annual linear frailty score progression was approximately 6-7%. Among the least frail, 11% remained robust over 10 years. A higher frailty score was equivalent to being 5 to 10 years older. Mortality was substantially higher in the highest quartile compared to the lowest based on baseline frailty score; after 10 years, 48.7% had died vs 17.2% (p = 1.7 × 10-14). Mortality risk over the first 5 years was highest in the frailest (Q4 vs Q1; HRunadj 3.26 [1.86-5.73]; p < 0.001) and continued to be elevated at 10 years (HRunadj 3.58 [2.55-5.03]; p < 0.001). Frailty was associated with BMD after adjusting for BMI (overall p = 0.006; Q1 vs Q4 p = 0.003). CONCLUSIONS The frailty index was highly predictive of mortality showing a threefold increased risk of death in the frailest both in a shorter and longer perspective. Only one in ten older women escaped progression after 10 years. Frailty and osteoporosis were associated.
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Affiliation(s)
- P Bartosch
- Lund University, Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, 20502, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - F E McGuigan
- Lund University, Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, 20502, Malmö, Sweden
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden
| | - K E Akesson
- Lund University, Department of Clinical Sciences Malmö, Clinical and Molecular Osteoporosis Research Unit, 20502, Malmö, Sweden.
- Department of Orthopaedics, Skåne University Hospital, 205 02, Malmö, Sweden.
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25
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Johnson AE, Adhikari S, Althouse AD, Thoma F, Marroquin OC, Koscumb S, Hausmann LRM, Myaskovsky L, Saba SF. Persistent sex disparities in implantable cardioverter-defibrillator therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1150-1157. [PMID: 29959781 DOI: 10.1111/pace.13435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/17/2018] [Accepted: 06/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Clinical guidelines recommend cardioverter defibrillator implantation for patients with heart failure and reduced ejection fraction. Despite this, women and minorities have been less likely to receive implantable cardioverter-defibrillator (ICD) therapy than white men. We examined race and sex differences in ICD implantation in a recent cohort. METHODS Using cross-sectional, retrospective analyses, we mined our health system's outpatient electronic medical records to assess age, race, sex, medications, and comorbidities for patients aged ≥18 years with ejection fraction ≤ 35% during 2014. While adjusting for confounding variables such as medications, age, and comorbidities, we conducted a multivariable logistic regression assessing whether racial and sex differences in ICD therapy persist. RESULTS Among 5,156 outpatients with ejection fraction ≤35%, 1,681 (32.6%) patients had an ICD present at the time of their index outpatient visit in 2014. Women were less likely to have an ICD than men (25.0% vs 36.3%, P < 0.01), and black patients were less likely to have an ICD than white patients (28.0% vs 33.2%, P = 0.02). In adjusted multivariable analyses, women were less like to have ICDs (adjusted odds ratio [OR] = 0.68, 95% confidence interval [CI], 0.58-0.79, P < 0.01) but the race difference dissipated (adjusted OR for black race = 0.86, 95% CI, 0.68-1.08, P = 0.18). CONCLUSIONS In this large, outpatient cohort, we have shown that sex differences in ICD therapy continue to exist, but the difference in ICD prevalence by race was attenuated. Dedicated studies are required to fully understand the causes of persistent sex differences in ICD therapy.
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Affiliation(s)
- Amber E Johnson
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | | | - Floyd Thoma
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Oscar C Marroquin
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,UPMC's Department of Clinical Analytics, Pittsburgh, PA, USA
| | - Stephen Koscumb
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,UPMC's Department of Clinical Analytics, Pittsburgh, PA, USA
| | - Leslie R M Hausmann
- University of Pittsburgh Department of Medicine, Pittsburgh, PA, USA.,Veterans Affairs Pittsburgh Healthcare System Center for Health Equity Research and Promotion, Pittsburgh, PA, USA
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease and Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, NM, USA
| | - Samir F Saba
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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26
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Álvarez-Sánchez N, Álvarez-Ríos AI, Guerrero JM, García-García FJ, Rodríguez-Mañas L, Cruz-Chamorro I, Lardone PJ, Carrillo-Vico A. Homocysteine levels are associated with bone resorption in pre-frail and frail Spanish women: The Toledo Study for Healthy Aging. Exp Gerontol 2018; 108:201-208. [DOI: 10.1016/j.exger.2018.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/16/2018] [Accepted: 04/22/2018] [Indexed: 10/17/2022]
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28
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Abstract
OBJECTIVE The study aims to assess the association between bone mineral density (BMD) and frailty in a cohort of HIV-infected patients. DESIGN A cross-sectional study in an HIV outpatient unit where nearly 1000 patients are monitored. METHODS Study participants undergoing bone densitometry were proposed an evaluation of frailty using criteria of the Cardiovascular Health Study (CHS) and the Study of Osteoporotic Fractures (SOF). Frailty markers were weight-loss, self-reported exhaustion, physical activity, grip strength, chair stands, and slow gait. Patients' characteristics were collected from an electronic medical record. Associations of frailty with BMD and osteoporosis were tested using multivariate linear and logit regression models, respectively. RESULTS In total, 175 HIV-infected patients, 121 (69.14%) men, were analyzed. Prevalence of frailty markers, osteopenia, and osteoporosis were comparable among sexes. Despite a younger age, spinal and femoral neck BMD were lower in women (P < 0.05). Linear regression model adjusting by age, duration of HIV follow-up, BMI, smoking status, osteoarthritis, osteoporosis treatment, and the age at menopause showed a negative association of spinal and femoral BMD with frailty according to SOF criteria in women (P < 0.05). In men, SOF-defined frailty was associated with osteoporosis (odds ratio 28.79; 95% confidence interval 2.15-386.4) in a model adjusting for age, duration of HIV follow-up, CD4 nadir, CD4 T-cell count, tobacco consumption, exposure to tenofovir (TDF) and protease inhibitors. No significant associations were found between BMD and CHS-defined frailty. CONCLUSION Our study shows that frailty according to SOF criteria is associated with low spinal BMD values in female and osteoporosis in male HIV-infected patients.
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29
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Cook MJ, Oldroyd A, Pye SR, Ward KA, Gielen E, Ravindrarajah R, Adams JE, Lee DM, Bartfai G, Boonen S, Casanueva F, Forti G, Giwercman A, Han TS, Huhtaniemi IT, Kula K, Lean ME, Pendleton N, Punab M, Vanderschueren D, Wu FC, O'Neill TW. Frailty and bone health in European men. Age Ageing 2017; 46:635-641. [PMID: 27852598 PMCID: PMC5859977 DOI: 10.1093/ageing/afw205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 09/21/2016] [Indexed: 11/14/2022] Open
Abstract
Background frailty is associated with an increased risk of fragility fractures. Less is known, however, about the association between frailty and bone health. Methods men aged 40-79 years were recruited from population registers in eight European centres for participation in the European Male Aging Study. Subjects completed a comprehensive assessment which included quantitative ultrasound (QUS) scan of the heel (Hologic-SAHARA) and in two centres, dual-energy bone densitometry (dual-energy x-ray absorptiometry, DXA). Frailty was defined based on an adaptation of Fried's phenotype criteria and a frailty index (FI) was constructed. The association between frailty and the QUS and DXA parameters was determined using linear regression, with adjustments for age, body mass index and centre. Results in total, 3,231 subjects contributed data to the analysis. Using the Fried categorisation of frailty, pre-frail and frail men had significantly lower speed of sound (SOS), broadband ultrasound attenuation (BUA) and quantitative ultrasound index (QUI) compared to robust men (P< 0.05). Similar results were seen using the FI after categorisation into 'high', 'medium' and 'low' levels of frailty. Using the Fried categorisation, frail men had lower femoral neck bone mineral density (BMD) compared to robust men (P < 0.05), but not lower lumbar spine BMD. Using the FI categorisation, a 'high' level of frailty (FI > 0.35) was associated with lower lumbar spine BMD (P < 0.05) when compared to those with low (FI < 0.2), but not lower femoral neck BMD. When analysed as a continuous variable, higher FI was linked with lower SOS, BUA and QUI (P < 0.05). Conclusions optimisation of bone health as well as prevention of falls should be considered as strategies to reduce fractures in frail older people.
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Affiliation(s)
- Michael J. Cook
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Address correspondence to: Michael J. Cook. Tel: (+44) 1612755499; Fax: (+44) 1613060547.
| | - Alexander Oldroyd
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Stephen R. Pye
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
| | - Kate A. Ward
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK
| | - Evelien Gielen
- Gerontology and Geriatrics, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium
| | | | - Judith E. Adams
- Radiology and Manchester Academic Health Science Centre, The Royal Infirmary, The University of Manchester, Manchester, UK
| | - David M. Lee
- Cathie Marsh Institute for Social Research, School of Social Sciences, The University of Manchester, ManchesterM13 9PL, UK
| | - Gyorgy Bartfai
- Department of Obstetrics, Gynaecology and Andrology, Albert Szent-György Medical University, Szeged, Hungary
| | - Steven Boonen
- University Division of Geriatric Medicine, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Felipe Casanueva
- Department of Medicine, Santiago de Compostela University, Complejo Hospitalario Universitario de Santiago (CHUS), CIBER de Fisiopatologia Obesidad y Nutricion (CIBERobn), Instituto Salud Carlos III,Santiago de Compostela, Spain
| | - Gianni Forti
- Endocrine Unit, Department of Clinical Physiopathology, University of Florence, Florence, Italy
| | - Aleksander Giwercman
- Scanian Andrology Centre, Department of Urology, Malmö University Hospital, University of Lund, Sweden
| | - Thang S. Han
- Egham & Department of Endocrinology, Ashford and St Peter's NHS Foundation Trust, Institute of Cardiovascular Research, Royal Holloway, University of London (ICR2UL), Chertsey, UK
| | | | - Krzysztof Kula
- Department of Andrology and Reproductive Endocrinology, Medical University of Lodz, Poland
| | | | - Neil Pendleton
- Division of Neuroscience and Experimental Psychology, University of Manchester, Salford Royal Hospital, Salford, UK
| | - Margus Punab
- Andrology Unit, United Laboratories of Tartu University Clinics, Tartu, Estonia
| | - Dirk Vanderschueren
- Department of Andrology and Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Frederick C. Wu
- Andrology Research Unit,Centre for Endocrinology and Diabetes,University of Manchester, Manchester,UK
| | - Terence W. O'Neill
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal & Dermatological Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester, UK
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Musculoskeletal health and frailty. Best Pract Res Clin Rheumatol 2017; 31:145-159. [DOI: 10.1016/j.berh.2017.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 12/20/2022]
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Efficacy of Daily Teriparatide Treatment in Low Levels of Walking State Patients. Clin Drug Investig 2017; 37:551-557. [PMID: 28247298 DOI: 10.1007/s40261-017-0511-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Little is known about the efficacy of osteoporosis medication in patients with low levels of walking state, namely, influence by immobilization levels. We retrospectively compared the efficacy of the daily teriparatide therapy in patients with low and high levels of walking state to detect possible immobilization-related differences. METHODS We analyzed 661 patients treated with 20 μg/day of teriparatide for 24 months. We measured the changes in the bone mineral density (BMD) of the lumbar spine (LS) and of the femoral neck (FN), the changes in serum procollagen type I N-terminal propeptide (PINP) levels and urinary N-telopeptide (uNTX) excretion. To compare the results of BMD and bone turnover marker, the patients were divided into two subgroups, low levels of walking state and high levels of walking state. RESULTS Compared with baseline, in the low levels of walking state subgroup, the percent LS BMD and FN BMD increased significantly by 12.8 ± 8.9% and 5.0 ± 13.8% at 24 months, respectively (p < 0.01 vs baseline for LS and FN, respectively); the mean absolute LS BMD and FN BMD change was 0.101 ± 0.067 g/cm2 and 0.017 ± 0.063 g/cm2 at 24 months, respectively. In the high levels of walking state subgroup, the percent LS BMD and FN BMD increased significantly by 13.4 ± 9.5% and 3.1 ± 7.8% at 24 months, respectively; the mean absolute LS BMD and FN BMD change was 0.104 ± 0.068 g/cm2 and 0.017 ± 0.042 g/cm2 at 24 months, respectively. The increases in percent and absolute BMD in LS and FN, and the changes in PINP and uNTX were similar between the subgroups. CONCLUSIONS The efficacy of the daily teriparatide treatment is similar between low levels of walking state patients and high levels of walking state patients and was not influenced by immobilization levels.
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Li G, Thabane L, Papaioannou A, Ioannidis G, Levine MAH, Adachi JD. An overview of osteoporosis and frailty in the elderly. BMC Musculoskelet Disord 2017; 18:46. [PMID: 28125982 PMCID: PMC5270357 DOI: 10.1186/s12891-017-1403-x] [Citation(s) in RCA: 112] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 01/14/2017] [Indexed: 12/20/2022] Open
Abstract
Osteoporosis and osteoporotic fractures remain significant public health challenges worldwide. Recently the concept of frailty in relation to osteoporosis in the elderly has been increasingly accepted, with emerging studies measuring frailty as a predictor of osteoporotic fractures. In this overview, we reviewed the relationship between frailty and osteoporosis, described the approaches to measuring the grades of frailty, and presented current studies and future research directions investigating osteoporosis and frailty in the elderly. It is concluded that measuring the grades of frailty in the elderly could assist in the assessment, management and decision-making for osteoporosis and osteoporotic fractures at a clinical research level and at a health care policy level.
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Affiliation(s)
- Guowei Li
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada. .,Programs for Assessment of Technology in Health, Centre for Evaluation of Medicines, Hamilton, ON, L8N 1Y3, Canada.
| | - Lehana Thabane
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - George Ioannidis
- Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Mitchell A H Levine
- Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.,St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada.,Programs for Assessment of Technology in Health, Centre for Evaluation of Medicines, Hamilton, ON, L8N 1Y3, Canada
| | - Jonathan D Adachi
- St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada. .,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada. .,St. Joseph's Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON, L8N 1Y2, Canada.
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Prevalence of Osteoporosis and Its Risk Factors in Men with COPD in Qazvin. Int J Chronic Dis 2016; 2016:4038530. [PMID: 27774508 PMCID: PMC5059585 DOI: 10.1155/2016/4038530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/24/2016] [Accepted: 09/14/2016] [Indexed: 01/23/2023] Open
Abstract
Introduction. Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Proper diagnosis of osteoporosis as a systemic adverse effect of COPD is of significant importance. The present study aimed at evaluating the prevalence of osteoporosis and its risk factors in men suffering from COPD in Qazvin (2014). Methods. This descriptive-analytical study was conducted on 90 patients with COPD using random sampling. Anthropometric data and results from physical examination were collected. Pulmonary function test and bone mineral densitometry were done for all participants as well. Results. The prevalence of osteopenia and osteoporosis in COPD patients was 31.5 and 52.8 percent, respectively. Bone mineral density (BMD) at the femoral neck was associated significantly with body mass index (BMI), increased severity of COPD, and use of oral corticosteroid (P < 0.05). Conclusion. The results showed that patients' BMI and severity of COPD are two valuable risk factors for osteoporosis screening in COPD patients.
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Kojima G. Frailty as a predictor of fractures among community-dwelling older people: A systematic review and meta-analysis. Bone 2016; 90:116-22. [PMID: 27321894 DOI: 10.1016/j.bone.2016.06.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 04/28/2016] [Accepted: 06/13/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE To identify prospective studies examining associations between frailty and fractures and to combine the risk measures to synthesize pooled evidence on frailty as a predictor of fractures among community-dwelling older people. METHODS A systematic literature search was conducted using five databases: Embase, MEDLINE, CINAHL Plus, PsycINFO, and the Cochrane Library for prospective studies on associations between frailty and fracture risk published from 2000 to August 2015 without language restriction. Odds ratios (OR) and hazard ratios (HR) extracted from the studies or calculated from available data were combined to synthesize pooled effect measures using random-effects or fixed-effects models. Heterogeneity, methodological quality, and publication bias were assessed. Meta-regression analyses were performed to explore the cause of high heterogeneity. RESULTS Of 1305 studies identified, six studies involving 96,564 older people in the community were included in this review. Frailty and prefrailty were significantly associated with future fractures among five studies with OR (pooled OR=1.70, 95% confidence interval (95% CI)=1.34-2.15, p<0.0001; pooled OR=1.31, 95% CI=1.18-1.46, p<0.00001, respectively) and four studies with HR (pooled HR=1.57, 95% CI=1.31-1.89, p<0.00001; pooled HR=1.30, 95% CI=1.12-1.51, p=0.0006, respectively). High heterogeneity was observed among five studies with OR of frailty (I(2)=66%). The studies from the United States were found to have a higher fracture risk than from those from other countries in a meta-regression model (regression coefficient=0.39, p=0.04). No evidence of publication bias was identified. CONCLUSIONS This systematic review and meta-analysis showed evidence that frailty and prefrailty are significant predictors of fractures among community-dwelling older people. Treating frailty may potentially lead to lowering fracture risks.
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Affiliation(s)
- Gotaro Kojima
- Japan Green Medical Centre, 10 Throgmorton Avenue, London EC2N 2DL, United Kingdom.
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Abstract
PURPOSE OF REVIEW The interaction between fall and fracture risk factors is an area of increasing clinical relevance, but little information is known about the age-specific issues in bone health unique to HIV-infected adults. The present review will focus on what is known about falls and fall risk factors among HIV-infected adults, and then review the association between decreased muscle, increased adiposity, and frailty with both low bone mineral density (BMD) and falls. RECENT FINDINGS The rate of falls among middle-aged HIV-infected adults is similar to that of HIV-uninfected adults 65 years and older. Many of the clinical factors that contribute to low BMD overlap with risk factors for falls, resulting in a high risk of a serious fall among older adults with the greatest risk for a fracture. Low muscle mass, increased adiposity and metabolic syndrome, physical function impairment and frailty, common among older HIV-infected adults, contribute to an increased risk for low BMD and falls, and subsequently, may increase the risk of fracture among HIV-infected older adults. SUMMARY Interventions with dual benefit on reducing fall risk and improving BMD are likely to have the greatest impact on fracture prevention in the older, HIV-infected adult.
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Affiliation(s)
- Kristine M Erlandson
- aUniversity of Colorado, Aurora, Colorado, USA bUniversity of Modena and Reggio Emilia, Modena, Italy cMcGill University, Montreal, Quebec, Canada
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Huang TH, Ables GP. Dietary restrictions, bone density, and bone quality. Ann N Y Acad Sci 2016; 1363:26-39. [PMID: 26881697 DOI: 10.1111/nyas.13004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/08/2015] [Accepted: 12/16/2015] [Indexed: 02/06/2023]
Abstract
Caloric restriction (CR), protein restriction (PR), and specific amino acid restriction (e.g., methionine restriction (MR)) are different dietary interventions that have been confirmed with regard to their comprehensive benefits to metabolism and health. Based on bone densitometric measurements, weight loss induced by dietary restriction is known to be accompanied by reduced areal bone mineral density, bone mass, and/or bone size, and it is considered harmful to bone health. However, because of technological advancements in bone densitometric instruments (e.g., high-resolution X-ray tomography), dietary restrictions have been found to cause a reduction in bone mass/size rather than volumetric bone mineral density. Furthermore, when considering bone quality, bone health consists of diverse indices that cannot be fully represented by densitometric measurements alone. Indeed, there is evidence that moderate dietary restrictions do not impair intrinsic bone material properties, despite the reduction in whole-bone strength because of a smaller bone size. In the present review, we integrate research evidence from traditional densitometric measurements, metabolic status assays (e.g., energy metabolism, oxidative stresses, and inflammatory responses), and biomaterial analyses to provide revised conclusions regarding the effects of CR, PR, and MR on the skeleton.
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Affiliation(s)
- Tsang-hai Huang
- Laboratory of Exercise, Nutrition and Bone Biology, Institute of Physical Education, Health and Leisure Studies, National Cheng Kung University, Tainan, Taiwan
| | - Gene P Ables
- Orentreich Foundation for the Advancement of Science, Cold Spring-on-Hudson, New York
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Abstract
INTRODUCTION Severe osteoporosis represents a disease of high mortality and morbidity. Recognition of what constitutes and causes severe osteoporosis and aggressive intervention with pharmacological agents with evidence to reduce fracture risk are outlined in this review. AREAS COVERED This review is a blend of evidence obtained from literature searches from PubMed and The National Library of Medicine (USA), clinical experience and the author's opinions. The review covers the recognition of what constitutes severe osteoporosis, and provides up-to-date references on this sub-set of high risk patients. EXPERT OPINION Severe osteoporosis can be classified by using measurements of bone densitometry, identification of prevalent fractures, and, knowledge of what additional risk factors contribute to high fracture risk. Once recognized, the potential consequences of severe osteoporosis can be mitigated by appropriate selection of pharmacological therapies and modalities to reduce the risk for falling.
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Affiliation(s)
- Paul D Miller
- a University of Colorado Health Sciences Center , Colorado Center for Bone Research , Lakewood , CO , USA
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Langsetmo L, Barr SI, Berger C, Kreiger N, Rahme E, Adachi JD, Papaioannou A, Kaiser SM, Prior JC, Hanley DA, Kovacs CS, Josse RG, Goltzman D. Associations of Protein Intake and Protein Source with Bone Mineral Density and Fracture Risk: A Population-Based Cohort Study. J Nutr Health Aging 2015; 19:861-8. [PMID: 26412291 PMCID: PMC5092173 DOI: 10.1007/s12603-015-0544-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
UNLABELLED High dietary protein has been hypothesized to cause lower bone mineral density (BMD) and greater fracture risk. Previous results are conflicting and few studies have assessed potential differences related to differing protein sources. OBJECTIVE To determine associations between total protein intake, and protein intake by source (dairy, non-dairy animal, plant) with BMD, BMD change, and incident osteoporotic fracture. DESIGN/SETTING Prospective cohort study (Canadian Multicentre Osteoporosis Study). Participants/Measures: Protein intake was assessed as percent of total energy intake (TEI) at Year 2 (1997-99) using a food frequency questionnaire (N=6510). Participants were contacted annually to ascertain incident fracture. Total hip and lumbar spine BMD was measured at baseline and Year 5. Analyses were stratified by group (men 25-49 y, men 50+ y, premenopausal women 25-49 y, and postmenopausal women 50+ y) and adjusted for major confounders. Fracture analyses were limited to those 50+ y. RESULTS Intakes of dairy protein (with adjustment for BMI) were positively associated with total hip BMD among men and women aged 50+ y, and in men aged 25-49. Among adults aged 50+ y, those with protein intakes of <12% TEI (women) and <11% TEI (men) had increased fracture risk compared to those with intakes of 15% TEI. Fracture risk did not significantly change as intake increased above 15% TEI, and was not significantly associated with protein source. CONCLUSIONS In contrast to hypothesized risk of high protein, we found that for adults 50+ y, low protein intake (below 15% TEI) may lead to increased fracture risk. Source of protein was a determinant of BMD, but not fracture risk.
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Affiliation(s)
- L Langsetmo
- David Goltzman, Royal Victoria Hospital, CaMos, 687 Pine Ave W, Room E1.64, Montreal, QC H3A 1A1, , Telephone: 514-843-1632, FAX: 514-843-1651
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Liu LK, Lee WJ, Chen LY, Hwang AC, Lin MH, Peng LN, Chen LK. Association between Frailty, Osteoporosis, Falls and Hip Fractures among Community-Dwelling People Aged 50 Years and Older in Taiwan: Results from I-Lan Longitudinal Aging Study. PLoS One 2015; 10:e0136968. [PMID: 26348034 PMCID: PMC4562637 DOI: 10.1371/journal.pone.0136968] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 08/11/2015] [Indexed: 12/25/2022] Open
Abstract
Background Association of frailty with adverse clinical outcomes has been reported in Western countries, but data from the Asian population are scarce. This study aimed to evaluate the epidemiology of frailty among community-dwelling middle-aged and elderly population and to explore its association with musculoskeletal health in Taiwan. Methods I-Lan Longitudinal Aging Study (ILAS) data were retrieved for this study. Frailty was defined by the Fried’s criteria; a comparison of demographic characteristics, physical performance, and body composition, including skeletal muscle mass and bone mineral density (BMD), as well as recent falls, history of hip fractures and the functional status of subjects with different frailty statuses were accomplished. Results Overall, the data of 1,839 participants (mean age: 63.9±9.3 years, male 47.5%) were obtained for analysis. The prevalence of pre-frailty was 42.3% in men and 38.8% in women, whereas the prevalence of frailty was 6.9% and 6.7% in men and women, respectively. Frailty was significantly associated with older age, the male gender, larger waist circumference, lower skeletal muscle index, lower hip BMD, poorer physical function, poorer nutritional status, and poorer cognitive function. Also, frailty was significantly associated with osteoporosis (OR: 7.73, 95% CI: 5.01–11.90, p<0.001), history of hip fractures (OR: 8.66, 95% CI: 2.47–30.40, p = 0.001), and recent falls (O.R: 2.53, 95% CI: 1.35–4.76, p = 0.004). Conclusions Frailty and pre-frailty, in Taiwan, was closely associated with recent falls, history of hip fractures and osteoporosis among community-dwelling people 50 years of age and older. Furthermore, frailty intervention programs should take an integrated approach towards strengthening both and muscle mass, as well as prevention of falls.
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Affiliation(s)
- Li-Kuo Liu
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ju Lee
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, I-Lan County, Taiwan
| | - Liang-Yu Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - An-Chun Hwang
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hsien Lin
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Ning Peng
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Liang-Kung Chen
- Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail:
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Abstract
Frailty is a common and important geriatric syndrome characterized by age-associated declines in physiologic reserve and function across multiorgan systems, leading to increased vulnerability for adverse health outcomes. Two major frailty models have been described in the literature. The frailty phenotype defines frailty as a distinct clinical syndrome meeting three or more of five phenotypic criteria: weakness, slowness, low level of physical activity, self-reported exhaustion, and unintentional weight loss. The frailty index defines frailty as cumulative deficits identified in a comprehensive geriatric assessment. Significant progress has recently been made in understanding the pathogenesis of frailty. Chronic inflammation is likely a key pathophysiologic process that contributes to the frailty syndrome directly and indirectly through other intermediate physiologic systems, such as the musculoskeletal, endocrine, and hematologic systems. The complex multifactorial etiologies of frailty also include obesity and specific diseases. Major clinical applications include risk assessment and stratification. This can be applied to the elderly population in the community and in a variety of care settings. Frailty may also be useful for risk assessment in surgical patients and those with cardiovascular diseases, cancer, or human immunodeficiency virus infection, as well as for assessment of vaccine effectiveness in older adults. Currently, exercise and comprehensive geriatric interdisciplinary assessment and treatment are key interventions for frailty. As understanding of the biologic basis and complexity of frailty further improves, more effective and targeted interventional strategies and innovative geriatric-care models will likely be developed.
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Affiliation(s)
- Xujiao Chen
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, People's Republic of China
| | - Genxiang Mao
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, People's Republic of China
| | - Sean X Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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