Association between High Levels of Parathyroid Hormone and Frailty: The Nepean Osteoporosis and Frailty (NOF) Study

BACKGROUND

Frailty is associated with poor outcomes hence identification of risks factors is pivotal. Since the independent role of parathyroid hormone (PTH) in frailty remains unexplored, we aimed to determine this in a population of older individuals with a history of falling.

DESIGN

Cross-sectional study.

SETTING

Falls and Fracture Clinic, Nepean Hospital (Penrith, Australia).

PARTICIPANTS

692 subjects (mean age=79, 65% women) assessed between 2009-2015.

MEASUREMENTS

Assessment included clinical examination, mood, nutrition, grip strength, gait velocity, bone densitometry and posturography. Chemistry included serum PTH, calcium, vitamin D (25(OH)D3), creatinine and albumin. Normocalcemic subjects were divided into 4 groups: (1) Normal: 25(OH)D3 >50nmol/L and PTH between 1.6-6.8pmol/L; (2) PTH responsive: low 25(OH)D3 (<50nmol/L) and high PTH (>6.8pmol/L); (3) PTH unresponsive: low 25(OH)D3 and normal PTH; (4) Hyper PTH (>6.8pmol/L) with normal 25(OH)D3. Frailty was defined using Fried's criteria. Difference between the groups was assessed using one-way ANOVA and X2 analysis. Multinomial logistic regression evaluated the association between the groups and the number of Fried's criteria adjusted for age, BMI, renal function, 25(OH)D3 levels, and albumin.

RESULTS

22.6% subjects had high PTH levels (>6.8pmol/L). All subjects in the high PTH groups had significantly lower grip strength, gait velocity, limits of stability, and higher BMI. The PTH responsive group had a higher risk of pre-frailty (β=3.8, 95% CI = 3.42 - 5.22, p≷ 0.01) and frailty (β=8.26, 95% CI = 2.8-16.1, p<0.01). The risk of frailty was also higher in the Hyper PTH group (β=2.3, 95% CI = 1.74-4.32, p<0.01).

CONCLUSION

We have reported an independent association of high PTH levels with high number of falls and with the clinical components of physical frailty in community dwelling older persons. Our results suggest a possible role of PTH in frailty that deserves further exploration.

Abdominal Obesity and Mobility Disability in Older Adults: A 4-Year Follow-Up the International Mobility in Aging Study

BACKGROUND

Abdominal obesity is related to the disability process in older adults, however, little is known about this relationship when adjusted for important confounders such as depression and physical performance measures in a diverse international aged population.

OBJECTIVES

To explore the longitudinal relationship between abdominal obesity and mobility disability controlling for physical performance and depression.

DESIGN AND SETTING

Longitudinal observational study using data from the International Mobility in Aging Study (IMIAS) Study.

PARTICIPANTS

1104 out of 2002 older adults aged 64-74 years old free of mobility disability at baseline (2012) and then reassessed in 2016.

MEASUREMENTS

Mobility disability was defined as reporting difficulty in walking 400 m or climbing stairs. Activities of daily living (ADL) disability was based on any self-reported difficulty in five mobility-related ADLs. Abdominal obesity was defined as waist circumference ≥ 88cm for women or ≥ 102 cm for men. Four meters gait speed, handgrip strength and depressive symptoms (CES-D) were assessed. Generalized Estimating Equations (GEE) and multinomial regressions were used to estimate associations between disability and abdominal obesity.

RESULTS

1104 free of disability participants were followed over 4 years, the mean age was 68.9 (±2.9) years among men and 68.7 (±2.6) years among women. Prevalence and incidence rates of mobility disability varied widely across research site and sex. The longitudinal associations between mobility disability and abdominal obesity remained significant even when adjusted by depressive symptoms, handgrip strength, gait speed, age, sex, education and research site. Participants with abdominal obesity had higher mobility disability (OR=1.68, 95% CI 1.23-1.76, p-value=0.01) and also increased risk for ADL disability (OR: 1.47, 95% CI 1.23-1.76, p-value=0.01). Abdominal obesity in baseline was also predictor of mobility disability in 2016 (OR: 1.93, 95% CI 1.17-3.17, p-value <0.01) but not for ADL disability (OR: 1.59, 95% CI 0.93-2.71, p-value =0.09) with accounting mortality.

CONCLUSION

Abdominal obesity is associated longitudinally and predicts mobility disability, even over a short period (4 years) in community-dwelling older adults from different epidemiological contexts.

Comprehensive nutritional status in sarco-osteoporotic older fallers

OBJECTIVES

In older persons, the combination of osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of falls and fractures. However, the particular nutritional status of the sarco-osteoporotic (SOP) patients remains unknown. The goal of this study was to obtain a comprehensive picture of nutritional status in SOP patients.

DESIGN

Cross-sectional study.

SETTING

Falls and Fractures Clinic, Nepean Hospital (Penrith, Australia).

PARTICIPANTS

680 subjects (mean age=79, 65% female) assessed between 2008-2013.

MEASUREMENTS

Assessment included medical history, mini-nutritional assessment, physical examination, bone densitometry and body composition by DXA, and blood tests for nutritional status (albumin, creatinine, hemoglobin, vitamin D, vitamin B-12, calcium, phosphate and folate). Patients were divided in 4 groups: 1) osteopenia/osteoporosis (BMD<-1.0 SD); 2) sarcopenia; 3) SOP; and 4) normal (no sarcopenia/no osteoporosis). Difference between groups was assessed with one-way ANOVA and chi square analysis. Multivariable linear regression evaluated the association between the groups and measures of nutritional parameters.

RESULTS

Sarcopenia was present in 47.4% of those with osteopenia (167/352) and 62.7% in those with osteoporosis (91/145). Mean age of the SOP was 80.4±7 years. SOP patients showed significantly higher prevalence of falls and fractures. Univariate analyses showed that SOP were more likely than normal to have a BMI< 25 (OR 2.42 95%CI 1.45-4.041, p<0.001), a MNA score <12 (OR 2.0, 95%CI 1.15-3.49, p<0.05), serum folate <20 nmol/L (OR 4.0 95%CI 1.35-11.87, p<0.01) and hemoglobin <120g/L (OR 2.0 95%CI 1.28-3.30, p<0.01). Multivariate analysis showed that a MNA score <12 was independently associated with SOP compared to normal when adjusted for age and gender. Hemoglobin <120g/L, BMI <25, and GDS >6 remained independently associated with SOP after adjustment for all variables including inflammatory conditions. Hypoalbuminemia (<35 g/L) was associated with just osteopenia/osteoporosis (OR: 2.03, 95%CI 1.08-3.81, p<0.01) and just sarcopenia (OR: 1.77, 95%CI 1.0-3.0, p<0.01) compared to normal. No differences in vitamin D, glomerular filtration rate, albumin, corrected calcium, phosphate, red blood cells folate or vitamin B12 levels were found between the subgroups.

CONCLUSIONS

In approaching SOP patients, early prevention protocols directed to optimize their nutritional status would be a key strategy to prevent poor outcomes such as falls and fractures in this high risk population. Therefore, nutritional assessment and early nutritional supplementation should be essential domains in this strategy.

Dizziness as a geriatric condition among rural community-dwelling older adults

BACKGROUND

Dizziness is a common symptom in older adults. The majority of those with dizziness tend to have more than one risk factor, suggesting that dizziness is a multifactorial geriatric condition. Therefore, associated factors must be determined to permit risk-reduction approaches.

OBJECTIVE

To examine the associations between dizziness and socio-demographic, physical, functional and psychological health factors among older persons living in the Andes Mountains.

DESIGN

Population-based cross-sectional study.

SETTINGS/PARTICIPANTS

One thousand six hundred ninety-two community-living people aged 60 years and over living in four rural and suburban areas of villages in coffee-grower zones in the Colombian Andes Mountains.

MEASUREMENTS

Outcome measures included self-reporting of dizziness as a symptom experienced either very frequently or continuously during the last month. Independent variables were demographic, socioeconomic and social factors; disease and biomedical factors; functional status and performance-based measures; and psychological factors such as depressive symptoms and self-rated health.

RESULTS

Dizziness was reported by 15.2% of participants in the study. Variables independently associated with dizziness were: number of chronic conditions, visual impairment, and use of more than four medications. Independently associated psychological variables were: poor self-perceived health, cognitive impairment and depression. Health and psychological factors accounted for 85% of dizziness.

CONCLUSION

Older persons who reported dizziness were more physically frail, with more instances of chronic conditions and sensory impairments, and had poor self-perceptions of their health. Biomedical and psychological factors showed a strong independent association with dizziness. A multifactorial intervention targeting the identified factors would reduce dizziness in older people. However, this approach may need to address different sets of specific factors related to the dizziness categories.