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Mature Focus: May 2

By: Lisa Russell


As the American population ages, preventing and treating osteoporosis will become more important than ever before.

News & Notes

Preventing the burdens of osteoporosis

U.S. Census projections indicate that by 2050, the population of adults age 65 and older will nearly double to almost 83 million, up from about 43 million in 2012. This “graying” of America will soon result in some staggering statistics when it comes to osteoporosis, a condition characterized by decreased bone mass and bone density that primarily impacts older women. By 2025, for example, the annual number of “fragility fractures” in adults caused by osteoporosis is projected to exceed 3 million, and will cost the American healthcare system about $25 billion per year.

But the burdens of osteoporosis extend far beyond financial concerns. Fragility fractures often lead to a rapidly declining quality of life, decreased mobility and, in some cases, death. Hip fractures are especially devastating – statistics show that less than half of seniors who survive a hip fracture will ever walk unaided again, most will require assistance with basic activities, and between 10 and 20 percent will need to move into care homes during the following year.

The best ways to combat osteoporosis are prevention – which is possible in many cases – timely screening, and proper treatment. During National Osteoporosis Awareness and Prevention Month in May, older adults are encouraged to understand the risk factors for osteoporosis, know when to be screened for it and learn how to keep fragility fractures from occurring whenever possible.

Basic measures every adult can take to promote healthy bones include getting sufficient dietary calcium; achieving adequate levels of vitamin D through a nutritious diet and exposure to sunlight; and getting regular weight-bearing exercise, like brisk walking, jogging and weight-lifting. Avoiding smoking, and only drinking in moderation also help to reduce the risk.

Screening for osteoporosis is called bone density testing, and is done using dual-energy X-ray absorptiometry [DEXA] technology. The recommended age at which to begin screening depends on a variety of factors, including body weight, age at menopause, past fractures and other variables which should be discussed with one’s primary care doctor. Bone density results are reported using a “T-score,” which indicates how one’s bone density compares to that of a healthy 30-year-old adult. Lower T-scores mean lower bone density;  a T-score of -2.5 or lower is a diagnosis of osteoporosis.

Over the past 25 years, a broad range of pharmaceutical options have become available to treat osteoporosis and its precursor, which is called osteopenia. These medicines, which can significantly reduce an older person’s risk of a fragility fracture, are available in a variety of ways, which include daily, weekly or monthly oral tablets; periodic injections; or annual infusions.

Woman drinking milk stock

Adequate levels of vitamin D may be protective against metabolic syndrome, a group of risk factors for heart disease and stroke.

Vitamin D and metabolic syndrome

Metabolic syndrome, a group of symptoms that affects about half of women over 50 in the U.S., may be related to vitamin D deficiency, according to recent research conducted in Brazil. The syndrome is not a disease in itself, but is a group of risk factors that together raise a woman’s risk of heart attacks, strokes and diabetes. It is characterized by high blood pressure, high blood sugar, unhealthy cholesterol levels and significant abdominal fat.

The Brazilian study, which included 463 women between the ages of 45 and 75, showed a strong correlation between vitamin D deficiency and metabolic syndrome in those who were 12 months or more past menopause. The women were monitored for two years, and had no pre-existing heart problems prior to the study.

To determine whether or not the participants had developed metabolic syndrome, they were compared to typical parameters for its diagnosis: having a waist circumference above 34.6 inches, blood pressure above 130/85 mmHg, high blood sugar [fasting glucose above 100 mg/dL], and abnormal levels of triglycerides [above 150 mg/dL] and cholesterol [HDL below 50 mg/dL]. The syndrome was diagnosed if the women met three or more of these criteria.

The researchers found metabolic syndrome in about 60 percent of the women who also had vitamin D deficiency [less than 20 nanograms per milliliter of blood] or who had insufficient vitamin D levels [20-29 ng/ml].  By contrast, about 40 percent of participants with sufficient vitamin D levels [30 ng/ml or more] were diagnosed with the syndrome.

According to the study’s authors, “the results suggest that supplementing and maintaining adequate levels of vitamin D in postmenopausal women can reduce the risk of disease.” The most plausible explanation for this, they said, is that vitamin D influences insulin secretion and sensitivity, both of which play a major role in metabolic syndrome.

A new use for Viagra?

According to the American Cancer Society, colorectal cancer is currently the third leading cause of cancer death among men in the United States, with about 1 in 22 men expected to develop the disease at some point in their lives.

A significant risk factor for colorectal cancer is a mutation in a gene called the adenomatous polyposis coli [APC]. People with an APC genetic mutation may develop hundreds of colorectal polyps, which often result in cancer.

In a new study on mice, researchers from the Georgia Cancer Center at Augusta University tested the effects of sildenafil – which is marketed as the hugely popular erectile dysfunction drug Viagra – on colorectal cancer risk. Researchers added tiny amounts of sildenafil to the drinking water of mice that had been genetically modified to develop hundreds of polyps.

In the mouse model, these small doses of Viagra were shown to reduce the formation of polyps by 50 percent. According to Dr. Darren D. Browning, a cancer researcher and professor of biochemistry and molecular biology at the university, it is reasonable to assume that the drug could produce similar results in humans.

Although it is not fully understood how sildenafil could prevent dangerous polyps, the researchers said it appears to increase levels of a chemical called GMP, which is known to protect the intestinal lining, and may suppress excessive cell growth that occurs in the colon and causes polyp formation.

Browning said that because sildenafil is already an FDA-approved drug, next steps would include human clinical trials in people who are already at high risk of colorectal cancer.

He added that, given in the very small doses required, Viagra is unlikely to cause side effects.

Man sitting on bed stock

Missing out on healthy sleep could increase a key indicator for Alzheimer’s disease, recent research suggests.

The case for a good night’s sleep

Adding to the list of reasons why adults of all ages should make healthy sleep a top priority, researchers at the National Institutes of Health [NIH] recently reported that losing just one night of sleep may cause an immediate rise in beta-amyloid, a protein in the brain associated with Alzheimer’s disease. In people who develop Alzheimer’s, beta-amyloid proteins are estimated to increase by over 40 percent compared to the brains of healthy older adults. These proteins clump together to form amyloid plaques, a hallmark of the disease.

While sleep deprivation has already been shown to increase brain beta-amyloid levels in mice, not much is currently known about the effects of losing sleep on human brains. This small NIH study is among the first to demonstrate the potential role of sleep in controlling beta-amyloid levels.

In their study, the researchers used positron emission tomography [PET] scans to measure beta-amyloid in the brains of 20 healthy adults, who ranged in age from 22 to 72. They conducted scans both after a night of rested sleep and after the participants were deprived of sleep for about 31 hours. They found beta-amyloid increases of about 5 percent after losing a single night of sleep in brain regions including the thalamus and the hippocampus, both of which are vulnerable in early Alzheimer’s. They also found that larger increases in beta-amyloid were also related to more significant mood effects in the participants after sleep deprivation.

“Even though our sample was small, this study demonstrated the negative effect of sleep deprivation on beta-amyloid burden in the human brain. Future studies are needed to assess the generalizability to a larger and more diverse population,” said neuroscientist and lead researcher Ehsan Shokri-Kojori, Ph.D.

On the calendar

AARP sponsors a Smart Driver course on Friday, May 4 from 1-5 p.m. at Manchester Methodist Church, 129 Woods Mill Road in Manchester. The course covers safe driving strategies, information about the effects of medications on driving, preventing driver distractions, proper use of technology and more. The cost is $15 for members and $20 for non-members. To register, call (314) 249-7799.

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Missouri Baptist Medical Center presents a free monthly program for caregivers, Legal Matters and Goals of Care, on Tuesday, May 8 from 1-2:30 p.m. in Auditorium 1 on the hospital’s campus, 3015 N. Ballas Road. An attorney will present information on advance directives, power of attorney and qualifications for assistance. A facilitator will lead the group in ways to engage elderly loved ones in conversations about their goals of care. To register, call (314) 996-5433.

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St. Luke’s Hospital presents a free community program, Living Mindfully with Chronic Pain, on Wednesday, May 9 from 6:30-8 p.m. at the hospital’s Institute for Health Education, 222 S. Woods Mill Road in Chesterfield [North Medical Office Building, Level 2]. Living with chronic pain can cause a great deal of suffering physically and emotionally. Learn how mindfulness can lessen the pain. Relaxation breathing, reframing the situation, daily meditation and an attitude of gratitude are some of the techniques that will be discussed. A 5-minute meditation will be a part of this program.  To register, visit www.stlukes-stl.com.

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St. Louis OASIS presents a free program, Osteoporosis: Do’s and Don’ts of Everyday Movement, on Wednesday, May 16 from 10 a.m.-noon at Chesterfield City Hall, 690 Chesterfield Parkway West. For those with osteoporosis or osteopenia, some common movements could contribute to or even cause a fracture. In this class, taught by a physical therapist, learn how osteoporosis fractures happen and how to avoid them with some simple modifications to your everyday movements. Learn how to use your joints wisely and protect your bones and joints from unnecessary injuries. To register, call (314) 862-4859.

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Join an orthopedic physician for Knee Replacement: Is It Right for Me?, a discussion about minimally invasive knee replacement surgery and other treatment options for arthritic knees. The free session is on Wednesday, May 23 from 6-7 p.m. at St. Luke’s Hospital, 232 S. Woods Mill Road in Chesterfield, in the third floor conference room.  Register online at www.stlukes-stl.com.

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BJC Healthcare sponsors A Matter of Balance, a free eight-session program for older adults interested in better balance, beginning on Thursday, June 7 and continuing each subsequent Thursday through July 26. Sessions meet from 10 a.m.-noon at Daniel Boone Library, 300 Clarkson Road in Ellisville. Almost half of older adults worry about falling – learn factors that can lead to a fall along with practical tips to keep yourself on your feet in this discussion-based program. Stretches and light movements targeting improved flexibility and range of motion will be introduced in the third class. Participants receive a workbook to keep. Registration is limited and is available online at https://classes-events.bjc.org/wlp2/.

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