Sleep and Risk of Fractures

Researchers writing in the Journal of the American Geriatrics Society say that long sleep and daily napping are associated with greater risk of falls and fractures in older women.

Stone KL, Ewing SK, Lui LY, Ensrud KE, Ancoli-Israel S, Bauer DC, Cauley JA, Hillier TA, Cummings SR. Self-reported sleep and nap habits and risk of falls and fractures in older women: the study of osteoporotic fractures. J Am Geriatr Soc. 2006 Aug;54(8):1177-83.

From the study abstract:

OBJECTIVES: To test the association between self-reported sleep and nap habits and risk of falls and fractures in a large cohort of older women.

DESIGN: Study of Osteoporotic Fractures prospective cohort study.

SETTING: Clinical centers in Baltimore, Maryland; Minneapolis, Minnesota; Portland, Oregon; and the Monongahela Valley, near Pittsburgh, Pennsylvania.
PARTICIPANTS: Eight thousand one hundred one community-dwelling Caucasian women aged 69 and older (mean 77.0).

MEASUREMENTS: Sleep and nap habits were assessed using a questionnaire at the fourth clinic visit (1993/94). Fall frequency during the subsequent year was ascertained using tri-annual questionnaire. Incident hip and nonspinal fractures during 6 years of follow-up were confirmed using radiographic reports. RESULTS: Five hundred fifty-three women suffered hip fractures, and 1,938 suffered nonspinal fractures. In multivariate models, women who reported napping daily had significantly higher odds of suffering two or more falls during the subsequent year (odds ratio=1.32, 95% confidence interval (CI)=1.03-1.69) and were more likely to suffer a hip fracture (hazard ratio (HR)=1.33, 95% CI=0.99-1.78) than women who did not nap daily. Those sleeping at least 10 hours per 24 hours had a higher risk of nonspinal fracture than (HR=1.26, 95% CI=1.00-1.58) and a similar but nonsignificant increased risk of hip fracture to (HR=1.43, 95% CI=0.95-2.15) those who reported sleeping between 8 and 9 hours.

CONCLUSION: Self-reported long sleep and daily napping are associated with greater risk of falls and fractures in older women. Interventions to improve sleep may reduce their risk of falls and fractures. Future research is needed to determine whether specific sleep disorders contribute to these relationships.

Hip Fracture in High Risk Groups

Researchers writing in the Journal of Postgraduate Medicine say “prevention of hip fracture is still inadequate in high risk patients. Discrepancy seemed to exist in treatment frequency among different high risk groups suggesting that emphasis on prevention of osteoporosis has not been reinforced in all people at risk.”

Peng EW, Elnikety S, Hatrick NC. Preventing fragility hip fracture in high risk groups: an opportunity missed. Postgrad Med J. 2006 Aug;82(970):528-31

From the study abstract:
OBJECTIVE: The national guideline recommends selective case finding as the main strategy by identification of high risk people. This study assessed whether high risk patients were identified before their presentation with fragility fracture.

METHODS: A prospective study for 3.5 consecutive months on patients with low energy hip fractures to Brighton and Sussex University Hospital NHS Trusts, which serves a population of 460,000. Data were collected by interview using standardised form, medical record review, and communication with family physicians.

Definition of high risk:
(1) untreated hypogonadism
(2) corticosteroid users
(3) disorders with increased bone loss
(4) previous fragility fractures.

RESULTS: 98 patients were admitted with hip fracture. Thirty nine (40%) had at least one high risk factor. High risk patients (7 of 39, 18%) were no more likely to receive prophylaxis compared with patients without high risk factor (5 of 59, 8%) (p = 0.21). Previous fragility fracture (23) was the commonest risk factor followed by disorders with increased bone loss (10), premature menopause (10), and corticosteroid users (5). Fifteen patients (15%) had susceptibility to frequent falls and two had maternal history of osteoporosis. The proportion of treated patients were 20% (2 of 10) in premature menopause, 10% (1 of 10) in diseases with secondary osteoporosis, 13% (3 of 23) in previous fragility fracture, and 80% (4 of 5) in corticosteroid users (p = 0.01)

CONCLUSION: Prevention of hip fracture is still inadequate in high risk patients. Discrepancy seemed to exist in treatment frequency among different high risk groups suggesting that emphasis on prevention of osteoporosis has not been reinforced in all people at risk.

Osteoporosis in Men

Testosterone and Estradiol Deficiency
Researchers writing in the Journal of Clinical Endocrinology & Metabolism say that: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency.

Fink HA, Ewing SK, Ensrud KE, Barrett-Connor E, Taylor BC, Cauley JA, Orwoll ES. Association of Testosterone and Estradiol Deficiency with Osteoporosis and Rapid Bone Loss in Older Men. J Clin Endocrinol Metab. 2006 Jul 18

From the article abstract:
Context: The clinical value of measuring testosterone and estradiol in older men with osteoporosis and of measuring bone mineral density (BMD) in older men with testosterone or estradiol deficiency is uncertain.

Objective: To examine the association of testosterone and estradiol deficiency with osteoporosis and rapid bone loss in older men.

Participants: 2447 community-dwelling men aged >/=65.

Main Outcome Measures: Total testosterone deficiency defined as <200 ng/dl.

Total estradiol deficiency defined as <10 pg/ml.

Results: Prevalence of osteoporosis in men with deficient and normal total testosterone was 12.3% and 6.0% (P = 0.003), and in those with deficient and normal total estradiol was 15.4% and 2.8% (P < 0.0001).

Among osteoporotic men and those with normal BMD, prevalence of total testosterone deficiency was 6.9% and 3.2% (P = 0.01) and prevalence of total estradiol deficiency was 9.2% and 2.4% (P = 0.0001). Incidence of rapid hip bone loss in men with deficient and normal total testosterone was 22.5% and 8.6% (P = 0.007), and in those with deficient and normal total estradiol was 14.3% and 6.3% (P = 0.08).

Conclusions: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency. BMD testing of older men with sex steroid deficiency may be clinically warranted.

Bone Loss

Estradiol, Testosterone, and Hip Fractures in Men
Researchers writing in The American Journal of Medicine say “Men with low estradiol levels are at an increased risk for future hip fracture. Men with both low estradiol and low testosterone levels seem to be at greatest risk for hip fracture.”

The Importance of Strength Training Exercises in Aging
Researchers writing in the medical journal Aging Clinical and Experimental Research say that “although aerobic exercise is important in maintaining overall health, the resistance type of muscle training may be more applicable to the basic rules of bone adaptation and site-specific effects of exercise, have more favorable effects in maintaining or improving bone mass and architecture, and be safe and feasible for older people.”

DHEA, Bone Mineral Density, Older Adults
Researchers writing in the medical journal The Journal of Clinical Endocrinology & Metabolism, say that DHEA replacement therapy for one year improved hip Bone Mineral Density in older adults and spine Bone Mineral Density in older women.

Lifelong risk factors for osteoporosis and fractures in elderly women with low body mass index
Researchers writing in the medical journal Bone, evaluated the association between lifelong lifestyle factors and bone density, falls and postmenopausal fractures in elderly women with low body mass index.

Osteoporosis in Men Testosterone and Estradiol Deficiency
Researchers writing in the Journal of Clinical Endocrinology & Metabolism say that: Older men with total testosterone or estradiol deficiency were more likely to be osteoporotic. Those with osteoporosis were more likely to be total testosterone or estradiol deficient. Rapid hip bone loss was more likely in men with total testosterone deficiency.

Hip Fracture in High Risk Groups
Researchers writing in the Journal of Postgraduate Medicine say “prevention of hip fracture is still inadequate in high risk patients. Discrepancy seemed to exist in treatment frequency among different high risk groups suggesting that emphasis on prevention of osteoporosis has not been reinforced in all people at risk.”

Sleep and Risk of Fractures
Researchers writing in the Journal of the American Geriatrics Society say that long sleep and daily napping are associated with greater risk of falls and fractures in older women